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15 ORGS · 142 ACTIVITIES ← all strategies ·
approach

Interdisciplinary Care Coordination

methodology: interdisciplinary_case_management

By integrating diverse professionals into unified care teams to collaboratively assess and manage patient needs, we improve health outcomes and care continuity, because multidisciplinary collaboration enables holistic, responsive, and personalized support across complex medical and social domains. This strategy emphasizes structured teamwork across medical, emotional, social, and rehabilitative disciplines to ensure comprehensive care planning and seamless transitions. Unlike unidimensional or siloed models, it relies on continuous coordination among specialists and caregivers to proactively address evolving needs, particularly for high-risk, aging, or neurologically impaired populations. Its distinguishing feature is the institutionalization of team-based decision-making as a core mechanism for improving both clinical effectiveness and patient dignity.

15
orgs running it
142
activities of those orgs
12
activity groups touched
who runs it

Organizations running this strategy · 15

what it looks like in practice

Activities of orgs running this strategy

A sample of programmatic activities from the orgs above — what the strategy looks like on the ground.

  • Cross-trains staff in hospice and palliative care BROTHERS OF MERCY FACILITIES FOUNDATION
    capacity building
    Cross-trains care teams in hospice and palliative care to deliver integrated, comfort-focused services across care settings.
  • Funds care for the sick and elderly through affiliated organizations BROTHERS OF MERCY FACILITIES FOUNDATION
    grantmaking
    Raises and allocates funds to support affiliated organizations that provide health care services for the sick and elderly.
  • Offers recreational, social, and spiritual programming for residents BROTHERS OF MERCY FACILITIES FOUNDATION
    direct service
    Provides recreational and social activities including Wi Bowling, bingo, book club, walking club, and faith-based spiritual programming such as weekly Catholic Mass and interfaith services for residents across facilities.
  • Operates assisted living and memory care facility BROTHERS OF MERCY FACILITIES FOUNDATION
    direct service
    Provides 24/7 assisted living and memory care with personalized enrichment programs and specialized amenities for residents with dementia and Alzheimer’s disease at Sacred Heart Home.
  • Operates independent living community for seniors BROTHERS OF MERCY FACILITIES FOUNDATION
    direct service
    Operates Trier Woods 55+ Independent Living Community for seniors, offering residential living and access to recreational and social programs.
  • Operates skilled nursing and rehabilitation center BROTHERS OF MERCY FACILITIES FOUNDATION
    direct service
    Operates a 240-bed skilled nursing facility rated four stars by Medicare and recognized as a “Best Nursing Home for 2026” by U.S. News & World Report and Newsweek, providing 24/7 care for the sick and elderly in Western New York.
  • Provides advanced wound care services BROTHERS OF MERCY FACILITIES FOUNDATION
    direct service
    Provides specialized wound care including management of pressure ulcers, venous, arterial, diabetic, and surgical wounds, using negative pressure wound therapy and other advanced interventions.
  • Provides inpatient and outpatient rehabilitation therapy services BROTHERS OF MERCY FACILITIES FOUNDATION
    direct service
    Offers physical, occupational, and speech therapy services in both inpatient and outpatient settings through the Russell J. Salvatore Outpatient Rehabilitation Clinic, serving adults 18+ in Western New York with individualized treatment plans for stroke, injury, neurological disorders, and mobility restoration.
  • Provides inpatient hospice and end-of-life care BROTHERS OF MERCY FACILITIES FOUNDATION
    direct service
    Provides inpatient hospice care with acute pain and symptom management, private and semiprivate rooms, overnight accommodations for families, and 13 months of bereavement counseling, in partnership with Hospice Buffalo.
  • Provides social work and discharge planning services BROTHERS OF MERCY FACILITIES FOUNDATION
    direct service
    Offers social work services including discharge planning, psychosocial support, assistance with advanced directives, home care referrals, and implementation of the Homeward Bound Program to support safe transitions to home.
  • Provides transitional housing and rehabilitation BROTHERS OF MERCY FACILITIES FOUNDATION
    direct service
    Provides transitional housing from skilled nursing and rehabilitation care to assisted living for individuals recovering from major surgery, including 30-day inpatient rehabilitation stays with physical and occupational therapy.
  • Supports multidisciplinary resident care through staffing and care planning BROTHERS OF MERCY FACILITIES FOUNDATION
    direct service
    Delivers multidisciplinary resident care through a team of over 400 employees in nursing, therapy, social work, nutrition, and activities, and develops individualized care plans focused on resident strengths and functional mobility via interdisciplinary teams.
  • Advocating for behavioral health care management policy and funding NEW YORK STATE CARE MANAGEMENT COALITION INC
    advocacy
    Engages in legislative lobbying and advocacy with state leaders, the Legislature, and state agencies to advance policy, budget, and regulatory priorities for care management and behavioral health services, including facilitating member engagement with elected officials.
  • Conducting policy research and data analysis for care management NEW YORK STATE CARE MANAGEMENT COALITION INC
    research
    Conducts research and data analysis initiatives to inform policy and improve care management for vulnerable populations in New York State, building on prior work related to behavioral health services.
  • Facilitating knowledge sharing and best practices among Assertive Community Treatment (ACT) teams NEW YORK STATE CARE MANAGEMENT COALITION INC
    capacity building
    Supports quality improvement and innovation in behavioral health care by organizing a Best Practices Poster Presentation Exhibition and reviewing proposals for the annual ACT Symposium to promote peer learning across ACT teams.
  • Organizing annual conferences and educational events for behavioral health professionals NEW YORK STATE CARE MANAGEMENT COALITION INC
    direct service
    Hosts the annual ACT-In-ACTION Conference and other educational events that bring together nearly 500 behavioral health and care management professionals, featuring presentations, webinars, and networking opportunities to share best practices in care management.
  • Providing information resources and member engagement NEW YORK STATE CARE MANAGEMENT COALITION INC
    direct service
    Offers ongoing access to information, resources, and updates through a website and membership network serving over 2,500 individuals across New York State, including legislative updates and key issues in care management.
  • Supporting Health Home Care Management for high-need populations NEW YORK STATE CARE MANAGEMENT COALITION INC
    direct service
    Provides care management services to over 180,000 high-risk, high-need adults and children through a network of 4,500 care managers across local agencies, achieving measurable reductions in healthcare utilization including 33% fewer emergency department visits and $288 per member per month in cost savings.