Evidence-based intervention at a behavioral health home improved health outcomes for patients with co-occurring type 2 diabetes and serious mental illness.
Medicare Advantage plans report different barriers to partnering with community-based organizations, but there are strategies to develop effective partnerships.
Personalized patient navigation supports for people with comorbid substance use disorders reduced rates of hospital readmissions and emergency department use.
Over 14 years, individuals experiencing chronic homelessness enrolled in a permanent supportive housing program had low housing retention and high mortality.
A permanent supportive housing program reduced emergency department visits within the first six months of placement but showed neutral effects on total cost of care and primary care utilization for Medicaid enrollees.
Presents a framework and tools to help health care organizations and communities design a community-based palliative care program to meet patient needs in rural settings.
Primary care and alternative payment models that reduce emergency department use and increase access to care for high-need populations share core components for success.
Disparities in transitional care training for caregivers of older adults based on race or financial status demonstrate need for changes in discharge processes and strategies to address bias.
Home-based program provided by a community health and social worker reduces acute care use and improves care for older adults with complex health and social needs.
Implementing a predictive model in acute settings can more reliably identify patients with high mortality risk, which can assist providers in prioritizing advance care planning.
Toolkit details how hospitals and health systems can use patient race, ethnicity, and language data to advance health equity and eliminate disparities.
Home-based intensive care model for Medicaid and dually eligible enrollees with complex needs led to positive health outcomes and reduced acute care spending, particularly for individuals with a behavioral health diagnosis.