Going Beyond Clinical Care to Reduce Health Care Spending A regional approach to health care transformation. Peer-Reviewed Article July 2018
Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study The psychological benefits of case management. Peer-Reviewed Article May 2018
Impact of a Complex Chronic Care Patient Case Conference on Quality and Utilization The case conference approach to caring for complex patients. Peer-Reviewed Article May 2018
Active Redesign of a Medicaid Care Management Strategy for Greater Return on Investment: Predicting Impactability This resource describes one tool to identify patients most likely to benefit from care management. Peer-Reviewed Article April 2018
Meal Delivery Programs Reduce the Use of Costly Health Care in Dually Eligible Medicare and Medicaid Beneficiaries Examines how home meal delivery programs show promise for reducing the use of costly health care and decreasing spending for dually eligible individuals. Peer-Reviewed Article April 2018
The Effects of Home-Based Primary Care on Medicare Costs at Spectrum Health/Priority Health from 2012-Present: A Matched Cohort Study A home-based primary care program led to reduced medical costs for frail elderly patients, primarily due to lower spending at end-of-life. Peer-Reviewed Article March 2018
Complex Care Models to Achieve Accountable Care Readiness: Lessons from Two Community Hospitals Case studies of two community hospitals show how to advance accountable care. Case Example March 2018
Care Ecosystem Toolkit Details implementation guidance for the evidence-based Care Ecosystem model, which improves supports for people with dementia and their caregivers. Implementation Tool February 2018
Operation and Challenges of Home-Based Medical Practices in the US: Findings from Six Aggregated Case Studies Strategies for home-based primary care practices to improve efficiency and support program growth based on qualitative research. Peer-Reviewed Article January 2018
What Works in Integrated Care Programs for Older Adults with Complex Needs? A Realist Review A literature review describes the most important success factors for integrated care programs. Peer-Reviewed Article October 2017
Community Health Worker Support for Disadvantaged Patients with Multiple Chronic Diseases: A Randomized Clinical Trial This resource describes the benefits of community health workers for people with multiple chronic conditions. Peer-Reviewed Article October 2017
Effective Care for High-Need Patients: Opportunities for Improving Value, Outcomes and Health The National Academy of Medicine offers a synthesis of the evidence for improving care for high-needs patients. Brief/Report June 2017
Integrating Health Care for High-Need Medicaid Beneficiaries With Serious Mental Illness and Chronic Physical Health Conditions at Managed Care, Provider, and Consumer Levels This resource describes the value of navigators for Medicaid beneficiaries with mental illness. Peer-Reviewed Article June 2017
Caregiver Integration during Discharge Planning of Older Adults to Reduce Resource Utilization: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Including caregivers in the discharge planning process reduces the risk of hospital readmission for older adults. Peer-Reviewed Article April 2017
Preventing Hospitalization with Veterans Affairs Home-Based Primary Care: Which Individuals Benefit Most? Home-based primary care program reduced hospitalizations for older adults with diabetes, especially those with higher levels of medical complexity. Peer-Reviewed Article March 2017
CareMore: Improving Outcomes and Controlling Health Care Spending for High-Needs Patients CareMore’s business model identifies high-risk patients and surrounds them with coordinated services Case Example March 2017
Innovative Home Visit Models Associated with Reductions in Costs, Hospitalizations, and Emergency Department Use Home visits can reach patients with complex needs before a higher level of care is needed Peer-Reviewed Article March 2017
Complex Care Program Development: A New Framework for Design and Evaluation A new framework outlines four steps to develop care management programs. Brief/Report March 2017
The Business Case for Community Paramedicine: Lessons from Commonwealth Care Alliance’s Pilot Program Cost considerations for the expansion of mobile integrated health care and community paramedicine programs. Case Example December 2016
Intensive Outpatient Care Program Toolkit The staff position of care coordinator is crucial to success. Implementation Tool December 2016