2025 NTOCC 
Transitions of Care Working Summit
Washington, DC 
September 16, 2025

Seamless Transitions. Improved Outcomes.
Impactful Care Coordination for the Future.

Opening Keynote: The Future of Transitions of Care
Shari Ling, MD, CMS Deputy Chief Medical Officer—The Centers for Medicare & Medicaid Services, Washington, DC

Welcome to the NTOCC Working Summit!

The National Transitions of Care Coalition (NTOCC) Working Summit is not your average healthcare conference—it’s a high-impact, solutions-focused event designed to align, activate, and advance the future of transitions of care.

 A Working Summit with Purpose

As healthcare enters a new era, we’re bringing together leaders from every corner of the system—clinicians, policymakers, patient advocates, academics, and innovators—to move beyond conversation and build coordinated solutions that work.

This summit is:
🔷 Interdisciplinary
🔷 Highly Interactive
🔷 Outcome-Driven
🔷 Collaborative by Design

Through strategic roundtable discussions, live solution mapping, and hands-on working sessions, we will dismantle silos, share insights, and co-create the future of transitions of care.

🗓️ Agenda Highlights & Featured Speakers

🔹 8:00 AM — Continental Breakfast and Networking

🔹 8:50 AM — Welcome & Opening

Jackie Vance, RNC, BSN, CDONA/LTC, FACDONA, IP-BC, CDP, LBBP, DPN
President, National Transitions of Care Coalition

Kick off the summit with an energizing welcome that sets the tone for collaboration. Attendees will be oriented to the day’s goals and encouraged to actively participate as co-creators of change.

🔹 9:00 AM — Opening Keynote The Future of Transitions of Care

Shari Ling, MD, CMS Deputy Chief Medical Officer— The Centers for Medicare & Medicaid Services, Washington, DC

This action forum will frame the national landscape of care transitions, highlighting current challenges and emerging priorities. Attendees will reflect on how these insights connect to their own work and where immediate innovation is needed.

🔹 9:45 AM — Bridging Gaps Between Acute & Post-Acute Care

Christian Bergman, MD, CMD — Virginia Commonwealth UniversityJackie Vance, RNC, BSN, CDONA/LTC, FACDONA, IP-BC, CDP, LBBP, DPN — Mission Health Communities

Instead of simply hearing about the divide, this session will surface real-world barriers and ask participants to discuss what systems-level or workflow solutions could bridge those gaps across settings.

🔹 10:30 AM — Building Standards for Transitions of Care -

Terrence A. O'Malley, M.D., CMD - Corresponding Faculty Harvard Medical School

Explore tech-enabled care coordination with a focus on what's working --and what's not. Attendees will workshop with Dr. O'Malley discussing work yet to be done and how this fits into the digital future.

🔹 11:15 AM — WORKING LUNCH

A chance to network, but also to continue the morning’s dialogue through informal peer discussions guided by prompts placed on tables.

🔹 12:15 PM — The Future of Value-Based Care

Stephen Buslovich, MD, CMD, MS — Chief Medical Officer, Senior Care

Tom Haithcoat — President, Ceptor Consulting, LLC

Through interactive discussion, attendees will evaluate the impact of VBC models on transitions of care and propose policy or operational tweaks to improve alignment with patient-centered outcomes.

🔹 1:00 PM — Policy Updates: The Impact of Transitions of Care

Alex Bardakh, MPP, CAE — Senior Director of Advocacy and Strategic Partnerships, Post-Acute and Long-Term Care Medical Association (PALTmed)

This isn’t just a policy briefing. Attendees will assess recent legislative and regulatory changes, then discuss what’s missing and how policy could better support smoother transitions.

🔹 1:45 PM — Pharmacists and Their Impact on TOC

Sara Panella, PharmD, CPh, BCPS, FASHP — Director of Pharmacy, Population Health, Emory Healthcare

Chad Worz, PharmD, BCGP — Chief Executive Officer, ASCP

Panelists will present scalable models, then attendees will examine how pharmacy-based interventions could be adapted or replicated across systems.

