The Johns Hopkins Community Health Partnership pilot was based on a set of acute care interventions rolled out in two hospitals and a community-based care management piece based in ambulatory care settings. Elements included a focus on medication management, multidisciplinary rounds and follow-up calls, in addition to improved transitions to skilled nursing or other post-acute care facilities. From 2012-2016, more than 2,100 patients enrolled in the community initiative, saving USD$24.4 million in healthcare costs during and reducing 30-day readmissions by 3.6%. The acute care interventions saved USD$29.2 million, while 30-day readmissions increased by 1.4%. The lead author of the study of this program reminded providers who want to learn from Johns Hopkins’ model need to first have a complete picture of what their local communities need.
NBHC Sustainability