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The New York State Behavioral Health Readmissions Quality
Collaborative
Molly Finnerty, MDEdith Kealey, PhD
Kate M. Sherman, LCSWNew York State Office of Mental Health
June 26, 2014
Participants:1-866-639-0744, no code needed
Minnesota RARE CampaignMinnesota RARE CampaignMonthly Call, June 26, 2014Monthly Call, June 26, 2014
The New York State The New York State Behavioral Health Behavioral Health
Readmissions Quality Readmissions Quality CollaborativeCollaborative
Molly Finnerty, MDMolly Finnerty, MDEdith Kealey, PhDEdith Kealey, PhDKate M. Sherman, LCSWKate M. Sherman, LCSWNew York State Office of Mental HealthNew York State Office of Mental Health
OutlineOutline
Overview of the ProjectOverview of the Project Participants and activitiesParticipants and activities Project metrics and dataProject metrics and data
Lessons Learned and RecommendationsLessons Learned and Recommendations Interventions Interventions
Emergency DepartmentEmergency Department InpatientInpatient AftercareAftercare
Managing the ProjectManaging the Project
Future PlansFuture Plans
Collaborative Collaborative Participants, Activities Participants, Activities
and Time Lineand Time Line
Readmissions Collaborative Readmissions Collaborative Project Context and FocusProject Context and Focus
Statewide behavioral health systems transformationStatewide behavioral health systems transformation
Previous successful learning collaborative to reduce Previous successful learning collaborative to reduce use of antipsychotics with higher risk for metabolic use of antipsychotics with higher risk for metabolic disturbance for individuals with existing metabolic disturbance for individuals with existing metabolic conditionsconditions
Focus on behavioral health readmissions Focus on behavioral health readmissions (individuals discharged from behavioral health (individuals discharged from behavioral health inpatient services who are readmitted to behavioral inpatient services who are readmitted to behavioral health inpatient services within 30 days of health inpatient services within 30 days of discharge)discharge)
Readmissions Collaborative Readmissions Collaborative Sponsors and ParticipantsSponsors and Participants
SponsorsSponsors NYS Office of Mental Health NYS Office of Mental Health The 2 major hospital associations in NYSThe 2 major hospital associations in NYS
Greater NY Hospital Association (NYC)Greater NY Hospital Association (NYC) Healthcare Association of NYSHealthcare Association of NYS
Steering Committee Steering Committee Sponsors plus 8 hospitals / systemsSponsors plus 8 hospitals / systems Specified project focus and requirementsSpecified project focus and requirements
Participants: 45 hospitals statewideParticipants: 45 hospitals statewide Invited all hospital association members with inpatient Invited all hospital association members with inpatient
behavioral health servicesbehavioral health services Participation not required, no direct financial incentivesParticipation not required, no direct financial incentives 24% of eligible hospitals participated (some attrition) 24% of eligible hospitals participated (some attrition)
Project Options: ParticipationProject Options: Participation Select services to participateSelect services to participate
Psychiatry and/orPsychiatry and/or Substance abuse servicesSubstance abuse services
Select settings to participate Select settings to participate InpatientInpatient Outpatient Outpatient Emergency departmentsEmergency departments
Multiple services encouraged to participateMultiple services encouraged to participate Inpatient strongly encouraged but not requiredInpatient strongly encouraged but not required
Project Options: StrategiesProject Options: Strategies Project focus: menu of options in 3 domainsProject focus: menu of options in 3 domains
Medication strategiesMedication strategies Increase use of Long-Acting Injectables / ClozapineIncrease use of Long-Acting Injectables / Clozapine Medication fill at dischargeMedication fill at discharge Counseling for medication adherence Counseling for medication adherence
Outpatient engagementOutpatient engagement Referrals to ACT / case management / health homesReferrals to ACT / case management / health homes Counseling for adherence to treatmentCounseling for adherence to treatment Peer servicesPeer services
Integrated dual diagnosis treatmentIntegrated dual diagnosis treatment
