The Herald Bulletin
---- — YORKTOWN – The new Care Transitions program being operated by LifeStream Services in east central Indiana in partnership with Aging and In-Home Services of Northeast Indiana in Fort Wayne was featured during a statewide teleconference Tuesday.
The teleconference, presented to critical access hospitals in Indiana at the invitation of Health Care Excel, looked at the Care Transitions program that is already having success in reducing hospital readmissions for older adults who have certain conditions. Jim Allbaugh, vice president of research and administration, made the presentation.
The Care Transitions of eastern Indiana program, one of the first in the nation and the largest, began in April in 22 counties, including the seven counties in east central Indiana currently being served by LifeStream, the local Aging and Disability Resource Center.
Care Transitions helps qualifying Medicare beneficiaries transition to home-based care once they are released from the hospital. The program encompasses 11 hospital sites and about 8,000 eligible Medicare beneficiaries.
The new program – Care Transitions of Eastern Indiana – is a Community-based Care Transitions Program (CCTP) funded by Medicare and Medicaid Services (CMS) under Section 3026 of the Affordable Care Act.
“We were pleased to have this opportunity to share with critical care hospitals throughout Indiana in this teleconference and appreciated the opportunity to come to the aid of seniors statewide,” said Kenneth D. Adkins, president / CEO of LifeStream.
LifeStream and Aging & In-Home Services created the program, which already has been implemented at the following hospitals:
· Indiana University Health Ball Memorial Hospital, Muncie.
· Community Hospital of Anderson and Madison County, Anderson.
· Henry County Memorial Hospital, New Castle.
· St. Vincent Anderson Regional Hospital, Anderson.
· DeKalb Health, Auburn
· Bluffton Regional Medical Center, Bluffton.
· Parkview Health System including Parkview Huntington Hospital, Parkview Noble Hospital, Parkview Hospital Randallia, Parkview Regional Medical Center and Parkview Whitley.
Hospital discharge planners identify qualifying patients who meet with Care Transitions coaches. The coaches help people be better health care self advocates. They meet with them in the hospital and follow their care for the first 30 days after discharge from the hospital. Coaches help educate older adults about medication management and other areas based on evidenced-based research. There is no cost to seniors participating in the program.
Eligible participants are fee-for-service Medicare (Part A & B) patients 65 years of age and over being discharged to a home setting with at least one of the following admission diagnoses: acute myocardial infarction; congestive heart failure; pneumonia, or chronic obstructive pulmonary disease.
Early statistics show the program is already helping to reduce hospital readmission for those who have been evaluated and coached in the program, Adkins said. “We are very encouraged that the extensive research and training of the coaches are paying off for at-risk seniors who want to continue to get better so they can remain independent,” he said.
Nationwide, nearly one in five Medicare patients discharged from a hospital — approximately 2.6 million seniors – is readmitted within 30 days, at a cost of more $26 billion every year. Aging & In-Home Services and LifeStream found in root cause analysis research conducted as part of the program application process there are three primary reasons of readmission: communication issues across all settings; limited patient understanding of discharge plans and medications, and lack of patient adherence to treatment plans.
For more about the program, call LifeStream at (800) 589-1121.
-- For The Herald Bulletin