Our medical group is a top performer in keeping patients with chronic and serious illness and frailty out of the hospital. In fact, we have helped reduce hospitalization rates more more than 50% compared with other care models. A big part of the reason is the collaborative, person-centered care approach that we take. We make it a top priority to understand a person’s goals, medical diagnoses, history and other areas so that we can help develop a care plan. In collaboration with patients, family members, caregivers, and senior community staff, we try to align appropriate community-based resources to address risks, instead of relying on emergency room and hospital care (when possible).