🔹 2:30 PM — Break

🔹 2:45 PM — Case Study Presentations: Innovative TOC Models

Norris Turner, PharmD, PhD — Turner Healthcare Quality Consulting, LLC

Cheri Lattimer, RN, BSN — Executive Director, NTOCC

Trisha Cash, PharmD, BCGP, CDCES — Fredrick Integrated Health Networks

Diane Kittle, MSN, RN, CCM — Complex Care Transitions, Mayo Clinic -Arizona

Saswat Kabisatpathy, PharmD — Chief Strategic Officer, Avant Pharmacy & Wellness Center

Each case will be a launchpad for live problem-solving — attendees will be encouraged to ask hard questions, identify success drivers, and brainstorm how to tailor the approach to their own settings.

🔹 3:45 PM — Roadmap to Closing the Gaps

Moderator: Norris Turner, PharmD, PhD —Turner Healthcare Quality Consulting

A facilitated, all-hands dialogue to synthesize insights from the day. Together, participants will help co-author a shared roadmap to address systemic issues and outline next steps for collective action.

🔹 4:30 PM — Closing Remarks

Jackie Vance, RNC, BSN, CDONA/LTC, FACDONA, IP-BC, CDP, LBBP, DPN

Summit leaders will recap the day’s breakthroughs and thank attendees for showing up not just to listen — but to lead.

 Why Attend?

Because talking about problems isn't enough. It's time to solve them.

At this summit, you will:
✅ Collaborate with national experts and frontline leaders
✅ Engage in dynamic, roundtable-style conversations
✅ Co-create real, actionable solutions
✅ Shape policy and practice for lasting impact
✅ Walk away with shared priorities and tangible next steps

Who Should Attend?

This summit is for changemakers ready to roll up their sleeves:

🔷Physicians, Pharmacist & APN's
🔷Nurses, Social Workers & Care Managers
🔷Community Health Workers & Patient Navigators
🔷Patient & Family Advocates
🔷Health System Executives
🔷Policymakers & Payers
🔷Health Educators & Researchers
🔷Innovators in Health Tech & Value-Based Care

If you are involved in or want to see improved care coordination, safer transitions, and measurable outcomes—this summit is your seat at the table.

What You’ll Gain

📌 Expanded network of cross-sector leaders
📌 Fresh perspective on care transition
📌 Have your voice heard on NTOCC's New Podcast Program
📌 Practical tools and insights
📌 Shared goals for collaborative action
📌 A renewed outlook and clear path forward

 Join the Movement

NTOCC Working Summit: Where Solutions Begin

If you're ready to be part of the collaborative change—
this is your summit.

→ Register Now
→ Learn More

REGISTER NOW

Mark your calendar for:

September 16, 2025
8:00AM-4:30PM
 

Where:
Washington, DC
General Gordon R. Sullivan Conference and Event Center hosted by

 THE ASSOCIATION OF THE UNITED STATES ARMY

2425 Wilson Blvd.
Arlington, VA 22201

HOTEL INFO
The AUSA Conference & Event Center Partner Hotel is attached to the Event Center. Hyatt Place Arlington Courthouse Hotel
Located at 2401 Wilson Blvd., Arlington, VA 22201

REGISTER NOW

SUMMIT REGISTRATION
Early Bird Registration: $125.00
(MAY 15- AUGUST 31)

Regular Registration: $150.00
(SEPTEMBER 1-SEPTEMBER 16)

________________________________________________________________

For Exhibitor and Sponsorship Opportunities contact Val Emmons at valemmons@gmail.com 

Join NTOCC for the next Lunch N’ Learn webinar:

September 25, 2025
AT 12 PM CDT/1PM EDT

“Postpartum and Beyond: Strategies and Tools

to Facilitate Transitions of Care for Patients with

Hypertensive Disorders of Pregnancy”

Presented by

Ana Safri, PharmD, MBA, BCACP

PGY2 Ambulatory Care

Residency Program Coordinator,

Boston Medical Center

Kara K. Hoppe, DO, MS, PhD, FACOG

Physician, Professor and

Vice Chair of Clinical Research

University of WI-Madison

Kim Soetaert, RN MSN C-EFM

Clinical Operations Specialist, Corwell Health

       Klodiana Myftari, PharmD, BCACP

 Director of Clinical Improvement Program,

American Medical Association (AMA),

Register Here

SUMMARY: 

