The CTI® is uniquely focused on providing patients and family caregivers with the skills, confidence, and tools they need to assert a more active role in their care and ensure that their needs are met. Unlike most of the current approaches available, the CTI® was co-designed with patients and families and was evaluated using the most rigorous scientific approach – randomized controlled trials.
Our Key Findings
Patients who received the CTI® were significantly less likely to be readmitted to the hospital, and the benefits were sustained for five months after the end of the one-month intervention.
Thus, rather than simply managing post-hospital care in a reactive manner, imparting self-management skills pays dividends long after the program ends. Anticipated net cost savings for a typical Transitions Coach® panel of 350 chronically ill adults with an initial hospitalization over 12 months is conservatively estimated at $365,000. Patients who received this program were also more likely to achieve self-identified personal goals around symptom management and functional recovery.
Looking to be successful under bundled payment or ACOs? Here is why the CTI® is a great fit!
20-50%
reduction in hospital readmissions
When organizations are trained by the Care Transitions Program® and follow model fidelity, they can expect reductions in readmission rate of 20-50% (reduction depends on current readmission rate). Reducing readmissions can also improve your CMS Star rating.
$365K
net saving per Transitions Coach®
An Independent evaluator estimates a $110 PMPM cost savings.
52%
Patients meeting or exceeding self-identified personal care goals
The majority of patient goals reflect better quality of life and improved functional status.
Eastern Virginia Care Transitions Partnership Outcomes
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Meritage ACO CTI Results
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Dominican Sisters Family Health Service, Inc. Success Using the CTI® in the CMS CCTP
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North Mississippi Medical Center Reduces Heart Failure Readmissions through CTI® and Simulation
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CTI® Coaching Decreases Re-admission and Costs for Medicare patients
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Finger Lakes Health System Agency demonstrates significant reduction in readmissions sustained for at least 90 days
Abstract from the 2014 AcademyHealth ARM
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The Impact of Kaua'i Care Transition Intervention on Hospital Readmission Rates
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Health care services for improving quality care and safety of patients during transitions across care settings
