Impact of Primary Care Intensive Management on High-Risk Veterans’ Costs and Utilization
Supplementing primary care with team-based management.
Peer-Reviewed Article
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Displaying 81 - 100 of 106
Integrated Home- and Community-Based Services Improve Community Survival Among Independence at Home Medicare Beneficiaries Without Increasing Medicaid Costs
Home-based primary care integrated with long-term services and supports in the community can delay long-term institutionalization in frail older adults without increased costs for home- and community-based services.
Peer-Reviewed Article
Home-Based Primary Care Fall Prevention and Management Toolkit
Shares best practices and screening tool options to identify and care for home-based primary care patients with potential fall risks.
Implementation Tool
Re-envisioning Care for People with Involved Disabilities
Video series details how health systems can redesign primary care, including through home-based primary care programs, to better meet the needs of people with disabilities.
Implementation Tool
Dedicated to the Mission: Strategies US Department of Veterans Affairs Home-Based Primary Care Teams Apply to Keep Veterans at Home
Fostering a culture of caring for veterans takes interdisciplinary teams focused on comprehensive, trusting and reliable relationships through open and frequent communication and ongoing education.
Peer-Reviewed Article
Outcomes of a Citywide Campaign to Reduce Medicaid Hospital Readmissions with Connection to Primary Care Within 7 Days of Hospital Discharge
The importance of timely primary care follow-up.
Peer-Reviewed Article
PACE 2.0: A Prime Opportunity for Delivery Systems and Payers
The Program of All-Inclusive Care for the Elderly provides comprehensive, compassionate medical care and long-term services and supports to older adults with persistent complex needs who are eligible for nursing home care. Yet, PACE reaches less than two percent of those who could benefit from its services.
Blog
September 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
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
Meal Delivery Programs Reduce the Use of Costly Health Care in Dually Eligible Medicare and Medicaid Beneficiaries
Examines how home meal delivery programs show promise for reducing the use of costly health care and decreasing spending for dually eligible individuals.
Peer-Reviewed Article
The Effects of Home-Based Primary Care on Medicare Costs at Spectrum Health/Priority Health from 2012-Present: A Matched Cohort Study
A home-based primary care program led to reduced medical costs for frail elderly patients, primarily due to lower spending at end-of-life.
Peer-Reviewed Article
Operation and Challenges of Home-Based Medical Practices in the US: Findings from Six Aggregated Case Studies
Strategies for home-based primary care practices to improve efficiency and support program growth based on qualitative research.
Peer-Reviewed Article
Community Health Worker Support for Disadvantaged Patients with Multiple Chronic Diseases: A Randomized Clinical Trial
This resource describes the benefits of community health workers for people with multiple chronic conditions.
Peer-Reviewed Article
Care Management Plus: Strengthening Primary Care for Patients with Multiple Chronic Conditions
A program to help clinics deliver comprehensive care may decrease mortality and hospitalization rates.
Case Example
Reduced Emergency Room and Hospital Utilization in Persons with Multiple Chronic Conditions and Disability Receiving Home-Based Primary Care
People with multiple chronic conditions and disabilities enrolled in home-based primary care experienced persistent reduced acute care utilization.
Peer-Reviewed Article
Hennepin Health: A Care Delivery Paradigm for New Medicaid Beneficiaries
By closing gaps in care, a safety-net ACO has reduced medical costs for Medicaid patients with complex needs.
Case Example
New Models of Primary Care Workforce and Financing: Case Example #1: Stanford Coordinated Care
Stanford Coordinated Care provides university employees with complex health needs better care at a lower cost
Case Example
Guided Care: A Structured Approach to Providing Comprehensive Primary Care for Complex Patients
Guided Care is designed to strike a balance between telephone-based and interdisciplinary team-based care management programs.
Case Example
Aging Gracefully: The PACE Approach to Caring for Frail Elders in the Community
Reviews lessons from the Program of All-Inclusive Care for the Elderly on serving high-need populations in community settings.
Case Example
Project ECHO’s Complex Care Initiative: Building Capacity to Help “Superutilizers”
Interdisciplinary teams provide support for Medicaid beneficiaries with mental illnesses, addictions, and other needs.
Case Example