Resources

This resource describes the work of Congregational Health Network (CHN), which is a collaboration between Methodist le Bonheur Healthcare (MLH), clergy, and other partners to improve health care...
This resource reviews emerging payer and provider partnerships that incentivize value-based payment models. Key points and recommendations include: The highest-need, highest-cost population is ever...
This resource is a case study of Commonwealth Care Alliance (CCA), a Boston-based Medicare Advantage plan and care delivery network that seeks to integrate medical, behavioral health, and social...
There is currently no single statement of what a delivery system must have to effectively serve adults with complex care needs. The SCAN Foundation convened a working group of diverse experts...
This resource explores whether individuals’ levels of engagement in their care — referred to as “patient activation” — correlates with their use of services and status as “high need, high cost.”...
This resource is a case study of the Program of All-Inclusive Care for the Elderly (PACE), focusing on On Lok, the original program. On Lok Senior Health Services was founded in 1971 in the San...
This resource is a case study of MedStar Washington Hospital Center’s Medical House Call Program, which offers home-based primary care to patients who are too sick, frail, or disabled to come to a...
This resource compares the operational approaches of 18 successful CCM programs for high-need, high-cost patients to offer guidance on best practices. CCM programs must be tailored to their particular...
This resource, drawing on Medicare survey and claims data, a literature review, and interviews, suggests a three-pronged strategy to manage care for Medicare beneficiaries with medical and social...
This resource describes the Guided Care model of care management and its implementation in two health systems: Lahey Health of Burlington, Massachusetts, and Holy Family Memorial of Manitowoc County...
This resource is a case study of Hennepin Health, a safety-net accountable care organization (ACO) in Hennepin County, Minnesota, that aims to reduce costs and improve outcomes for Medicaid...
This resource examines health care spending and use of services among adults with high needs, defined as people who have three or more chronic diseases and a functional limitation. One in 20 US adults...