Coordination and continuity of care

Acumentra Health experts work with various healthcare settings and their healthcare partners to improve the communication regarding the continuity or transition of care from one setting to another, including

  • assessment of current process for completion and distribution of discharge orders
  • root cause analysis about the successes or failures of the current system of communicating the person’s medical status at discharge
  • incorporating best practices learned in other healthcare environments

Transition of care between hospitals and nursing homes

As part of a joint effort between the 5 Million Lives and Advancing Excellence statewide campaigns to reduce pressure ulcers, Acumentra Health facilitated the development of best practices and improved transfer of care plan information for use across hospitals, nursing homes, community-based long-term care, and home health agencies.

Compliance review of Medicaid managed care organizations

As part of Acumentra Health’s external quality review work, our experts review policies and records and conduct interviews with managers of Medicaid managed care organizations (MCO) to determine whether the MCO has 

  • developed and implemented methods to coordinate the services the Regional Support Networks furnish with services that enrollees receive from other health plans
  • consulted and communicated with enrollees' other healthcare providers to coordinate care
  • implemented policies and procedures to assess special healthcare needs (SHCN) enrollees, coordinate care for those enrollees, and monitor this process
  • developed treatment plans that address necessary additional care for SHCN enrollees, with the participation of the enrollees and their families
  • incorporated treatment recommendations of other agencies and providers of specialized healthcare services
  • applied methods to monitor treatment plans for SHCN enrollees and a quality assurance process to follow through on findings from the monitoring
  • applied policies and procedures for providing direct access to specialists for SHCN enrollees
  • applied mechanisms to ensure the quality and appropriateness of care furnished to SHCN enrollees

Quality-of-care studies

Acumentra Health is conducting a mental health quality-of-care study focused on coordination of care, as well as assessment of cultural needs, client involvement in treatment planning, and other quality issues.

More information


Last updated February 17, 2009