Effective care coordination and transition planning are essential to improving patient outcomes while containing healthcare expenditures, which are the basic goals of value-based care. In this White Paper, we identify effective coordination and transition strategies in the management of chronic kidney disease and end-stage renal disease. We also outline Healthmap’s strategy for improving care coordination and transitions, and how our Kidney Population Health Management program used these tactics to support the delivery of high-quality care while containing healthcare expenditure and achieving financial goals.
