Preventable hospitalizations are costing health systems millions, especially among Medicare and dual-eligible populations. Too often, traditional care models fall short when social determinants of health go unaddressed.
Discover how Trinity Health’s social and clinical care integration improved patient outcomes, reduced costs, and narrowed health disparities among Medicare Shared Savings Program patients. Integrating Community Health Workers into care teams, leveraging the Findhelp social care platform, and focusing on heart failure contributed to a 3% reduction in preventable hospitalizations overall, a 16% reduction among the patients dually enrolled in Medicaid, and a 45% reduction in the disparity between these groups over 3.5 years.
In this session, Trinity Health leadership unpacks their approach and the practical steps your organization can take now to drive improvements.
Key insights:
- How to scale CHW integration across multidisciplinary care teams
- How to align clinical and social care with the right tools
- How social care platforms helped streamline referrals and close gaps
