The New York State Behavioral Health Readmissions Quality

Collaborative

Molly Finnerty, MDEdith Kealey, PhD

Kate M. Sherman, LCSWNew York State Office of Mental Health

June 26, 2014

Participants:1-866-639-0744, no code needed

Minnesota RARE CampaignMinnesota RARE CampaignMonthly Call, June 26, 2014Monthly Call, June 26, 2014

The New York State The New York State Behavioral Health Behavioral Health

Readmissions Quality Readmissions Quality CollaborativeCollaborative

Molly Finnerty, MDMolly Finnerty, MDEdith Kealey, PhDEdith Kealey, PhDKate M. Sherman, LCSWKate M. Sherman, LCSWNew York State Office of Mental HealthNew York State Office of Mental Health

OutlineOutline

Overview of the ProjectOverview of the Project Participants and activitiesParticipants and activities Project metrics and dataProject metrics and data

Lessons Learned and RecommendationsLessons Learned and Recommendations Interventions Interventions

Emergency DepartmentEmergency Department InpatientInpatient AftercareAftercare

Managing the ProjectManaging the Project

Future PlansFuture Plans

Collaborative Collaborative Participants, Activities Participants, Activities

and Time Lineand Time Line

Readmissions Collaborative Readmissions Collaborative Project Context and FocusProject Context and Focus

Statewide behavioral health systems transformationStatewide behavioral health systems transformation

Previous successful learning collaborative to reduce Previous successful learning collaborative to reduce use of antipsychotics with higher risk for metabolic use of antipsychotics with higher risk for metabolic disturbance for individuals with existing metabolic disturbance for individuals with existing metabolic conditionsconditions

Focus on behavioral health readmissions Focus on behavioral health readmissions (individuals discharged from behavioral health (individuals discharged from behavioral health inpatient services who are readmitted to behavioral inpatient services who are readmitted to behavioral health inpatient services within 30 days of health inpatient services within 30 days of discharge)discharge)

Readmissions Collaborative Readmissions Collaborative Sponsors and ParticipantsSponsors and Participants

SponsorsSponsors NYS Office of Mental Health NYS Office of Mental Health The 2 major hospital associations in NYSThe 2 major hospital associations in NYS

Greater NY Hospital Association (NYC)Greater NY Hospital Association (NYC) Healthcare Association of NYSHealthcare Association of NYS

Steering Committee Steering Committee Sponsors plus 8 hospitals / systemsSponsors plus 8 hospitals / systems Specified project focus and requirementsSpecified project focus and requirements

Participants: 45 hospitals statewideParticipants: 45 hospitals statewide Invited all hospital association members with inpatient Invited all hospital association members with inpatient

behavioral health servicesbehavioral health services Participation not required, no direct financial incentivesParticipation not required, no direct financial incentives 24% of eligible hospitals participated (some attrition) 24% of eligible hospitals participated (some attrition)

Project Options: ParticipationProject Options: Participation Select services to participateSelect services to participate

Psychiatry and/orPsychiatry and/or Substance abuse servicesSubstance abuse services

Select settings to participate Select settings to participate InpatientInpatient Outpatient Outpatient Emergency departmentsEmergency departments

Multiple services encouraged to participateMultiple services encouraged to participate Inpatient strongly encouraged but not requiredInpatient strongly encouraged but not required

Project Options: StrategiesProject Options: Strategies Project focus: menu of options in 3 domainsProject focus: menu of options in 3 domains

Medication strategiesMedication strategies Increase use of Long-Acting Injectables / ClozapineIncrease use of Long-Acting Injectables / Clozapine Medication fill at dischargeMedication fill at discharge Counseling for medication adherence Counseling for medication adherence

Outpatient engagementOutpatient engagement Referrals to ACT / case management / health homesReferrals to ACT / case management / health homes Counseling for adherence to treatmentCounseling for adherence to treatment Peer servicesPeer services

Integrated dual diagnosis treatmentIntegrated dual diagnosis treatment

Enhanced discharged planning required in Inpatient Enhanced discharged planning required in Inpatient and Emergency Services (defined by hospitals)and Emergency Services (defined by hospitals)

Target population defined by hospitals according to the Target population defined by hospitals according to the intervention selectedintervention selected

Collaborative ActivitiesCollaborative Activities ConferencesConferences

Kick-OffKick-Off Mid-point, share successful strategiesMid-point, share successful strategies ConcludingConcluding

