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Imagine all across ���������� State, no patient falling through the cracks. Where the historically siloed systems of care are torn down by new, collaborative models. Where every patient with a serious mental illness receives the care he or she deserves. And where clinicians and their teams are empowered to engage with their clients and make informed clinical decisions.

The is working synergistically with DSRIP, health homes and managed care initiatives to help you make this world a reality.

Together with Montefiore Medical Center, Northwell Health (formerly North Shore-LIJ Health System), the ���������� State Office of Mental Health and Netsmart Technologies, the National Council for Behavioral Health has launched the , a four-year initiative in ���������� State funded by the Centers for Medicare and Medicaid Services. In the midst of statewide initiatives like DSRIP, health homes and the transition to managed care and value-based payments, the Care Transitions Network will help enrolled organizations and their clinicians stay tuned to their true north – improved quality of care for people with serious mental illness.

Over the next four years, the Care Transitions Network will help providers in ���������� State reach their targets for reduced all-cause re-hospitalization rates for people with serious mental illness. Enrolled organizations can expect individualized support and resources including:

• Care Transitions Support to facilitate and ensure engagement with outpatient practices for patients after discharge from psychiatric hospitalizations;
• Expert Faculty to offer real-time clinical consultation, targeted coaching and training on implementation of evidence-based practices and the transition to value-based payment arrangements;
• A Web-Based Platform to enable your organization to track progress for continuous quality improvement (for organizations that want it, free licensure and implementation support is available to adopt Netsmart’s Care Manager Solution to be used as part of this project) and
• Up to $1,000 per enrolled eligible professional over the course of this initiative.��

How can you be part of this? ; hundreds already have. Behavioral health, primary care, inpatient, outpatient, rural and urban – all are welcome. We seek to build a network of organizations committed to improving the quality of care for people with serious mental illness.

If your organization is interested in joining the Care Transitions Network, or contact us directly at CareTransitions@TheNationalCouncil.org or (202) 684-7457 x 293.

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