Hypertensive disorders of pregnancy (HDP) are significant contributors to maternal morbidity and mortality, especially during the early postpartum period. This timeframe includes numerous types of transitions of care, and a team-based approach is essential to maintain continuity of blood pressure monitoring and management between care delivery settings and disciplines. In this session, speakers will share insights on transitions of care considerations during this critical time of birthing persons’ care continuum. Additionally, three different health care systems will share their unique experiences designing and implementing postpartum blood pressure monitoring and management programs. Practical strategies that have helped facilitate and optimize transitions of care will be highlighted, along with specific tools and resources.

Learning Objectives

1. Describe the complexity of transitions of care during the early postpartum period and potential impact on blood pressure monitoring and management

2. Review strategies to facilitate and optimize continuity of blood pressure monitoring and management postpartum

3. Highlight specific tools and resources to facilitate and optimize transitions of care

    

:SPEAKER BIOS

Ana Safri, PharmD, MBA, BCACP is an ambulatory care clinical pharmacy specialist and the PGY2 Ambulatory Care Residency Program Coordinator at Boston Medical Center. She practices in the outpatient cardiology clinic, where she provides comprehensive care for patients with hypertension, hyperlipidemia, heart failure, and other cardiovascular conditions. Dr. Safri earned her Bachelor of Arts in Educational Studies from Emory University in 2015, her Master of Business Administration from Texas Tech University in 2020, and her Doctor of Pharmacy degree from Texas Tech University Health Sciences Center in 2021. She completed both her PGY1 Pharmacy Practice and PGY2 Ambulatory Care residencies at Boston Medical Center, where she now serves as the PGY2 Ambulatory Care Residency Coordinator.

Kara K. Hoppe, DO, MS, PhD, FACOG is a Professor (CHS) and Vice Chair of Clinical Research in the Department of Obstetrics and Gynecology at the University of Wisconsin School of Medicine and Public Health. A nationally recognized Maternal-Fetal Medicine specialist, Dr. Hoppe leads research focused on maternal cardiovascular health, particularly hypertensive disorders during pregnancy and postpartum. She is the principal investigator of the Staying Healthy After Childbirth (STAC) program, a remote monitoring initiative that has influenced national guidelines. Transition of care is a focus of her groups work with the goal to improve immediate and long-term outcomes for patients with hypertension during pregnancy. Dr. Hoppe has authored over 40 peer-reviewed publications and serves as Core Project PI on a $5 million CDC-funded study to improve hypertension control among Black women and birthing people. She is also a dedicated educator and mentor, committed to advancing health equity through clinical care, research, and community partnerships.

Kim Soetaert, RN MSN C-EFM. As Clinical Operations Specialist at Corewell Health, and former OB Nurse, I bring a deep understanding of patient care and system-level strategy to my work. In my current role, I collaborate with clinical teams to standardize and streamline processes, improving both the patient experience and clinical outcomes. I am passionate about leveraging technology to enhance patient-centered care, and I have successfully led and implemented innovative solutions in areas such as nurse triage and the safe management of postpartum hypertension. My work is driven by a commitment to excellence, safety, and continuous improvement—ensuring that both patients and providers are supported every step of the way.

Klodiana Myftari, PharmD, BCACP, is the Director of Clinical Improvement Program at the American Medical Association (AMA), Dr. Myftari collaborates with healthcare teams nationwide to implement quality improvement (QI) programs focused on cardiovascular disease (CVD) prevention and management. Her emphasis is on developing, implementing, and supporting adaptations of clinical and operational solutions for healthcare networks, organizations, clinics, and pharmacy services. Dr. Myftari advocates for evidence-based prescribing practices that benefit all patient populations. Her work highlights improving medication use through research, education, coaching, and the deployment of team-based care services. With more than 15 years of experience as a clinical pharmacist in academia, pharmacy practice, and leadership roles, she is a pioneer in establishing and evaluating pharmacists’ services in community pharmacies, ambulatory care settings, and population health management.

Register Here

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