Medicare Advantage plans report different barriers to partnering with community-based organizations, but there are strategies to develop effective partnerships.
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.
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.
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.
Use of machine learning clustering algorithms revealed 30 distinct subgroups of patients among high-risk veterans, indicating a need for tailored approaches to health care.
The 4Ms approach developed for the Age-Friendly Health System model — what matters, medication, mentation, mobility — has a robust evidence base for providing quality care to older adults.
Suggests that community-based organizations are responding to Medicaid redesign efforts that prioritize social determinants of health by adopting practices similar to health care organizations.
Home-based primary care programs enable care teams to gain insights on a variety of social factors that impact older adults’ health, which allows them to better tailor care to meet patient needs.
Demonstrates that intensive outpatient care programs show promise in reducing utilization and costs and improving patient outcomes for high-need, high-cost populations.