Displaying 1 - 20 of 26

Understanding the Medicare Physician Fee Schedule Billing Codes For: Community Health Integration, Principal Illness Navigation, and Principal Illness Navigation-Peer Support Services

This toolkit details options for implementing recently introduced Medicare services that address members’ health-related social needs.

Implementation Tool

March 2024

Equity in CalAIM: How to Identify the Patients Who Will Benefit Most

Rethinking eligibility, beyond cost and utilization, offers a more equitable approach to identify high-need individuals for care management.

Implementation Tool

May 2023

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

Addressing Social Isolation and Loneliness Among Older Dually Eligible Individuals

Toolkit offers recommendations and examples for screening and interventions that support social connectivity of older adults.

Implementation Tool

November 2022

Telehealth Implementation Playbook

This toolkit shares practical steps and best practices for health care providers and administrators looking to implement telehealth services for their patients.

Implementation Tool

January 2022

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

Telemedicine for Health Equity Toolkit

Offers practical recommendations to improve telemedicine interventions to be more equitable for diverse populations, particularly those with low incomes.

Implementation Tool

June 2021

HCCIntelligence: Tools and Tip Sheets

Downloadable tools, tip sheets, sample forms, and how-to guides on home-based primary care, with a focus on clinical and operational best practices.

Implementation Tool

June 2021

Complex Care Startup Toolkit

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

Implementation Tool

June 2021

Health Equity Resource Series: Data-Driven Care Delivery: Data Collection, Stratification and Use

Toolkit details how hospitals and health systems can use patient race, ethnicity, and language data to advance health equity and eliminate disparities.

Implementation Tool

March 2021

Tele-Social Care: Implications and Strategies

Discusses the benefits and challenges of tele-social care and offers practical tips for providers administering telehealth services for social care activities.

Implementation Tool

February 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

Age-Friendly Health Systems: Guide to Using the 4Ms in the Care of Older Adults

Step-by-step guide with robust tools for health systems to apply the 4Ms framework to deliver age-friendly, evidence-based care for older adults.

Implementation Tool

July 2020

Rural Community Paramedicine Toolkit

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

Implementation Tool

June 2020

A Practical Guide to Expanding Home-Based Primary Care with Telehealth

Tools, tips, and vignettes for incorporating telehealth into home-based primary care models.

Implementation Tool

December 2019

HOUSED BEDS: A Clinical Tool for Taking a History on an Unsheltered Homeless Patient

A tool helps providers capture essential information when interviewing people experiencing unsheltered homelessness to support effective treatment planning.

Implementation Tool

July 2019

Home-Based Primary Care Resources: A Toolkit for Health Partners

This toolkit details the benefits of home-based primary care to help providers demonstrate the need for these programs.

Implementation Tool

June 2019

Home-Based Primary Care Fall Prevention and Management Toolkit

Shares best practices and screening tool options to identify and care for home-based primary care patients with potential fall risks.

Implementation Tool

April 2019

Identifying and Designing the Right Care Management Program: Insights from ACOs

Four care management models for ACOs.

Implementation Tool

April 2019

All Resources

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State

Understanding the Medicare Physician Fee Schedule Billing Codes For: Community Health Integration, Principal Illness Navigation, and Principal Illness Navigation-Peer Support Services

Equity in CalAIM: How to Identify the Patients Who Will Benefit Most

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

Addressing Social Isolation and Loneliness Among Older Dually Eligible Individuals

Telehealth Implementation Playbook

Building the Value Case for Complex Care Toolkit

Telemedicine for Health Equity Toolkit

HCCIntelligence: Tools and Tip Sheets

Complex Care Startup Toolkit

Health Equity Resource Series: Data-Driven Care Delivery: Data Collection, Stratification and Use

Tele-Social Care: Implications and Strategies

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

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

Age-Friendly Health Systems: Guide to Using the 4Ms in the Care of Older Adults

Rural Community Paramedicine Toolkit

A Practical Guide to Expanding Home-Based Primary Care with Telehealth

HOUSED BEDS: A Clinical Tool for Taking a History on an Unsheltered Homeless Patient

Home-Based Primary Care Resources: A Toolkit for Health Partners

Home-Based Primary Care Fall Prevention and Management Toolkit

Identifying and Designing the Right Care Management Program: Insights from ACOs