Enhanced discharged planning required in Inpatient Enhanced discharged planning required in Inpatient and Emergency Services (defined by hospitals)and Emergency Services (defined by hospitals)
Target population defined by hospitals according to the Target population defined by hospitals according to the intervention selectedintervention selected
Collaborative ActivitiesCollaborative Activities ConferencesConferences
Kick-OffKick-Off Mid-point, share successful strategiesMid-point, share successful strategies ConcludingConcluding
Monthly Learning Collaborative CallsMonthly Learning Collaborative Calls Interactive, report on progressInteractive, report on progress
Strategies Calls: Training on specific Strategies Calls: Training on specific strategiesstrategies
Site Visits (selected hospitals)Site Visits (selected hospitals) Technical assistanceTechnical assistance Identify best practicesIdentify best practices
Resources and Resources and Technical AssistanceTechnical Assistance
PSYCKES ApplicationPSYCKES Application NYS Medicaid claims / encounter dataNYS Medicaid claims / encounter data Behavioral health population (4.6 million)Behavioral health population (4.6 million) Track performance and identify clients with quality Track performance and identify clients with quality
concernsconcerns
Project Website
Clinical tools Clinical tools (e.g., Readmission Risk Assessment)(e.g., Readmission Risk Assessment) Developed for the collaborativeDeveloped for the collaborative Shared by participantsShared by participants Identified from outside sourcesIdentified from outside sources
Time LineTime Line 6/2012 - 12/2012: Kick-off and Planning 6/2012 - 12/2012: Kick-off and Planning
Begin monthly callsBegin monthly calls Project Planning form due 10/2012Project Planning form due 10/2012 Note: Superstorm Sandy 10/2012Note: Superstorm Sandy 10/2012
1/2013 - 6/2013: Begin delivering and tracking 1/2013 - 6/2013: Begin delivering and tracking interventions (monthly reporting), Midpoint Conferenceinterventions (monthly reporting), Midpoint Conference
Decision to extend Collaborative through 6/2014Decision to extend Collaborative through 6/2014
7/2013 - 6/2014: Site Visits (n=15) and Calls (n=3)7/2013 - 6/2014: Site Visits (n=15) and Calls (n=3)
11/2013: Midpoint Survey11/2013: Midpoint Survey
6/2014: End / Concluding Conference6/2014: End / Concluding Conference
Data SourcesData Sources
NYS Medicaid Claims/Encounter DataNYS Medicaid Claims/Encounter Data PSYCKES applicationPSYCKES application Data Analysis TeamData Analysis Team
Hospital Self-ReportHospital Self-Report Reported monthly by each hospitalReported monthly by each hospital Aggregated and distributed to hospitals monthlyAggregated and distributed to hospitals monthly
SurveysSurveys Prescriber Survey on LAI and ClozapinePrescriber Survey on LAI and Clozapine Midpoint Survey on project interventions (value, Midpoint Survey on project interventions (value,
feasibility) and lessons learnedfeasibility) and lessons learned
Key Project MetricsKey Project Metrics Inpatient (primary indicator)Inpatient (primary indicator)
Among clients discharged from your hospitalAmong clients discharged from your hospital’’s inpatient s inpatient service (psychiatry or substance abuse)service (psychiatry or substance abuse)
Percentage readmitted to the same service at any hospital Percentage readmitted to the same service at any hospital within 30 dayswithin 30 days
OutpatientOutpatient Among clients seen in your outpatient service who had a Among clients seen in your outpatient service who had a
behavioral health hospitalization at any hospital behavioral health hospitalization at any hospital Percentage readmitted to behavioral health inpatient at any Percentage readmitted to behavioral health inpatient at any
hospital within 30 days hospital within 30 days
EmergencyEmergency Among clients who come to ED within 30 days of discharge Among clients who come to ED within 30 days of discharge
from psychiatric inpatient at any hospitalfrom psychiatric inpatient at any hospital Percentage readmitted by your EDPercentage readmitted by your ED
Readmissions within 30 Days of Readmissions within 30 Days of Discharge from Inpatient PsychiatryDischarge from Inpatient Psychiatry
Length of Stay 4+ DaysLength of Stay 4+ Days
Average Annual Percent Change 6/2012 to 9/2013
Participating:-0.5 (ns.)
Non-Participating: -3.8 (sig.)
