Supplementing primary care with team-based management.

This case study analyzes a successful example of a medical group partnering with a home health agency to provide community-based palliative care for high-risk members of their accountable care organization.

Long-term services and supports may reduce medical utilization.

Details how dually enrolled beneficiaries have significantly higher levels of comorbidities and higher costs of care than their non-dually enrolled counterparts.

Includes case studies, clinical assessment tools, and other resources for identifying and assessing the needs of patients with serious illness.

A tool for assessing readiness for value-based partnerships.

Practical strategies for health plans and ACOs to improve care for patients with serious illness.

Care model that integrates home-based primary care and palliative care for patients with serious illness reports reduced health care utilization and improved patient care experience.

Strategies for preventing opioid use disorder.

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

Case study explores the unique structure of Washington State’s demonstration under the federal Financial Alignment Initiative, including summary of results to date.

A practical guide for payers to create a home-based palliative care program centered upon a value-based case example from a payer’s perspective.

The importance of timely primary care follow-up.

Idaho's innovative Medicare Medicaid Coordinated Plan offers valuable lessons for states nationwide.

Telehealth interventions had similar outcomes to in-person care for different services and populations, but did not consistently impact utilization such as physician or emergency department visits.

Maximizing the impact of outpatient complex case management.

Analyzes the largest drivers of high costs among persistently high-cost Medicare-Medicaid beneficiaries, and finds most spending related to long-term care.

A web-based financial tool that helps navigate partnerships between health care organizations and social service organizations.

Overcoming barriers to patient engagement.

A regional approach to health care transformation.