Advanced Patient Care and H.E.A.L.T.H. Partners Launch Innovative Pilot Program to Improve Hospital-to-Home Transitions for Low-Income Residents of Montgomery County, MD

Sterling, VA – March 15, 2016 – Advanced Patient Care (APC Corp, Sterling, Virginia) and H.E.A.L.T.H. Partners (Hospitals Effectively Assisting Lasting Transition to Home), a coalition of more than 20 community partners, will collaborate on an innovative new pilot designed to help low-income seniors maximize the benefits of medication therapy. The coalition will implement an innovative approach to medication therapy management that aims to better identify, prevent and correct medication-related problems.

The Primary Care Coalition (PCC) – the backbone organization and fiscal sponsor for H.E.A.L.T.H. Partners – received a Montgomery County Executive grant to support this initiative to improve health outcomes among low-income seniors residing in subsidized housing in Montgomery County, Maryland.

Medicare reports annually nearly one in five patients discharged from the hospital is readmitted shortly after discharge. Managing medications has been identified as a primary cause for readmission. This is a particular problem for seniors and chronic care patients who face complex medication needs. Hospitals, providers, home health and assisted living are searching for new ways to reduce rehospitalization, to improve value of care, and to reduce medical spending.

Advanced Patient Care has developed a comprehensive program to improve medication adherence, reduce readmissions and improve waste. The program integrates reconciliationcomprehensive medication reviews and care coordination while it tracks outcomes with clients to provide guidance on organizational improvement. Currently, Advanced Patient Care is working with several health systems in Maryland to implement its program, significantly improving outcomes in patient populations transitioning into the home setting.

The purpose of the Montgomery County program is to determine which residents will benefit most from enhanced medication management and care coordination services, and to provide immediate assistance when it is needed. Additionally, the program is designed to improve and track specific outcomes in reducing hospital risk (inpatient or emergency department), to improve patient identification, and to implement best practices and overall cost savings.

“In speaking with the residents, it becomes quite evident that they have a poor understanding of medications or the illnesses they are prescribed to treat. Pharmacists are in a unique position to evaluate medication regimes and to advise patients and physicians,” said Mary Jane Joseph of the Primary Care Coalition and Program Director for H.E.A.L.T.H. Partners.

“APC is looking forward to working with H.E.A.L.T.H. Partners to further support the excellent work that has been done to date,” stated Michele Arling, President and CEO of Advanced Patient Care. “We are very excited to work with the local healthcare community in Montgomery County to define best practices for keeping patients safe in the home setting.”


About Advanced Patient Care:
Advanced Patient Care (APC Corp) provides patient focused, pharmacist driven care coordination, working collaboratively with hospitals, health systems, payers and patients to optimize outcomes. We leverage our expertise in chronic care to provide exceptional medication reconciliation, innovative packaging, and ongoing medication therapy management to help improve quality, reduce cost and improve patient experience. Our care coordination platform fulfils the concept of the patient centered medical home (PCMH), and impacts outcomes in all areas of the Triple-Aim. Learn more at

About Primary Care Coalition:
The Primary Care Coalition (PCC) works with clinics, hospitals, health care providers, and other community partners to coordinate health services for low-income, uninsured and underinsured residents of Montgomery County, Maryland and the surrounding communities. The most vulnerable members of our community frequently lead medically and socially complex lives. The PCC is committed to providing a continuum of care for these individuals by administering a variety of health care access and quality improvement initiatives. Learn more at

About H.E.A.L.T.H Partners:
H.E.A.L.T.H Partners (Hospitals Effectively Assisting Lasting Transition to Home) is a workgroup composed of representatives from PCC, Montgomery County Department of Health and Human Services, Housing Opportunities Commission, local hospitals, community residents, and 20 other organizations and individuals from the community are working to implement post-discharge protocols to prevent hospital readmission. The group meets monthly and tests different strategies for improving health outcomes among older adults residing in subsidized housing in Montgomery County. Current initiatives include Medication Therapy Management, Nursing Wellness Programs, e-Health Literacy Platform, Emergency Medical Services activity notification, and discharge coordination between hospitals and resident counselors.


For more information, contact:
Rob Gisotti, VP, Business Development
571-577-8013 ext. 107