Monthly Learning Collaborative CallsMonthly Learning Collaborative Calls Interactive, report on progressInteractive, report on progress

Strategies Calls: Training on specific Strategies Calls: Training on specific strategiesstrategies

Site Visits (selected hospitals)Site Visits (selected hospitals) Technical assistanceTechnical assistance Identify best practicesIdentify best practices

Resources and Resources and Technical AssistanceTechnical Assistance

PSYCKES ApplicationPSYCKES Application NYS Medicaid claims / encounter dataNYS Medicaid claims / encounter data Behavioral health population (4.6 million)Behavioral health population (4.6 million) Track performance and identify clients with quality Track performance and identify clients with quality

concernsconcerns

Project Website

Clinical tools Clinical tools (e.g., Readmission Risk Assessment)(e.g., Readmission Risk Assessment) Developed for the collaborativeDeveloped for the collaborative Shared by participantsShared by participants Identified from outside sourcesIdentified from outside sources

Time LineTime Line 6/2012 - 12/2012: Kick-off and Planning 6/2012 - 12/2012: Kick-off and Planning

Begin monthly callsBegin monthly calls Project Planning form due 10/2012Project Planning form due 10/2012 Note: Superstorm Sandy 10/2012Note: Superstorm Sandy 10/2012

1/2013 - 6/2013: Begin delivering and tracking 1/2013 - 6/2013: Begin delivering and tracking interventions (monthly reporting), Midpoint Conferenceinterventions (monthly reporting), Midpoint Conference

Decision to extend Collaborative through 6/2014Decision to extend Collaborative through 6/2014

7/2013 - 6/2014: Site Visits (n=15) and Calls (n=3)7/2013 - 6/2014: Site Visits (n=15) and Calls (n=3)

11/2013: Midpoint Survey11/2013: Midpoint Survey

6/2014: End / Concluding Conference6/2014: End / Concluding Conference

Project Data and Measurement

Data SourcesData Sources

NYS Medicaid Claims/Encounter DataNYS Medicaid Claims/Encounter Data PSYCKES applicationPSYCKES application Data Analysis TeamData Analysis Team

Hospital Self-ReportHospital Self-Report Reported monthly by each hospitalReported monthly by each hospital Aggregated and distributed to hospitals monthlyAggregated and distributed to hospitals monthly

SurveysSurveys Prescriber Survey on LAI and ClozapinePrescriber Survey on LAI and Clozapine Midpoint Survey on project interventions (value, Midpoint Survey on project interventions (value,

feasibility) and lessons learnedfeasibility) and lessons learned

Key Project MetricsKey Project Metrics Inpatient (primary indicator)Inpatient (primary indicator)

Among clients discharged from your hospitalAmong clients discharged from your hospital’’s inpatient s inpatient service (psychiatry or substance abuse)service (psychiatry or substance abuse)

Percentage readmitted to the same service at any hospital Percentage readmitted to the same service at any hospital within 30 dayswithin 30 days

OutpatientOutpatient Among clients seen in your outpatient service who had a Among clients seen in your outpatient service who had a

behavioral health hospitalization at any hospital behavioral health hospitalization at any hospital Percentage readmitted to behavioral health inpatient at any Percentage readmitted to behavioral health inpatient at any

hospital within 30 days hospital within 30 days

EmergencyEmergency Among clients who come to ED within 30 days of discharge Among clients who come to ED within 30 days of discharge

from psychiatric inpatient at any hospitalfrom psychiatric inpatient at any hospital Percentage readmitted by your EDPercentage readmitted by your ED

Readmissions within 30 Days of Readmissions within 30 Days of Discharge from Inpatient PsychiatryDischarge from Inpatient Psychiatry

Length of Stay 4+ DaysLength of Stay 4+ Days

Average Annual Percent Change 6/2012 to 9/2013

Participating:-0.5 (ns.)

Non-Participating: -3.8 (sig.)

