The National Academy of Medicine offers a synthesis of the evidence for improving care for high-needs patients.

Difficulty with activities of daily living is a major cost driver in health care that is typically overlooked.

Experts describe how delivery systems can effectively serve adults with complex needs.

Reviews lessons from the Program of All-Inclusive Care for the Elderly on serving high-need populations in community settings.

Key opportunities include strengthening information technology connections across service providers.

The Department of Veterans Affairs home-based primary care program reduced total costs of care for VA and Medicare and earned high satisfaction ratings from patients and their caregivers.

Indicates that a community-based nurse care management model reduced all-cause mortality for older adults with chronic conditions.