Evidence-based intervention at a behavioral health home improved health outcomes for patients with co-occurring type 2 diabetes and serious mental illness.
Personalized patient navigation supports for people with comorbid substance use disorders reduced rates of hospital readmissions and emergency department use.
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.
Discusses the benefits and challenges of tele-social care and offers practical tips for providers administering telehealth services for social care activities.
Evaluates the evidence on interventions for people living with dementia, their care partners, and caregivers to help identify what interventions are ready for broad implementation.
Enhanced primary care for adults with serious mental illness led to increases in primary care visits and health screenings as well as decreases in inpatient utilization.
Initiative successfully implemented several evidence-based and promising addiction care models across multiple medical settings, including an inpatient addiction consult team, a low-threshold bridge clinic, peer recovery coaches, and office-based addiction treatment nurses.
Describes core competencies that convey the essential knowledge, skills, and attitudes of complex care practitioners and teams to improve care for people with complex needs.
Demonstrates that intensive outpatient care programs show promise in reducing utilization and costs and improving patient outcomes for high-need, high-cost populations.
Offers a practical framework for safety-net health systems to better identify and segment patients with complex needs, and tailor care models to meet their needs.
Integrated health care systems can better support high-risk patients by embedding high-risk patient care within general primary care and mental health care.