Interventions for Frequently Hospitalized Patients and Their Effect on Outcomes: A Systematic Review Mixed evidence for efforts to reduce rehospitalizations. Peer-Reviewed Article December 2018
Academic Medical Centers and High-Need, High-Cost Patients: A Call to Action This resource describes how academic medical centers can reshape the health system for patients with complex needs. Peer-Reviewed Article November 2018
Outpatient Complex Case Management: Health System-Tailored Risk Stratification Taxonomy to Identify High-Cost, High-Need Patients Maximizing the impact of outpatient complex case management. Peer-Reviewed Article November 2018
Persistence and Drivers of High-Cost Status Among Dual-Eligible Medicare and Medicaid Beneficiaries Analyzes the largest drivers of high costs among persistently high-cost Medicare-Medicaid beneficiaries, and finds most spending related to long-term care. Peer-Reviewed Article October 2018
Engaging High-Need Patients in Intensive Outpatient Programs: A Qualitative Synthesis of Engagement Strategies Overcoming barriers to patient engagement. Peer-Reviewed Article August 2018
Patient Engagement in ACO Practices and Patient-Reported Outcomes Among Adults with Co-Occurring Chronic Disease and Mental Health Conditions Patient engagement improves patient-reported outcomes. Peer-Reviewed Article July 2018
Going Beyond Clinical Care to Reduce Health Care Spending A regional approach to health care transformation. Peer-Reviewed Article July 2018
Systematic Review of High-Cost Patients’ Characteristics and Healthcare Utilisation An international analysis of high-cost patients. 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
Medical Respite for People Experiencing Homelessness: Financial Impacts with Alternative Levels of Medicaid Coverage A financial analysis projected that hospitals and health plans could achieve cost savings by investing in medical respite programs. 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
Development of a Care Guidance Index Based on What Matters to Patients The What Matters Index measures quality of life for people with chronic conditions. Peer-Reviewed Article January 2018
Case Managers for High-Risk, High-Cost Patients as Agents and Street-Level Bureaucrats How to improve the cost benefits of case management. Peer-Reviewed Article August 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
Competing Health Care Systems and Complex Patients: An Inter-Professional Collaboration This paper describes competing health care systems can collaborate to improve care for overlapping patient populations. Peer-Reviewed Article June 2017
Bending the Spending Curve: The Role of Care Management in a Pioneer ACO ACOs have lowered costs for high-need patients through care management programs focused on modifiable spending. Peer-Reviewed Article May 2017
Nursing Student Coaches for Emergency Department Super Utilizers Nursing students successfully coach patients with complex needs to avoid ED use. Peer-Reviewed Article January 2017
The Core of Care Management: The Role of Authentic Relationships in Caring for Patients with Frequent Hospitalizations This study links “authentic healing relationships” with patient motivation and active health management. Peer-Reviewed Article August 2016
Leveraging the Social Determinants of Health: What Works? This literature review assesses the impact of social service interventions. Peer-Reviewed Article August 2016