Coordinating care throughout continuum keeps patients out of hospital, emergency department.
D002140:California; D002908:Chronic Disease / Q000628:therapy; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006333:Heart Failure / Q000628:therapy; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration; D006278:Medicare; D010346:Patient Care Management / Q000458:organization & administration; D018802:Patient-Centered Care; D014481:United States