Includes age 18+ Excludes SUD
Readmissions within 30 Days of Discharge Readmissions within 30 Days of Discharge from Inpatient Psychiatry from Inpatient Psychiatry
Length of Stay 4+ DaysLength of Stay 4+ DaysAverage Annual Percent Change, 6/2012 – 9/2013Average Annual Percent Change, 6/2012 – 9/2013
by Hospital by Hospital
Green = Significant improvement
Yellow = Strong trend toward improvement
Red = Significant increase
Psychiatric ED visits by Individuals with a Psychiatric ED visits by Individuals with a Psychiatric Inpatient Stay in the Prior 30 Psychiatric Inpatient Stay in the Prior 30
days, and Disposition:days, and Disposition:Aggregate data for all Participating HospitalsAggregate data for all Participating Hospitals
Baseline (June 2012)
ED visits
Baseline rate of Readmissions
in ED
Most recent(Sep 2013)
ED visits
Most recent rate of
Readmissions in ED Average
Annual Percent Change
AAPC95% CI Statistic-
ally Significant
Trend? (P-Value
<0.05)(N) (n) % (N) (n) % Low High
ED visits with Psychiatric Inpatient stay at any hospital in prior 30 days
824 444 54% 914 454 50% -4.2 -8.3 0.1 No
ED visits with Psychiatric Inpatient stay at the same hospital in prior 30 days
413 223 54% 473 220 47% -7.6 -12.9 -1.9 Yes
30-Day BH Readmissions (Any Hospital) 30-Day BH Readmissions (Any Hospital) among Mental Health Outpatientsamong Mental Health Outpatients
PSYCKES Indicator: 12-month look-backPSYCKES Indicator: 12-month look-back
Project Start
Average Annual Average Annual Percent Change Percent Change 7/1/2013 to 7/1/2013 to 4/1/20144/1/2014
Participating:Participating:-10.4-10.4
Non-Non-Participating: Participating: -7.5-7.5
Both statistically Both statistically significantsignificant
Includes individuals Includes individuals of all agesof all ages
Measurement Challenges:Measurement Challenges:Defining ReadmissionsDefining Readmissions
What is a hospitalization?What is a hospitalization? Any length of stay?Any length of stay? Exclude short term observation?Exclude short term observation?
Service typesService types Separate psychiatry and substance abuseSeparate psychiatry and substance abuse
What is a readmission?What is a readmission? Same service type vs. Same service type vs. Any behavioral health vs. Any behavioral health vs. Any service type including medicalAny service type including medical
Time frame Time frame 15 / 30 / 45 day15 / 30 / 45 day Readmission vs. high utilization over timeReadmission vs. high utilization over time
Measurement Challenges: Measurement Challenges: Other IssuesOther Issues
Data maturity: need to wait 6 months to see both index Data maturity: need to wait 6 months to see both index admission and readmission appear in claims/encounter admission and readmission appear in claims/encounter datadata
Observation periods: Monthly data vs. longer intervalsObservation periods: Monthly data vs. longer intervals
Confounding trends and variationConfounding trends and variation Seasonal fluctuationsSeasonal fluctuations Super-storm SandySuper-storm Sandy Health Home and other systems transformation initiativesHealth Home and other systems transformation initiatives
Limited baseline dataLimited baseline data
Exploring alternative statistical methods Exploring alternative statistical methods
Exploring other related outcome and process measuresExploring other related outcome and process measures
Methods: Methods: Review of Models and InitiativesReview of Models and Initiatives
RQC: RQC: Behavioral Health Readmissions Quality CollaborativeBehavioral Health Readmissions Quality Collaborative Clinic CQI:Clinic CQI: OMH Continuous Quality Improvement Initiative OMH Continuous Quality Improvement Initiative
for Health Promotion and Care Coordinationfor Health Promotion and Care Coordination CTI: CTI: Critical Time InterventionsCritical Time Interventions Transitions: Transitions: ACT Transitions Project ACT Transitions Project RED: RED: Project RED (Re-Engineered Discharge)Project RED (Re-Engineered Discharge) STAAR: STAAR: State Action on Avoidable ReadmissionsState Action on Avoidable Readmissions AHRQ: AHRQ: Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality
(AHRQ) Reducing Medicaid Readmissions Project (AHRQ) Reducing Medicaid Readmissions Project RARE: RARE: Reducing Avoidable Readmissions Effectively Reducing Avoidable Readmissions Effectively
Note: all quotations are from RQC Midpoint SurveyNote: all quotations are from RQC Midpoint Survey
Prevent avoidable readmissions in ED
Identify high utilizers and potential readmissions Identify high utilizers and potential readmissions
Consult/ approval by last inpatient team (they Consult/ approval by last inpatient team (they come to ED to evaluate) before determining come to ED to evaluate) before determining disposition disposition Is the clientIs the client’’s status the same as last discharge? s status the same as last discharge? Is another admission likely to be helpful? Is another admission likely to be helpful? Are there safe alternatives that could be tried?Are there safe alternatives that could be tried?
