AHRQ’s Health Care Innovations Exchange Focuses on Coordinating Community Care for Seniors

AHRQ Innovations Exchange

AHRQ Innovations Exchange | Outreach Workers Connect Low-Income Individuals Living in Rural Areas to Home- and Community-Based Services, Reducing Costs and Nursing Home Placements

AHRQ Innovations Exchange | Innovations & QualityTools

AHRQ’s Health Care Innovations Exchange Focuses on Coordinating Community Care for Seniors

Programs that provide care coordination and support to seniors and to adults with serious mental illness reduced hospital and nursing home admissions and emergency department visits and are featured in the May 23 issue of AHRQ’s Health Care Innovations Exchange. One such program is the Tri-County Rural Health Network, a nonprofit community development organization that works with low-income individuals in the Mississippi Delta. The program uses outreach workers known as “community connectors” to identify Medicaid-eligible residents who have unmet, long-term health care needs. These workers arrange for residents to receive appropriate home and community-based care, such as medical equipment delivery, home health aide visits, and meals. Over three years, none of the participants needed to be placed in a nursing home. The program also reduced health care costs and generated a return on investment. Read more profiles of innovations related to care coordination on the Innovations Exchange Web site, which contains more than 700 searchable innovations and 1,500 QualityTools.