Includes age 18+ Excludes SUD

Readmissions within 30 Days of Discharge Readmissions within 30 Days of Discharge from Inpatient Psychiatry from Inpatient Psychiatry

Length of Stay 4+ DaysLength of Stay 4+ DaysAverage Annual Percent Change, 6/2012 – 9/2013Average Annual Percent Change, 6/2012 – 9/2013

by Hospital by Hospital

Green = Significant improvement

Yellow = Strong trend toward improvement

Red = Significant increase

Psychiatric ED visits by Individuals with a Psychiatric ED visits by Individuals with a Psychiatric Inpatient Stay in the Prior 30 Psychiatric Inpatient Stay in the Prior 30

days, and Disposition:days, and Disposition:Aggregate data for all Participating HospitalsAggregate data for all Participating Hospitals

 

Baseline (June 2012)

ED visits

Baseline rate of Readmissions

in ED

Most recent(Sep 2013)

ED visits

Most recent rate of

Readmissions in ED Average

Annual Percent Change

AAPC95% CI Statistic-

ally Significant

Trend? (P-Value

<0.05)(N) (n) % (N) (n) % Low High

ED visits with Psychiatric Inpatient stay at any hospital in prior 30 days

824 444 54% 914 454 50% -4.2 -8.3 0.1 No

ED visits with Psychiatric Inpatient stay at the same hospital in prior 30 days

413 223 54% 473 220 47% -7.6 -12.9 -1.9 Yes

30-Day BH Readmissions (Any Hospital) 30-Day BH Readmissions (Any Hospital) among Mental Health Outpatientsamong Mental Health Outpatients

PSYCKES Indicator: 12-month look-backPSYCKES Indicator: 12-month look-back

Project Start

Average Annual Average Annual Percent Change Percent Change 7/1/2013 to 7/1/2013 to 4/1/20144/1/2014

Participating:Participating:-10.4-10.4

Non-Non-Participating: Participating: -7.5-7.5

Both statistically Both statistically significantsignificant

Includes individuals Includes individuals of all agesof all ages

Measurement Challenges:Measurement Challenges:Defining ReadmissionsDefining Readmissions

What is a hospitalization?What is a hospitalization? Any length of stay?Any length of stay? Exclude short term observation?Exclude short term observation?

Service typesService types Separate psychiatry and substance abuseSeparate psychiatry and substance abuse

What is a readmission?What is a readmission? Same service type vs. Same service type vs. Any behavioral health vs. Any behavioral health vs. Any service type including medicalAny service type including medical

Time frame Time frame 15 / 30 / 45 day15 / 30 / 45 day Readmission vs. high utilization over timeReadmission vs. high utilization over time

Measurement Challenges: Measurement Challenges: Other IssuesOther Issues

Data maturity: need to wait 6 months to see both index Data maturity: need to wait 6 months to see both index admission and readmission appear in claims/encounter admission and readmission appear in claims/encounter datadata

Observation periods: Monthly data vs. longer intervalsObservation periods: Monthly data vs. longer intervals

Confounding trends and variationConfounding trends and variation Seasonal fluctuationsSeasonal fluctuations Super-storm SandySuper-storm Sandy Health Home and other systems transformation initiativesHealth Home and other systems transformation initiatives

Limited baseline dataLimited baseline data

Exploring alternative statistical methods Exploring alternative statistical methods

Exploring other related outcome and process measuresExploring other related outcome and process measures

Recommendations and Recommendations and Lessons LearnedLessons Learned

Methods: Methods: Review of Models and InitiativesReview of Models and Initiatives

RQC: RQC: Behavioral Health Readmissions Quality CollaborativeBehavioral Health Readmissions Quality Collaborative Clinic CQI:Clinic CQI: OMH Continuous Quality Improvement Initiative OMH Continuous Quality Improvement Initiative

for Health Promotion and Care Coordinationfor Health Promotion and Care Coordination CTI: CTI: Critical Time InterventionsCritical Time Interventions Transitions: Transitions: ACT Transitions Project ACT Transitions Project RED: RED: Project RED (Re-Engineered Discharge)Project RED (Re-Engineered Discharge) STAAR: STAAR: State Action on Avoidable ReadmissionsState Action on Avoidable Readmissions AHRQ: AHRQ: Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality

(AHRQ) Reducing Medicaid Readmissions Project (AHRQ) Reducing Medicaid Readmissions Project RARE: RARE: Reducing Avoidable Readmissions Effectively Reducing Avoidable Readmissions Effectively

Note: all quotations are from RQC Midpoint SurveyNote: all quotations are from RQC Midpoint Survey

Emergency DepartmentEmergency Department

Prevent avoidable readmissions in ED

Identify high utilizers and potential readmissions Identify high utilizers and potential readmissions

Consult/ approval by last inpatient team (they Consult/ approval by last inpatient team (they come to ED to evaluate) before determining come to ED to evaluate) before determining disposition disposition Is the clientIs the client’’s status the same as last discharge? s status the same as last discharge? Is another admission likely to be helpful? Is another admission likely to be helpful? Are there safe alternatives that could be tried?Are there safe alternatives that could be tried?

