HealthCare Access Maryland announced a partnership with The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, both in Baltimore, to reduce unnecessary emergency department visits and preventable 30-day hospital readmissions.
Two social work care coordinators from HCAM, a nonprofit that helps people enroll in public healthcare coverage, will work with the hospitals to coordinate care for patients at high risk of a readmission. For 30 days after discharge, the care coordinators will visit or call patients weekly, conduct assessments and provide several support services, such as:
• Find and enroll in a health insurance plan
• Find a primary medical care provider
• Find prescription assistance options
• Get transportation to and from follow-up medical appointments
In addition, the care coordinators can help patients find disease case management programs, food pantries, housing agencies, employment programs and homeless shelters, according to the news release.
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