A care management model designed to center patients’ health priorities shows promising results.

An interdisciplinary care management program for Medicare patients at increased risk of hospitalization demonstrates a positive return on investment.

Community health worker-led program associated with reduced acute care utilization and lower Medicaid and total costs for dually eligible individuals.

Pharmacist-led telephonic motivational interviewing intervention increased medication adherence among an older adult population with chronic disease.

A health-plan-administered telehealth care coaching intervention led to long-term cost savings as well as increased behavioral health service use for adults with behavioral health needs and a history of high utilization.

Toolkit offers recommendations and examples for screening and interventions that support social connectivity of older adults.

Highlighted two community paramedicine programs in New England and rural North Carolina that serve people with complex needs.

A health plan-led telepsychiatry program for older adults can address the shortage of psychiatrists to improve outcomes related to depression and access to mental health care.

Including spiritual care within care management programs in outpatient, managed care, and population health settings can enhance patient care and support the effectiveness of the interdisciplinary care team.

Explored how complex care stakeholders can incorporate a multi-factor approach to measure and demonstrate the value of complex care programs for diverse stakeholders.

CAPABLE, a home-based care program that provides interdisciplinary services for older adults, leads to reductions in disability as well as cost savings.

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.

Home-based intensive care model for Medicaid and dually eligible enrollees with complex needs led to positive health outcomes and reduced acute care spending, particularly for individuals with a behavioral health diagnosis.

Highlighted lessons from two recent studies to help guide future program and measurement approaches for complex care management interventions.

Complex care management program for high-need, high-cost Medicaid patients demonstrates substantially lower spending and inpatient utilization.

Explored innovative integrated health plan approaches to improve care transitions. Health plans featured in the webinar participate in Promoting Integrated Care for Dual Eligibles (PRIDE), a project to advance health plan strategies for providing high-quality care for dually eligible beneficiaries.

Details how two health plans in California developed programs to transition dually eligible members from institutional settings back into their communities.

This resource is an updated quick reference guide to promising models for people with complex needs.

Maximizing the impact of outpatient complex case management.

Examines how home meal delivery programs show promise for reducing the use of costly health care and decreasing spending for dually eligible individuals.