Connected Transitions: Aligning Teams, Tools, and Tech for Seamless Care
Session Summary: This session explores how transitions of care are among the most vulnerable points in the healthcare continuum. This session will present evidence-based, tech-enabled strategies to strengthen coordination across the care continuum. Participants will learn actionable approaches for enhancing interdisciplinary collaboration, leveraging technology, and aligning care across teams. Emphasis will be placed on using technology platforms to support warm handoffs, digital documentation exchange, telehealth integration, and patient engagement tools. Special considerations—including behavioral health coordination and addressing social determinants of health—will also be covered to promote whole-person, equitable care.
Learning Objectives:
- Identify common breakdowns in care transitions and their impact on outcomes, especially for patients with complex needs.
- Implement evidence-based and technology-supported strategies to enhance communication and reduce errors during transitions.
- Evaluate models of care and policy levers that promote safer, more equitable transitions, with attention to behavioral health and social risk factors.
Charissa Duffy, DNP, PMHNP-BC
Dr. Charissa Duffy is a doctorally prepared Psychiatric Mental Health Nurse Practitioner and the CCO of Vérité Health Collective, an advisory firm specializing in clinical and operational strategy across healthcare. She is a strategic healthcare executive and leader with extensive expertise in post-acute and behavioral healthcare. Charissa has driven clinical strategy, compliance, and program development initiative grounded in evidence and value-based care. Charissa is currently a member on PALTmed State Based Advocacy Committee and works with state based APRN groups to improve advocacy across all areas of healthcare. She is focused on improving access, outcomes, and responsibility through innovative, strategic program design and models of care.
Tana Whitt, DNP, MSN, PMHNP-BC
CEO
Vérité Health Collective
Dr. Tana Whitt is a doctorally prepared Psychiatric-Mental Health Nurse Practitioner (PMHNP-BC) and the Co-Founder and CEO of Vérité Health Collective, an advisory firm specializing in clinical, operational, and care model strategy across healthcare settings. She began her executive career scaling multi-state post-acute behavioral health services and later served as Chief Operating Officer of a national behavioral health organization, overseeing operations across the continuum of care in more than 800 facilities nationwide.
Dr. Whitt is a former Vice Chair of PALTmed's Behavioral Health Subcommittee and currently serves as a member of the Clinical Practice Committee and the Certification Council. She advises healthcare organizations and innovators on integrated care delivery, workforce strategy, regulatory alignment, and system performance. With over a decade of executive and clinical leadership experience, she is nationally recognized for advancing team-based models that improve access, accountability, and outcomes across post-acute and long-term care.
Jody Long, MSN, MBA, RN, CEN
Director of Clinical Affairs
PointClickCare
Jody Long, MSN, MBA, RN, CEN, a proud double alumna of Western Governors University with an MSN and an MBA, has dedicated her career to advancing the nursing profession since 1999. With more than 18 years of specialized experience in Emergency Care and nursing leadership, Jody has recently shifted her focus to Clinical Innovation and Technology, championing tools and solutions that elevate bedside care and empower nursing teams. Her leadership extends beyond clinical settings —Jody was appointed by the Governor to serve on the Florida Board of Nursing and contributes nationally through the National Council of State Boards of Nursing.
Robert Russell, MD
Medical Director
CommuniCare Health Services
Dr. Robert L. Russell, MD, MBA is an internal medicine and geriatric physician. He is currently Chief Medical Officer for Majestic Care and Bluegrass Consulting Group a multi state long term care provider. He is a post acute care specialist who has specialized in all aspect of long term care.
Dr. Russell is the former regional medical director for the Midwest for CommuniCare Healthcare. He is currently the chairman of the medical advisory committee for CICOA (Indiana's largest Area Agency on Aging) and has been on the committee since its inception. He is a member of CICOA's strategic planning committee and medical director of CICOA's medical nutrition therapy program and a former two time president for the Indiana Medical Directors Association.
He is a member of PALTMED (formerly AMDA) and has served on numerous committees within the organization. He currently serves on the PALTMed Foundation and is a former Futures Fellow. He is former member of the executive board of the Alzheimer's Association of Greater Indiana and completed 8 years as a board member. He is a Hospice Medical Director for Gentiva Hospice (formerly Kindred hospice). He is a 2022 graduate of the Kelley School of Business Physician MBA program. He is on the medical advisory board for Lilly and Neurocrine pharmaceutical companies and is on Neurocrine's Delphi advisory board.
