Resources

This resource proposes a framework to help guide the development of programs for populations with complex needs. While medical drugs and devices go through a well-established, rigorous development...
This resource examines the experience of providers with the Medicaid health home option, a provision of the Affordable Care Act. The health home model focuses on providing whole-person care to high...
This resource describes a care guidance index based on what matters to patients. Identifying a high-risk subgroup is a strategy for chronic care management. However, common methods of assessing risk...
This resource is the product of a collaborative assessment on strategies for better serving high-need patients convened by the National Academy of Medicine (NAM). Activities included workshops, a...
This study examined five programs that serve patients with complex needs through medical and non-medical services. Authors created a framework to illustrate the foundational factors that encourage...
This systematic review, which includes 27 studies across five models of care, evaluates the effectiveness of programs to improve care and lower cost for people with multiple chronic conditions or...
This resource offers a description and evaluation of House Calls, a well-established program in Southern California that provides home-based care for high-risk frail and homebound older adults. House...
This resource provides a systematic review of transitional care interventions that reported hospital readmission as an outcome. Transitional care is a set of actions designed to ensure the...
This resource is a case study of CareMore, a Medicare Advantage plan and medical provider based in Cerritos, California, that serves 130,000 enrollees in Medicare and Medicaid managed care plans...
Telemedicine has the potential to expand access to acute illness care and prevent ED visits for older adults. This resource describes a study assessing a high-intensity telemedicine program for older...
This resource explores the value of five different home visit program models. Home visits offer a way to reach high-risk, high-needs patients before a higher level of care is needed, thereby reducing...
This resource summarizes a descriptive study of the Health Resilience Program (HRP) in Oregon, a program designed to address the needs of high-risk Medicaid and Medicare patients and reduce costs. In...