Topics: Care coordination

For more information and resources, see RHIhub’s Care Coordination topic guide.

Relationships and Partnerships: How ACOs Are Improving Treatments for Super-Utilizers

Patients and staff at Gritman Medical Center: Potlatch Family Care


Super-utilizers are those patients who are hospitalized multiple times each year and, due to circumstances outside their control, are unable to make the changes needed to keep them out of the ER. Three rural Accountable Care Organizations (ACOs) are working on reducing these readmissions and improving their super-utilizers’ health.

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May 30, 2018

Rural Health Philanthropy Partnership: Leveraging Public-Private Funds to Improve Health

FORHP Grants in Motion, featuring Williamson, West Virginia


Public agencies and private non-profit groups have mutual interests in improving the health of rural Americans. The Federal Office of Rural Health Policy and philanthropy organizations worked together to create a unique funding opportunity, the Rural Health Care Coordination Network Partnership Program. Two health care organizations and their philanthropy partners share how coordinated efforts benefit patients with diabetes, congestive heart failure and chronic obstructive pulmonary disease.

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May 31, 2017

Keeping PACE with the Rural Elderly

PACE, the Program of All-inclusive Care that helps elderly people remain independent, is especially needed in rural areas.

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August 20, 2014

Health Care Integration Offers Multiple Benefits

Sheila Brijade, DDS, pediatric dentist welcomes a new patient


As healthcare reform encourages integration of healthcare to treat the patient as a whole, behavioral health and oral care are being integrated into primary care practices around the country.

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November 18, 2013

Care Coordination Keeps Patients, Providers in the Loop

Community Care of NC care manager


Provides an update on three providers’ coordinated care services and the progress they’ve made since their stories were first published in the Rural Monitor. Includes programs in North Carolina, Idaho, and Missouri.

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February 21, 2013

What I Saw in 2019

Myers visits the year 2019 and likes what he sees, especially the formation of regional health care systems.

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February 21, 2013