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From the Experts
Doing More with Less Affords Emergency Medical Services Agencies Challenges and Opportunities
By: James McLaughlin
Ute Pass Regional Health Service District (UPRHSD)

Ute Pass Regional Health Service District (UPRHSD) has provided emergency medical and ambulance transport services to portions of Teller, Park, Douglas, and El Paso Counties for nearly 40 years. However, as the structure of health insurance has changed, the district has seen a decline in revenue with increased demands. This meant our agency was being asked to do more every year with fewer resources.            
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Neighborhood Leaders in Change
A Mainstay for the Unmoored: Anchor Center for Blind Children
By: Stephanie Spriggs
Grant Writer and Report Specialist, CIVHC

The American Federation for the Blind estimates that in 2013, Colorado had 108,599 visually impaired or blind residents and 1,409 were under the age of five. Anchor Center for Blind Children in Denver is teaching these young, visually impaired children how to orient themselves in the world and helping their families learn how best to support them.           
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In The News
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Community Paramedics Curb Hospital Readmissions and Non-Emergent 9-1-1 Use
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Attributes Common to Programs That Successfully Treat High-Need, High-Cost Individuals
Authors: G erard F. Anderson, PhD; Jeromie Ballreich, MHS; Sara Bleich, PhD; Cynthia Boyd, MD; Eva DuGoff, PhD; Bruce Leff, MD; Claudia Salzburg, PhD; and Jennifer Wolff, PhD
Many of the attempts to design programs for high-need, high-cost patients have been unable to achieve even 1 of the triple aims. This article examines the published literature, government reports, and reports by managed care organizations, hospitals, and physician groups to identify the commonalities of successful programs. 
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Is Observation Status Substituting for Hospital Readmission?
By Claire Noel-Miller  and  Keith Lind, October 2015
Health Affairs Blog
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Discharge Planning Proposed Rule Focuses on Patient Preferences
CMS.gov, Oct 2015  

CMS introduced a proposed Discharge Planning rule that would focus on patient preferences. The rule would bring discharge planning requirements into alignment with current practice; help improve patient quality of care and outcomes; and reduce avoidable complications, adverse events, and readmissions.

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CMS Releases OPPS Rule For 2016, Finalizes Two-Midnight Changes: 10 Things to Know 
By: Ayla Ellison, Nov 2015  
Beckershospitalreview.com
CMS released its final 2016 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System. Here are 10 things to know about the two midnight rule and other modifications to CMS medical review.
In This Issue
Upcoming Events

Nurse Patient
Healthy Transitions Webinars Available 

Recordings and slides of our monthly webinars are located on the Webinar Archive page of the Healthy Transitions Colorado Website. 

Webinar Archives 

New and Updated Tools
If you have mental health conditions, you probably work with more than one provider for your health care in more than one place. People transitioning between settings often need additional support. Resources for Integrated Care created the Care Transitions Toolkit for Persons with Mental Health Conditions to help before, during, or after a transition between care locations or providers.


AHRQ has added a sixth tool to the AHRQ Pharmacy Health Literacy Center: How to Conduct a Postdischarge Followup Phone Call . This tool, from the Re-Engineered Discharge (RED) Toolkit , describes how pharmacists or other staff can to prepare for and conduct the call to patients after they leave the hospital. The tool includes a call script, an example conversation, and a template for documenting the call.

Select to access Tool 5: How to Conduct a Postdischarge Followup Phone Call:

Select to access AHRQ Pharmacy Health Literacy Center:

Select to access the Re-Engineered Discharge (RED) Toolkit , which helps hospitals implement a tested strategy for changing discharge processes to increase patient understanding and reduce readmissions: 
Let Your Voice Be Heard
Healthy Transitions Colorado is a collaborative effort, focused on aligning and accelerating existing efforts to improve transitions of care for Coloradans. Our guiding principles are simple - by working together to break down the silos of health care, we can foster true community care coordination across facilities, specialties, and practices.