Collaborating to Reduce Hospital Readmissions for Older Adults with Complex Needs: Eastern Virginia Care Transitions Partnership

The Eastern Virginia Care Transitions Partnership (EVCTP) is a largescale partnership including Bay Aging and four other Area Agencies on Aging (AAAs), four health systems, three managed care organizations (MCOs), and other health care and human service providers. This case study describes several topics including the service delivery model, information sharing and reporting, shared governance, success factors, and challenges.