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Rural Health Information Hub

Other Case Studies and Collections of Program Examples: Care coordination

In addition to RHIhub's Rural Health Models and Innovations rural program examples, you may also want to browse other case studies, databases, and websites with collections of health programs.

Each resource listed below uses its own criteria for selecting program examples, which may range from programs known to be effective based on research to anecdotal accounts. In each resource, you may want to review information on the level of evidence required for a program's inclusion.

May include non-rural programs that could be applicable to rural health delivery.

Medical Center Barbour Reduces Readmission Rates
Highlights the accomplishments of Medical Center Barbour (MCB), a prospective payment system (PPS) hospital located in Eufaula, Alabama, as it progressed through a Small Rural Hospital Transition (SRHT) quality of care and transition of care project. MCB's top accomplishments include reducing readmissions, improving communication among staff and patients, and enhancing the discharge process.
Additional links: One-Page Summary
Date: 06/2017
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Rural Health Philanthropy Partnership: Leveraging Public-Private Funds to Improve Health
Highlights the work of two grantees funded through the Rural Health Care Coordination Network Partnership Program, a combined effort of the Federal Office of Rural Health Policy and philanthropy organizations. Discusses how the coordinated efforts of the grantees and their philanthropy partners benefit patients.
Author(s): Kay Miller Temple
Citation: Rural Monitor
Date: 05/2017
Type: Document
Sponsoring organization: Rural Health Information Hub
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Innovations in Rural Health System Development: Service Delivery Advances in Care Coordination, Emergency Care, and Telehealth
Offers examples of emergency services, telehealth technology, and care coordination initiatives with a focus on Maine, and how they impact rural service delivery and safeguard rural access to critical health services.
Author(s): Amanda Burgess, Andrew Coburn
Date: 10/2016
Type: Document
Sponsoring organizations: Maine Health Access Foundation, Maine Rural Health Research Center
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Project ECHO's Complex Care Initiative: Building Capacity to Help "Superutilizers" in Underserved Communities
Describes a case study from the University of New Mexico's Project ECHO (Extension for Community Health Outcomes) program, which uses telehealth to support primary care clinicians in underserved areas. Focuses on a project targeting Medicaid beneficiaries with substance abuse and mental health issues, with details on two primary care teams being supported, including one in a rural New Mexico community.
Author(s): Martha Hostetter, Sarah Klein, Douglas McCarthy
Date: 08/2016
Type: Document
Sponsoring organization: Commonwealth Fund
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Integrated Care in a Frontier Community
Examines the Southeast Health Group (SHG) in La Junta, Colorado, which coordinates physical and behavioral health using patient-centered, wellness-based care coordination to empower patients and promote self-directed care. Focuses on hiring providers who share SHG's philosophy of care, using community resources, and engaging peer support specialists.
Date: 07/2016
Type: Document
Sponsoring organization: Rural Health Value
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Investing in Population Health
Profile of a pilot project in rural New Mexico focused on population health for Medicaid recipients. Offers communities 3 levels of patient services and payment. Uses community health workers to address the social determinants of health.
Date: 08/2015
Type: Document
Sponsoring organization: Rural Health Value
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Rural Accountable Care Organization Care Coordination
Profile of the MaineHealth Accountable Care Organization (MHACO), which uses regional teams to provide care coordination to patients with complex medical profiles.
Date: 2015
Type: Document
Sponsoring organization: Rural Health Value
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