Identify and contact community-based supports Identify and contact community-based supports before disposition/admissionbefore disposition/admission

Source(s): RQCSource(s): RQC

On Admission / On Admission / During Inpatient StayDuring Inpatient Stay

AssessmentAssessment Identify readmissions / high utilizersIdentify readmissions / high utilizers

Conduct in-depth review or case conference Conduct in-depth review or case conference What was the last discharge plan? How well did it work? What was the last discharge plan? How well did it work? Why were they readmitted (root causes)? Why were they readmitted (root causes)? What can we do differently this time? What can we do differently this time? Review in treatment team meeting, cross department Review in treatment team meeting, cross department

meetings (ER, inpatient, case workers, outpatient)meetings (ER, inpatient, case workers, outpatient)

““Engaging the patient in reasons why the prior discharge Engaging the patient in reasons why the prior discharge failed can help staff gain insight.failed can help staff gain insight.””

Source(s): STAAR, AHRQ, RQCSource(s): STAAR, AHRQ, RQC

After Hospital Care PlanAfter Hospital Care Plan Develop and use After Hospital Care Plan (e.g. Develop and use After Hospital Care Plan (e.g.

Project RED format), including Project RED format), including Clear medication instructions Clear medication instructions Follow-up appointments (arranged before discharge) Follow-up appointments (arranged before discharge) Name and phone number to call with any problemsName and phone number to call with any problems

Educate client and family using teach-back Educate client and family using teach-back method throughout inpatient staymethod throughout inpatient stay

Source(s): Project RED (key intervention), STAAR, RARESource(s): Project RED (key intervention), STAAR, RARE

Access to MedicationAccess to MedicationEnsure access to medication post discharge! Ensure access to medication post discharge!

Verify insurance formulary for meds before initiating Verify insurance formulary for meds before initiating

Obtain and verify pre-authorization for meds before Obtain and verify pre-authorization for meds before discharge discharge

Fill prescriptions at discharge: patients leave with meds Fill prescriptions at discharge: patients leave with meds in hand (or are walked to the pharmacy by staff)in hand (or are walked to the pharmacy by staff)

Check Medicaid status - enroll in Medicaid if eligibleCheck Medicaid status - enroll in Medicaid if eligible

““Make sure that the patient can afford the medications they Make sure that the patient can afford the medications they are discharged on.are discharged on.””

Source(s): RARE, RQCSource(s): RARE, RQC

Involve Family / Natural SupportsInvolve Family / Natural Supports

Support evaluation Support evaluation

Assess family needsAssess family needs

Provide crisis interventionProvide crisis intervention

Psychoeducation and skill-buildingPsychoeducation and skill-building

““Family involvement is key to a patient's recovery.Family involvement is key to a patient's recovery.””

““Family support makes a tremendous difference with patient Family support makes a tremendous difference with patient compliance.compliance.””

Source(s): RQC, CTI, STAAR, RED, RARESource(s): RQC, CTI, STAAR, RED, RARE

Bridging and Bridging and ““Warm Hand-offsWarm Hand-offs””

Face to face meeting with receiving outpatient Face to face meeting with receiving outpatient provider during inpatient stay or immediately provider during inpatient stay or immediately upon discharge. Ideally: upon discharge. Ideally: Discharge planning meeting: outpatient provider, Discharge planning meeting: outpatient provider,

client, family, and inpatient team; andclient, family, and inpatient team; and

Individual meeting/session: outpatient provider Individual meeting/session: outpatient provider and clientand client

Source(s): STAAR, RARE, RQC, Transitions Project, CTISource(s): STAAR, RARE, RQC, Transitions Project, CTI

Co-Occurring Mental Health and Co-Occurring Mental Health and Substance Use DisordersSubstance Use Disorders

Provide Integrated Dual Diagnosis Treatment, Provide Integrated Dual Diagnosis Treatment, e.g.: e.g.:

Screening at intakeScreening at intake

4-quadrant model of assessment4-quadrant model of assessment

Motivational interviewingMotivational interviewing

Refer to providers of integrated treatment for Refer to providers of integrated treatment for aftercare aftercare

