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Taconic IPA Community Transformation Department
The Taconic IPA Community Transformation Department is responsible for building capacity and expertise in the Hudson Valley in the implementation of the chronic care model and evidence-based care for chronic illness by:
- Ensuring that all participating practices are engaged in practice re-design strategies to become enhanced team-based patient-centered medical homes (PCMH);
- Ensuring that participating practices are implementing standardized evidence-based best practices for managing chronic illness;
- Integrating care coordination and community based support into practice workflow;
- Ensuring transitional support strategies are in place to coordinate care across providers and delivery settings;
- Supporting the development of service agreements between PCMHs and specialty physicians
- Supporting practices in the implementation of the self management component
- Identifying and sharing best practices across the participating PCMHs, in concert with MassPro, Tranformed, HITCH CHITA and other stakeholder organizations.
Dr. Paul Kaye, Medical Director will oversee the effort within the IPA to develop a community based care coordination program that will promote population management strategies, including disease, care and self management. Care coordination / case management staff will be integrated into the transformation effort to support the PCMH in managing the highest cost and risk patients. Quality improvement and health outcomes metrics will be indentified and monitored and compared to benchmarks and shared with the PCMHs.
For further information on practice transformation, care coordination, and Medical Home activities, please contact Jill Quaresimo at jquaresimo@taconicipa.com.
The Taconic Community Transformation Program is part of the Hudson Valley Initiative. To stay up to date on all Hudson Valley Initiative activities, please sign up for the Hudson Valley Connector newsletter.
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