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Start time
10:00 AM Pacific
End time
11:00 AM Pacific
Part of the Aging and Disability Business Institute Series—a Collaboration of n4a and ASA.

Register now for FREE

Includes complimentary CEs

If you require ADA accommodation to participate in this web seminar, please contact Steve Moore at your earliest convenience to make arrangements –

Partners in Care Foundation secured a partnership with a local medical provider to develop a model of transitional care management and chronic care management focusing on addressing the Social Determinants of Health for the target population. The group received grant funding to develop and implement a model for delivering transitional care management and chronic care management to demonstrate the model’s sustainability.

This web seminar will provide an overview of the project, define the opportunity and describe the process necessary to implement a model of care delivery that integrates a community-based organization (CBO) with an established medical provider.

Participants in this web seminar will be able to:

  • Describe the CMS federal policy changes that enable CBOs to work with medical providers to deliver services that can be contracted to the CBO, as a third-party entity;
  • List the specific billing codes, national reimbursement rates and requirements to deliver the defined services;
  • Describe the process planning required to deploy the integrated model of care;
  • Identify business planning requirements to deploy the integrated model of care to reach the medical provider’s and CBO’s financial sustainability requirements; and,
  • Describe the impact of proposed changes to the requirements that will support the expansion of medical provider and CBO partnerships to deliver a range of services.


Tim%20McNeill_0.jpgTimothy P. McNeill is a healthcare consultant specializing in health program development and sustainability, with clients such as the U.S. Department of Health and Human Services, the Administration on Aging/Administration for Community Living and the National Association of Area Agencies on Aging, as well as foundations and national nonprofit organizations.



Sandy%20Atkins_0.jpgSandy Atkins is executive director of Hospice of Pasadena, and has worked at Partners for 11 years. She leads Partners’ nationally recognized HomeMeds program, and works closely with Partners’ CEO, June Simmons, to provide strategic guidance to the organization.




The Aging and Disability Business Institute is funded by:

The Administration for Community Living

The John A. Hartford Foundation

The SCAN Foundation


National Association of Area Agencies on Aging (n4a)

Independent Living Research Utilization/National Center for Aging and Disability

The American Society on Aging

Partners in Care Foundation

Elder Services of the Merrimack Valley/Healthy Living Center of Excellence.


The Evidence-Based Leadership Council

Meals on Wheels America



Learn more about The Aging and Disability Business Institute at