Source(s): RQC, EBP for co-occurring disordersSource(s): RQC, EBP for co-occurring disorders

Post Discharge /Post Discharge /OutpatientOutpatient

AftercareAftercare Follow-up appointment with aftercare mental health Follow-up appointment with aftercare mental health

provider within 3 days of discharge (5 at most)provider within 3 days of discharge (5 at most)

Use higher-intensity outpatient services for hospital Use higher-intensity outpatient services for hospital diversion and hospital step-downdiversion and hospital step-down Partial Hospitalization Program (PHP)Partial Hospitalization Program (PHP)

Some clinics developing Intensive Outpatient (IOP) Some clinics developing Intensive Outpatient (IOP) level of carelevel of care

Identification of and coordination with existing services Identification of and coordination with existing services such as ACT such as ACT

Source(s): RARE, RQC, TransitionsSource(s): RARE, RQC, Transitions

Follow-Up Phone CallsFollow-Up Phone Calls Follow-up phone call to Follow-up phone call to client/familyclient/family

Within 72 hours Within 72 hours Clinical intervention, intensive (not just a reminder call) Clinical intervention, intensive (not just a reminder call) Use teach-back method (donUse teach-back method (don’’t read the med list)t read the med list) Ideally by staff known to clientIdeally by staff known to client Not Not ““dischargeddischarged”” until attends first outpatient appointment until attends first outpatient appointment

Follow-up phone call to Follow-up phone call to providerprovider

““Follow-up phone calls are very important, to make sure that Follow-up phone calls are very important, to make sure that discharged patients continue to take their meds and keep their discharged patients continue to take their meds and keep their follow-up appointments.follow-up appointments.””

Source(s): Project RED (key component), RARE, RQC, TransitionsSource(s): Project RED (key component), RARE, RQC, Transitions

Follow-Up Phone Call to Client: Follow-Up Phone Call to Client: Project RED Key ComponentsProject RED Key Components

1.1. Assess clinical statusAssess clinical status

2.2. Review and confirm each medicationReview and confirm each medication

3.3. Review follow-up appointmentsReview follow-up appointments

4.4. Assess for barriers, problem-solve, and review Assess for barriers, problem-solve, and review what to do if a problem ariseswhat to do if a problem arises

5.5. After call: take any needed follow-up actions / After call: take any needed follow-up actions / inform treatment team of any issuesinform treatment team of any issues

Short-Term Case ManagementShort-Term Case Management Services may be provided by case manager, Services may be provided by case manager,

bridger, peer, etc.bridger, peer, etc.

Key principlesKey principles Assess client risk/needs, adjust intensity and time Assess client risk/needs, adjust intensity and time

frame accordinglyframe accordingly Include home visits if neededInclude home visits if needed Actively follow up on non-adherence to the plan, e.g.: Actively follow up on non-adherence to the plan, e.g.:

make another appointment if missedmake another appointment if missed

Source(s): CTI, RARE, RQC, TransitionsSource(s): CTI, RARE, RQC, Transitions

Community Functioning / SupportCommunity Functioning / Support Build, practice and test self-management skillsBuild, practice and test self-management skills

Examples: filling pill boxes, keeping appointmentsExamples: filling pill boxes, keeping appointments Skill-building at each level of care to prepare for next Skill-building at each level of care to prepare for next

Refer to intensive community supports, e.g.: Refer to intensive community supports, e.g.: ACTACT Health Home / other care managementHealth Home / other care management

““Very helpful to establish referral links to Health Homes for Very helpful to establish referral links to Health Homes for care coordination services and ACT Teams.care coordination services and ACT Teams.””

Source(s): RQCSource(s): RQC

Outpatient Crisis ManagementOutpatient Crisis Management

Outpatient programs develop strategies for crisis Outpatient programs develop strategies for crisis management, e.g.: management, e.g.: relapse prevention plansrelapse prevention plans monitoring for early warning signsmonitoring for early warning signs urgent care / walk-in appointmentsurgent care / walk-in appointments on call availabilityon call availability

Educate clients (and staff) not to use the ED for Educate clients (and staff) not to use the ED for urgent careurgent care

Source(s): Clinic CQISource(s): Clinic CQI

Managing the ProjectManaging the Project

Continuous Improvement Continuous Improvement Across All SettingsAcross All Settings

No single solutionNo single solution Portfolio of mutually reinforcing interventionsPortfolio of mutually reinforcing interventions Ongoing incremental changesOngoing incremental changes

All relevant services within the hospital should All relevant services within the hospital should participate and collaborate on the projectparticipate and collaborate on the project

““There is definitely a need for increased collaboration between the There is definitely a need for increased collaboration between the inpatient and outpatient staff. Though we are one agency, and inpatient and outpatient staff. Though we are one agency, and consider ourselves seamless, reviewing our internal referral consider ourselves seamless, reviewing our internal referral process has demonstrated a disconnect in identifying and process has demonstrated a disconnect in identifying and following up with patients deemed high-risk for readmission.following up with patients deemed high-risk for readmission.””

