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About the Partnership

One of the ways the Partnership for Patients will achieve the goal of reducing hospital readmissions is to focus on reducing complications during transitions from one care setting to another. Safe, effective, and efficient care transitions require thoughtful collaboration among health care providers, hospitals, nursing homes and other facilities, social service providers, patient caregivers, and patients themselves.

Program Overview

The Community-based Care Transitions Program, created by Section 3026 of the Affordable Care Act, tests care delivery models for improving care transitions from the hospital to other settings and reducing readmissions for high-risk Medicare beneficiaries.

The goals of the Community-based Care Transitions Program are:

  • To improve transitions of beneficiaries from the inpatient hospital setting to other care settings
  • To improve quality of care
  • To reduce readmissions for high risk Medicare beneficiaries
  • To document measurable savings to the Medicare program

Up to $500 million in total funding is available for 2011 through 2015 to community-based organizations partnering with hospitals and other providers to provide care transition services to effectively manage Medicare patients' transitions and improve their quality of care.

The CCTP Partners

Select the map below to go to the Where Partnerships are In Action interactive map page to see the sites participating in the Community-based Care Transitions Program, or learn more about the Community-based Transitions Program and its partners.

Community-based Care Transitions Program Map

Number of organizations participating in the Community-based Care Transitions Program

  • light blue box that represents number range of organizations pledged depending on state
    1 to 2
  • blue box that represents number range of organizations pledged depending on state
    3 to 4
  • dark blue box that represents number range of organizations pledged depending on state
    5and more

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