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EmblemHealth Announces Expanded Transition of Care Program

EmblemHealth Care Management recognizes the importance of managing the transition of care for our Medicare, Medicaid and Family Health Plus members. Thoughtful oversight of discharge planning and case management services will increase patient safety and quality of care for our members, while reducing health care costs.

Gaps in patient care occur when a member leaves one health care setting and moves to another. Gaps and barriers result in negative outcomes across the continuum of care. The most common care management obstacles are:

• Member or member caregiver confusion about the condition itself or appropriate care for the condition
• Lack of follow-through on referrals
• Overuse, underuse or inappropriate use of prescribed medications
• Inconsistent monitoring of a member’s condition
• Duplication of services or resources

Care Transitions
EmblemHealth developed the Care Transitions program to further enhance discharge planning activities. As part of this program, which began in 2009, we implemented a post-discharge welcome-home call to our Medicare, Medicaid and Family Health Plus members with a high risk for readmission.

On May 1, 2010, the program will expand to include outreach to members during their inpatient stays. The objectives are:

• Establish rapport with the member
• Determine and support discharge planning activities
• Assess caregiver resources
• Identify members needing coordination

Members needing coordination of care and services are followed for a 30-day period, post discharge.

For information about this program you may contact our Case Management department at 1-800-447-0768.