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From Our Experts
Patient Navigation and Community Health Work in Colorado

Andrea (Andi) Dwyer

Program Director
The Colorado School of Public Health
Patient Navigation (PN) and Community Health Work (CHW) are two distinctive areas of the health care work force that have received a lot of attention and focus over the last several years; particularly with ACA implementation, call for increase in patient engagement, team based care initiatives, and improvement in quality standards.  


PNs and CHWs have specific roles and scope of practice with a mission to work in and with the community and/or medical setting to improve health. The literature and data suggests that PN and CHW do make an impact in improve health outcomes.  

Neighborhood Leaders in Change
Creating Something Out of Nothing: South Metro Transitions
By: Stephanie Spriggs
Grant Writer and Report Specialist, CIVHC

"Alone we can do so little, together we can do so much"

 - Helen Keller

The word "vulnerable" can describe many different types of populations - from those with limited access to care or lack of insurance, to those with a language barrier or new to the United States. The South Metro Health Alliance (SMHA) evolved as the health and wellness arm of the Littleton Immigrant Integration Initiative, an organization dedicated to making a new country feel like home to recently relocated individuals.

In The News
Chronic Care Management: 4 Steps to Implementation

Implementing the new Medicare Chronic Care Management codes can be challenging. Problems with IT, infrastructure, and the need for additional staff to manage the process are just some of the obstacles practices encounter. Looking at all of the necessary steps to implementation can help ease the process.

Full Article 

Patient Navigation Eases Clinical Workforce Challenges-Without Clinical Expertise
From Accenture, 2014

Patient navigators are a new addition to the health care workforce that is helping with non-clinical duties such as supporting patient communication and helping patients navigate the financial and logistical challenges of the health care system. The additional support from patient navigators is helping patients make significant strides in adherence and wellness. 

  Full Article


Hospitals Press for Relief From Medicare Readmission Penalty

By Kerry Young

A new bill introduced in both the House and Senate (HR 1343, S 688) would amend the current hospital readmission calculation to take the socioeconomic status of the patient population into account when calculating readmission rates for Medicare penalties. 

HR 1343 


Achieving Health Equity by Design

Since the Institute of Medicine called attention to the role of equity in ensuring health care quality, many health care organizations have pursued broad initiatives such as establishing medical homes, implementing electronic medical records, and eliminating hospital-acquired infections to try to improve equity in service provision



Beginning June 2015, Healthy Transitions Colorado is hosting a series of three symposia focused on key aspects of Care Transitions:
  • June 26th - Building Transitions from the Inside Out
  • October 16th - Nurturing Community Collaboration
  • January 15th - Fostering Patient and Family Engagement

Watch this space for updates!

Let Your Voice Be Heard
In This Issue
Pledge to Reduce Readmissions!

Upcoming Events

Nurse Patient
Healthy Transitions Webinars Available 

Recordings and slides of our monthly webinars are located on the Webinar Archive page of the Healthy Transitions Colorado Website. 

Webinar Archives 

Healthy Transitions Colorado is a collaborative effort, focused on aligning and accelerating existing efforts to improve transitions of care for Coloradans. Our guiding principles are simple - by working together to break down the silos of health care, we can foster true community care coordination across facilities, specialties, and practices.