For frail older adults with complex care needs, an inpatient hospital stay is destabilizing and often marks the beginning of a decline in functioning. For these older adults and their families, the post-hospital period is a risky, confusing, and stressful time.

The time constraints of the typical primary care practice often do not allow providers to take a comprehensive look at all of their patients’ needs. Enabling office staff to assist in this work, presents a tremendous opportunity to create patient-centered and comprehensive care plans.

From continued enrollment growth to expanded flexibility to offer non-medical supplemental benefits, Medicare Advantage plans are playing an increasingly important role in the lives of older adults.

Christine Schaeffer, MD, medical director of Northwestern Medicine Transitional Care Clinic, describes the core components of its transitional care program. She also shares important considerations for health systems interested in implementing person-centered transitional care.

Provides an overview on Special Needs Plans (SNPs), a type of Medicare Advantage plan for individuals with special needs, the types of SNPs serving different populations, and how SNPs serving institutionalized individuals are unique.