Provides an overview of home-based medical care models, the patients that they serve, and their robust evidence base.

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 intensive outpatient care programs show promise in reducing utilization and costs and improving patient outcomes for high-need, high-cost populations.

Integrated health care systems can better support high-risk patients by embedding high-risk patient care within general primary care and mental health care.

Toolkit offers health care stakeholders in rural areas with practical information to support the design, implementation, and evaluation of community paramedicine programs.

Enhanced primary care for Medicaid enrollees with serious mental illness can help decrease emergency department use over time.

Social workers on rural primary care teams may help decrease high-risk veterans’ acute care use.

Randomized controlled trial of a care management intervention offers important lessons for the field of complex care.

Providing virtual case mentoring to outpatient care teams may reduce unnecessary hospital and emergency department visits for high-need, high-cost patients.

Connecting complex care teams with specialists through videoconferencing can increase their effectiveness in caring for high-need high-cost patients.

Implementing a trauma-informed approach in primary care.

A permanent supportive housing program did not improve most measures related to physical health for individuals experiencing chronic homelessness, but did improve access to and trust in primary care.

Supplementing primary care with team-based management.

The importance of timely primary care follow-up.

The case conference approach to caring for complex patients.

The psychological benefits of case management.

By closing gaps in care, a safety-net ACO has reduced medical costs for Medicaid patients with complex needs.

Stanford Coordinated Care provides university employees with complex health needs better care at a lower cost

Interdisciplinary teams provide support for Medicaid beneficiaries with mental illnesses, addictions, and other needs.

Health Resilience Specialists work with the patients to meet their personal health needs