Identify and contact community-based supports Identify and contact community-based supports before disposition/admissionbefore disposition/admission
Source(s): RQCSource(s): RQC
AssessmentAssessment Identify readmissions / high utilizersIdentify readmissions / high utilizers
Conduct in-depth review or case conference Conduct in-depth review or case conference What was the last discharge plan? How well did it work? What was the last discharge plan? How well did it work? Why were they readmitted (root causes)? Why were they readmitted (root causes)? What can we do differently this time? What can we do differently this time? Review in treatment team meeting, cross department Review in treatment team meeting, cross department
meetings (ER, inpatient, case workers, outpatient)meetings (ER, inpatient, case workers, outpatient)
““Engaging the patient in reasons why the prior discharge Engaging the patient in reasons why the prior discharge failed can help staff gain insight.failed can help staff gain insight.””
Source(s): STAAR, AHRQ, RQCSource(s): STAAR, AHRQ, RQC
After Hospital Care PlanAfter Hospital Care Plan Develop and use After Hospital Care Plan (e.g. Develop and use After Hospital Care Plan (e.g.
Project RED format), including Project RED format), including Clear medication instructions Clear medication instructions Follow-up appointments (arranged before discharge) Follow-up appointments (arranged before discharge) Name and phone number to call with any problemsName and phone number to call with any problems
Educate client and family using teach-back Educate client and family using teach-back method throughout inpatient staymethod throughout inpatient stay
Source(s): Project RED (key intervention), STAAR, RARESource(s): Project RED (key intervention), STAAR, RARE
Access to MedicationAccess to MedicationEnsure access to medication post discharge! Ensure access to medication post discharge!
Verify insurance formulary for meds before initiating Verify insurance formulary for meds before initiating
Obtain and verify pre-authorization for meds before Obtain and verify pre-authorization for meds before discharge discharge
Fill prescriptions at discharge: patients leave with meds Fill prescriptions at discharge: patients leave with meds in hand (or are walked to the pharmacy by staff)in hand (or are walked to the pharmacy by staff)
Check Medicaid status - enroll in Medicaid if eligibleCheck Medicaid status - enroll in Medicaid if eligible
““Make sure that the patient can afford the medications they Make sure that the patient can afford the medications they are discharged on.are discharged on.””
Source(s): RARE, RQCSource(s): RARE, RQC
Involve Family / Natural SupportsInvolve Family / Natural Supports
Support evaluation Support evaluation
Assess family needsAssess family needs
Provide crisis interventionProvide crisis intervention
Psychoeducation and skill-buildingPsychoeducation and skill-building
““Family involvement is key to a patient's recovery.Family involvement is key to a patient's recovery.””
““Family support makes a tremendous difference with patient Family support makes a tremendous difference with patient compliance.compliance.””
