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SDOH Points of Light 2024 Case Study 2
Reducing Readmissions with Effective Interventions
Author
Benjamin Cassity
Author
Paul Warburton
Author
Ciera Walker
Addressing patients’ SDOH needs helps prevent readmissions; however, it can be difficult for organizations to manage treatment plans of high-risk patients and prevent relapses. In this case study, the collaborators worked together to lower readmission rates of complex and high-risk patients. With the help of Epic Compass Rose and a strong care management team, the collaborators achieved their goal by creating holistic treatment plans, referring patients to community programs, and using effective SDOH screenings and interventions.
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Key Findings:
- Executive Summary
- The Collaborators
- Points of Friction—Challenges to Be Solved
- Action Plan—How the Collaborators Worked Together to Reduce Friction
- Points of Light—Outcomes Achieved through Collaboration
- Lessons Learned—What Best Practices Can Other Organizations Apply?
- What's Next?—Vision for the Future
- Project Scalability & Replicability
Writer
Sarah Brown
Designer
Jess Wallace-Simpson
Project Manager
Kyle Chilton
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.