Expanding Health Care Coverage

Project Title

Collaborative Case Management to Reduce Hospital Readmissions

Grant Amount


Priority Area

Expanding Health Care Coverage

Date Awarded

December 10, 2007


Capital Region





Hospital readmissions are costly to the health care system and too often traumatizing to patients and their families—a sign of ineffective and fractured health care service delivery. The readmission rate for hospitals in the Glens Falls metropolitan area is 18.5%—a full 6% higher than the statewide average. A planning grant to Hudson Headwaters helped them and their partner organizations, Glens Falls Hospital, and Warren and Washington County Home Health Service Agencies, assess the problem and develop an intervention that addresses the problem.

At national and State levels, communities have struggled with rising health care costs and the financial and social ramifications. Locally, the Resource Utilization Management Committee of the Glens Falls Hospital has focused on reducing 30 day Medicare readmissions to the hospital. Current data shows a high readmission rate: 18.5% compared to a statewide average of 12.5%. Similarly, the Warren County Home Health Service Agency has an acute care hospitalization/ risk adjusted rate of 32.5% versus a statewide CMS average of 23% and a home health target goal of 26.7%. As the high rate of hospital readmissions are costly to the health care system, Hudson Headwaters Health Network proposes to work with Glens Falls Hospital, Warren and Washington County Home Health Service Agencies, and Shadi Saleh, Ph.D., Professor at SUNY – Albany School of Public Health, in executing a planning assessment of the problem. As part of this planning grant, these groups assessed the problem, identified a potential intervention, and developed an evaluation plan for the intervention.