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Presbyterian's Hospital at Home program, launched in 2008, is based on a model developed in the mid-1990s by Bruce Leff, M.D., a geriatrician and health services researcher at Johns Hopkins University, who noticed that many of his patients suffered poor outcomes after hospital stays.1 At Johns Hopkins, teams of physicians, nurses, and other clinical staff make house calls to treat elderly patients, many of whom either refuse to go to the hospital or are at such high risk for adverse events that physicians prefer not to admit them. For select patients, this approach produces superior outcomes at a lower cost than hospital care (see Results).The Hospital at Home model has struggled to gain traction elsewhere in the United States, however, in part because Medicare's fee-for-service program will not pay for its services. Presbyterian is able to secure reimbursement from its health plan, which covers 470,000 Medicare Advantage, Medicaid, and commercially insured members throughout the state and has incentives to reduce costs and improve care.Presbyterian's program fits within a suite of services designed to deliver care in the home. These include home-based primary care, home health, hospice, and Complete Care, a care management program designed to improve coordination of services for patients with advanced illness and, when desired, avoid unwanted aggressive care at the end of life.
Institute for Transportation and Development Policy;
While momentum in recent decades has elevated bus rapid transit (BRT) as more than an emerging mode in the U.S., this high-capacity, high-quality bus-based mass transit system remains largely unfamiliar to most Americans. In the U.S., lack of clarity and confusion around what constitutes BRT stems both from its relatively low profile (most Americans have never experienced BRT) and its vague and often conflicting sets of definitions across cities, sectors, and levels of government. As a result, many projects that would otherwise be labeled as bus improvements or bus priority under international standards have become branded in American cities as BRT. This leads to misperceptions among U.S. decisionmakers and the public about what to expect from BRT. Since its inception in Curitiba, Brazil, BRT has become a fixture of urban transport systems in more than 70 cities on six continents throughout the globe. Just twelve BRT corridors exist in the United States so far.This guide offers proven strategies and insights for successfully implementing BRT within the political, regulatory, and social context that is unique to the United States. This guide seeks to illuminate the upward trends and innovations of BRT in U.S. cities. Through three in-depth case studies and other examples, the guide shares the critical lessons learned by several cities that have successfully implemented, or are in the midst of completing, their own BRT corridors. Distinct from previous BRT planning and implementation guides, this is a practical resource to help planners, and policy makers specifically working within the U.S. push beyond the parameters of bus priority and realize the comprehensive benefits of true BRT.
W.K. Kellogg Foundation;
Highlights community-based initiatives in Albuquerque, New Mexico; Ingham County, Michigan; El Paso, Texas; Alameda County, California; and North Carolina that have developed health plans for uninsured individuals and families.
Center for American Progress;
Profiles the goals, activities, implementation, and challenges of the twelve states that won Race to the Top federal funds to improve teacher quality and preparation program accountability; analyzes their strategies; and makes policy recommendations.