Source(s): RED, STAAR, RARE, RQC, TransitionSource(s): RED, STAAR, RARE, RQC, Transition

Data-Driven Decision Making:Data-Driven Decision Making:Project Level and Client LevelProject Level and Client Level

Start with a root cause analysis of a sample of Start with a root cause analysis of a sample of readmissions, including: readmissions, including: client/caregiver interviewsclient/caregiver interviews quantitative analysis quantitative analysis input from hospital staff and other providersinput from hospital staff and other providers

Track interventions and outcomes over time Track interventions and outcomes over time

““Reducing behavioral health re-hospitalizations requires Reducing behavioral health re-hospitalizations requires developing a system for close monitoring and tracking of developing a system for close monitoring and tracking of patients identified as at-risk for re-hospitalization.patients identified as at-risk for re-hospitalization.””

Source(s): RED, STAAR, AHRQ, RQCSource(s): RED, STAAR, AHRQ, RQC

Collaboration across the Collaboration across the Continuum of CareContinuum of Care

Know and engage your community partners Know and engage your community partners Standardize communication Standardize communication Develop protocols for expedited referrals Develop protocols for expedited referrals Collaboration on treatment and discharge planning Collaboration on treatment and discharge planning Must include: BH, medical, housingMust include: BH, medical, housing

Develop a relationship with at least one pharmacyDevelop a relationship with at least one pharmacy

Improved, real-time communication between inpatient Improved, real-time communication between inpatient and outpatient behavioral health providers and and outpatient behavioral health providers and primary care physicianprimary care physician

Source(s):STAAR, AHRQ, RQC, RED, RARESource(s):STAAR, AHRQ, RQC, RED, RARE

Importance of LeadershipImportance of Leadership Buy-in / MotivationBuy-in / Motivation

EducationEducation

Resource AllocationResource Allocation

““Behavioral health re-admissions can be reduced when Behavioral health re-admissions can be reduced when providers use the proper, evidence-based treatments for providers use the proper, evidence-based treatments for serious mental health problems….serious mental health problems….””

““When administration plans a project without staff buy-in or When administration plans a project without staff buy-in or support, it is doomed to be less successful than if staff had support, it is doomed to be less successful than if staff had themselves designed the interventions/strategies. Any themselves designed the interventions/strategies. Any future collaborative project needs to incorporate more future collaborative project needs to incorporate more representation from front line staff.representation from front line staff.””

Future Plans: Readmissions Future Plans: Readmissions Collaborative Phase IICollaborative Phase II

Expanded FocusExpanded Focus

Discharge Discharge from behavioral health inpatientfrom behavioral health inpatient PsychiatryPsychiatry Substance abuseSubstance abuse

Readmission Readmission to any inpatient service to any inpatient service within 30 within 30 daysdays PsychiatryPsychiatry Substance abuseSubstance abuse MedicalMedical

Project Structure and StrategiesProject Structure and Strategies

All behavioral health services in the hospital All behavioral health services in the hospital participate and work collaborativelyparticipate and work collaboratively

Focus on processes and care transitionsFocus on processes and care transitions

Timeline:Timeline: Summer 2014: Planning with Steering CommitteeSummer 2014: Planning with Steering Committee

Fall 2014: Learning Collaborative Kick-OffFall 2014: Learning Collaborative Kick-Off

Question and Answer

Upcoming RARE Events….

Stay tuned for the next RARE Mental Health Webinar:

July 23, 2014 (12-1pm)Care transitions for the homelessMinnesota Department of Human Services

Future webinars…

To suggest future topics for this series, MH - Reducing Avoidable Readmissions Effectively “RARE” Networking Webinars, contact:

Kathy Cummings, kcummings@icsi.org

Jill Kemper, jkemper@icsi.org