Community Health Worker Model Best Practice Toolkit for Designing, Implementing and Showing Impact

Toolkit provides best practices and practical tools for designing, implementing, and evaluating the impact of community health workers.

Implementation Tool

March 2023

Words Matter: Strategies to Reduce Bias in Electronic Health Records

A provider tool that promotes person-centered and equitable care by recognizing and avoiding bias in electronic health record notes.

Implementation Tool

October 2022

High-Need, High-Cost Segmentation Framework

Segmentation framework with publicly available code files identifies specific and actionable patient cohorts with complex needs.

Implementation Tool

October 2021

Building the Value Case for Complex Care Toolkit

This toolkit can support health care organizations in creating the business case for complex care programs.

Implementation Tool

September 2021

Complex Care Startup Toolkit

Contains practical guides, tools, and other resources for developing complex care programs.

Implementation Tool

June 2021

Improving Health Care for Adults with Disabilities: An Overview of Federal Data Sources

Health care organizations can use population-level data sources about the experiences of people with disabilities to improve care.

Implementation Tool

December 2020

Operational Guide to Identify, Understand, and Treat High-Need Patients

Offers a practical framework for safety-net health systems to better identify and segment patients with complex needs, and tailor care models to meet their needs.

Implementation Tool

September 2020

Person-Centered Engagement at the Organizational Level

Contains strategies, tips, and case studies to assist health care stakeholders in building meaningful, person-centered engagement in their organizations.

Implementation Tool

January 2020

Health Care Transformation Task Force Value Partnership Evaluation Tool

A tool for assessing readiness for value-based partnerships.

Implementation Tool

March 2019

High-Need, High-Cost Personas

An in-depth overview of different personas.

Implementation Tool

February 2019

Blueprint for Complex Care: Advancing the Field of Care for Individuals with Complex Health and Social Needs

This resource outlines the current state of complex care and recommendations for the future.

Implementation Tool

December 2018

The ROI Calculator for Partnerships to Address the Social Determinants of Health

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

Implementation Tool

August 2018

Care Management Contracting for Complex Populations: Best Practices and Tools

This resource offers guidance on contracting for populations with complex needs.

Implementation Tool

July 2018

Investing in Social Services as a Core Strategy for Healthcare Organizations: Developing the Business Case

This resource explains how to invest in social services as a business strategy.

Implementation Tool

March 2018

Accountable Care Atlas: A Development Guide for Competency Implementation

This resources describes the competencies organizations need to transition to value-based payment.

Implementation Tool

November 2017

The Return on Investment (ROI) Calculator: The Business Case and Person-Centered Care

A calculator that can help build and present business case for serving adults with complex needs.

Implementation Tool

November 2016

Taxonomy of Long-Term Services and Supports Integration

A standardized tool to assess where along a continuum a program lies with regard to components of integration.

Implementation Tool

April 2016

Overview of Segmentation of High-Need, High-Cost Patient Population

There are many promising strategies to segment individuals with complex needs. Here is one conceptual framework.

Implementation Tool

January 2016

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Community Health Worker Model Best Practice Toolkit for Designing, Implementing and Showing Impact

Words Matter: Strategies to Reduce Bias in Electronic Health Records

High-Need, High-Cost Segmentation Framework

Building the Value Case for Complex Care Toolkit

Complex Care Startup Toolkit

Improving Health Care for Adults with Disabilities: An Overview of Federal Data Sources

Operational Guide to Identify, Understand, and Treat High-Need Patients

Person-Centered Engagement at the Organizational Level

Health Care Transformation Task Force Value Partnership Evaluation Tool

High-Need, High-Cost Personas

Blueprint for Complex Care: Advancing the Field of Care for Individuals with Complex Health and Social Needs

The ROI Calculator for Partnerships to Address the Social Determinants of Health

Care Management Contracting for Complex Populations: Best Practices and Tools

Investing in Social Services as a Core Strategy for Healthcare Organizations: Developing the Business Case

Accountable Care Atlas: A Development Guide for Competency Implementation

The Return on Investment (ROI) Calculator: The Business Case and Person-Centered Care

Taxonomy of Long-Term Services and Supports Integration

Overview of Segmentation of High-Need, High-Cost Patient Population