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7 key parts of an intensive outpatient-care program

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This HealthAffairs article looks at how to use an intensive outpatient care program to lower the cost of caring for high-cost patients while improving their care.

The  model is driven by workforce training and has seven key elements,  say the authors:

  1. “Trained Care Coordinators such as nurse or social worker-led teams that can include community health workers and medical assistants.
  2. “A face-to-face super-visit within one month of enrollment.
  3. “Standardized longitudinal assessment tools for physical function, mental well-being and patient engagement in care.
  4. “Monthly, bi-directional communication between the care coordinator and patient;
  5. “Shared Action Plan created with the patient’s own goals at its center.
  6. Warm handoffs to relevant support services such as home health, behavioral health, and transportation.
  7. “24/7 access to services, with communication to the care coordinator the next business day.”

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