As the region’s Area Agency on Aging, DRCOG is partnering with seven local hospitals and more than 50 other community service providers on the Community-based Care Transitions Program for the Denver region. An early pilot project led to funding from the Centers for Medicaid and Medicare Services to implement this innovative program. The program coaches patients and caregivers to actively engage in self-management skill development as the patient transitions from hospital care to independent living at home.
The program is a 30-day free program designed to improve quality of life for Medicare beneficiaries. Staff helps Medicare patients understand and manage medications, avoid unnecessary re-hospitalization and improve health and connect with supporting community services to receive the care they need.
Eligible patients receive assistance from transitions coaches who personally show and guide them to take charge of their health care. Qualifying patients also have access to supportive services needed to keep them healthy at home. The program saves Medicare money and helps patients maintain healthier lifestyles.
Contact 303-480-6799 for more information.