Source(s): RQC, CTI, STAAR, RED, RARESource(s): RQC, CTI, STAAR, RED, RARE
Bridging and Bridging and ““Warm Hand-offsWarm Hand-offs””
Face to face meeting with receiving outpatient Face to face meeting with receiving outpatient provider during inpatient stay or immediately provider during inpatient stay or immediately upon discharge. Ideally: upon discharge. Ideally: Discharge planning meeting: outpatient provider, Discharge planning meeting: outpatient provider,
client, family, and inpatient team; andclient, family, and inpatient team; and
Individual meeting/session: outpatient provider Individual meeting/session: outpatient provider and clientand client
Source(s): STAAR, RARE, RQC, Transitions Project, CTISource(s): STAAR, RARE, RQC, Transitions Project, CTI
Co-Occurring Mental Health and Co-Occurring Mental Health and Substance Use DisordersSubstance Use Disorders
Provide Integrated Dual Diagnosis Treatment, Provide Integrated Dual Diagnosis Treatment, e.g.: e.g.:
Screening at intakeScreening at intake
4-quadrant model of assessment4-quadrant model of assessment
Motivational interviewingMotivational interviewing
Refer to providers of integrated treatment for Refer to providers of integrated treatment for aftercare aftercare
Source(s): RQC, EBP for co-occurring disordersSource(s): RQC, EBP for co-occurring disorders
AftercareAftercare Follow-up appointment with aftercare mental health Follow-up appointment with aftercare mental health
provider within 3 days of discharge (5 at most)provider within 3 days of discharge (5 at most)
Use higher-intensity outpatient services for hospital Use higher-intensity outpatient services for hospital diversion and hospital step-downdiversion and hospital step-down Partial Hospitalization Program (PHP)Partial Hospitalization Program (PHP)
Some clinics developing Intensive Outpatient (IOP) Some clinics developing Intensive Outpatient (IOP) level of carelevel of care
Identification of and coordination with existing services Identification of and coordination with existing services such as ACT such as ACT
Source(s): RARE, RQC, TransitionsSource(s): RARE, RQC, Transitions
Follow-Up Phone CallsFollow-Up Phone Calls Follow-up phone call to Follow-up phone call to client/familyclient/family
Within 72 hours Within 72 hours Clinical intervention, intensive (not just a reminder call) Clinical intervention, intensive (not just a reminder call) Use teach-back method (donUse teach-back method (don’’t read the med list)t read the med list) Ideally by staff known to clientIdeally by staff known to client Not Not ““dischargeddischarged”” until attends first outpatient appointment until attends first outpatient appointment
Follow-up phone call to Follow-up phone call to providerprovider
““Follow-up phone calls are very important, to make sure that Follow-up phone calls are very important, to make sure that discharged patients continue to take their meds and keep their discharged patients continue to take their meds and keep their follow-up appointments.follow-up appointments.””
Source(s): Project RED (key component), RARE, RQC, TransitionsSource(s): Project RED (key component), RARE, RQC, Transitions
Follow-Up Phone Call to Client: Follow-Up Phone Call to Client: Project RED Key ComponentsProject RED Key Components
1.1. Assess clinical statusAssess clinical status
2.2. Review and confirm each medicationReview and confirm each medication
3.3. Review follow-up appointmentsReview follow-up appointments
4.4. Assess for barriers, problem-solve, and review Assess for barriers, problem-solve, and review what to do if a problem ariseswhat to do if a problem arises
5.5. After call: take any needed follow-up actions / After call: take any needed follow-up actions / inform treatment team of any issuesinform treatment team of any issues
Short-Term Case ManagementShort-Term Case Management Services may be provided by case manager, Services may be provided by case manager,
bridger, peer, etc.bridger, peer, etc.
Key principlesKey principles Assess client risk/needs, adjust intensity and time Assess client risk/needs, adjust intensity and time
frame accordinglyframe accordingly Include home visits if neededInclude home visits if needed Actively follow up on non-adherence to the plan, e.g.: Actively follow up on non-adherence to the plan, e.g.:
make another appointment if missedmake another appointment if missed
Source(s): CTI, RARE, RQC, TransitionsSource(s): CTI, RARE, RQC, Transitions
Community Functioning / SupportCommunity Functioning / Support Build, practice and test self-management skillsBuild, practice and test self-management skills
Examples: filling pill boxes, keeping appointmentsExamples: filling pill boxes, keeping appointments Skill-building at each level of care to prepare for next Skill-building at each level of care to prepare for next
Refer to intensive community supports, e.g.: Refer to intensive community supports, e.g.: ACTACT Health Home / other care managementHealth Home / other care management
““Very helpful to establish referral links to Health Homes for Very helpful to establish referral links to Health Homes for care coordination services and ACT Teams.care coordination services and ACT Teams.””
