Toolkit can help guide implementation of integrated care teams into primary care settings.

A Comprehensive Medication Management program that employs a remote clinical pharmacist effectively addresses most drug therapy problems in a complex care population.

During the COVID-19 pandemic, Cityblock Health implemented a virtually integrated care management model to maintain continuity of care for patients with complex needs.

A novel street psychiatry program offers essential mental health support to unsheltered individuals experiencing homelessness.

A longitudinal study found that members of recovery community centers had increased rates of substance use abstinence, psychological well-being, and quality of life after three months of engagement.

A pharmacist-led substance use disorder intervention improved treatment retention for patients with opioid and alcohol use disorder.

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.

Literature review examines the roles and contributions of community health workers in improving dementia care.

A review of existing literature finds that medical respite care reduces hospital and emergency department visits, increased use of outpatient care, and leads to overall cost savings.

Peer recovery services offered to people with substance use disorder returning to community from incarceration is shown to reduce substance use and improve health and treatment motivation.

An integrated community health program demonstrated a cost savings of over three million dollars.

Community health worker-led interventions for older adults with complex needs show evidence of improving participant mood and functional outcomes.

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.

Demonstrates that a program assisting older adults with complex needs in navigating medical and social services may lower acute care utilization.

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.

Applying principles of trauma-informed care for patients at end of life.

Explored opportunities for health systems and plans to work with CHW/Ps to support high-need individuals, with a focus on addressing the long-term impacts of the COVID-19 pandemic.