Source(s): RQCSource(s): RQC
Outpatient Crisis ManagementOutpatient Crisis Management
Outpatient programs develop strategies for crisis Outpatient programs develop strategies for crisis management, e.g.: management, e.g.: relapse prevention plansrelapse prevention plans monitoring for early warning signsmonitoring for early warning signs urgent care / walk-in appointmentsurgent care / walk-in appointments on call availabilityon call availability
Educate clients (and staff) not to use the ED for Educate clients (and staff) not to use the ED for urgent careurgent care
Source(s): Clinic CQISource(s): Clinic CQI
Continuous Improvement Continuous Improvement Across All SettingsAcross All Settings
No single solutionNo single solution Portfolio of mutually reinforcing interventionsPortfolio of mutually reinforcing interventions Ongoing incremental changesOngoing incremental changes
All relevant services within the hospital should All relevant services within the hospital should participate and collaborate on the projectparticipate and collaborate on the project
““There is definitely a need for increased collaboration between the There is definitely a need for increased collaboration between the inpatient and outpatient staff. Though we are one agency, and inpatient and outpatient staff. Though we are one agency, and consider ourselves seamless, reviewing our internal referral consider ourselves seamless, reviewing our internal referral process has demonstrated a disconnect in identifying and process has demonstrated a disconnect in identifying and following up with patients deemed high-risk for readmission.following up with patients deemed high-risk for readmission.””
Source(s): RED, STAAR, RARE, RQC, TransitionSource(s): RED, STAAR, RARE, RQC, Transition
Data-Driven Decision Making:Data-Driven Decision Making:Project Level and Client LevelProject Level and Client Level
Start with a root cause analysis of a sample of Start with a root cause analysis of a sample of readmissions, including: readmissions, including: client/caregiver interviewsclient/caregiver interviews quantitative analysis quantitative analysis input from hospital staff and other providersinput from hospital staff and other providers
Track interventions and outcomes over time Track interventions and outcomes over time
““Reducing behavioral health re-hospitalizations requires Reducing behavioral health re-hospitalizations requires developing a system for close monitoring and tracking of developing a system for close monitoring and tracking of patients identified as at-risk for re-hospitalization.patients identified as at-risk for re-hospitalization.””
Source(s): RED, STAAR, AHRQ, RQCSource(s): RED, STAAR, AHRQ, RQC
Collaboration across the Collaboration across the Continuum of CareContinuum of Care
Know and engage your community partners Know and engage your community partners Standardize communication Standardize communication Develop protocols for expedited referrals Develop protocols for expedited referrals Collaboration on treatment and discharge planning Collaboration on treatment and discharge planning Must include: BH, medical, housingMust include: BH, medical, housing
Develop a relationship with at least one pharmacyDevelop a relationship with at least one pharmacy
Improved, real-time communication between inpatient Improved, real-time communication between inpatient and outpatient behavioral health providers and and outpatient behavioral health providers and primary care physicianprimary care physician
Source(s):STAAR, AHRQ, RQC, RED, RARESource(s):STAAR, AHRQ, RQC, RED, RARE
Importance of LeadershipImportance of Leadership Buy-in / MotivationBuy-in / Motivation
EducationEducation
Resource AllocationResource Allocation
““Behavioral health re-admissions can be reduced when Behavioral health re-admissions can be reduced when providers use the proper, evidence-based treatments for providers use the proper, evidence-based treatments for serious mental health problems….serious mental health problems….””
““When administration plans a project without staff buy-in or When administration plans a project without staff buy-in or support, it is doomed to be less successful than if staff had support, it is doomed to be less successful than if staff had themselves designed the interventions/strategies. Any themselves designed the interventions/strategies. Any future collaborative project needs to incorporate more future collaborative project needs to incorporate more representation from front line staff.representation from front line staff.””
Expanded FocusExpanded Focus
Discharge Discharge from behavioral health inpatientfrom behavioral health inpatient PsychiatryPsychiatry Substance abuseSubstance abuse
Readmission Readmission to any inpatient service to any inpatient service within 30 within 30 daysdays PsychiatryPsychiatry Substance abuseSubstance abuse MedicalMedical
Project Structure and StrategiesProject Structure and Strategies
All behavioral health services in the hospital All behavioral health services in the hospital participate and work collaborativelyparticipate and work collaboratively
Focus on processes and care transitionsFocus on processes and care transitions
Timeline:Timeline: Summer 2014: Planning with Steering CommitteeSummer 2014: Planning with Steering Committee
Fall 2014: Learning Collaborative Kick-OffFall 2014: Learning Collaborative Kick-Off
Upcoming RARE Events….
Stay tuned for the next RARE Mental Health Webinar:
July 23, 2014 (12-1pm)Care transitions for the homelessMinnesota Department of Human Services
Future webinars…
To suggest future topics for this series, MH - Reducing Avoidable Readmissions Effectively “RARE” Networking Webinars, contact:
Kathy Cummings, [email protected]
Jill Kemper, [email protected]