Resources

This resource used national survey data from physician practices and ACOs, paired with qualitative interviews, to learn about home visiting programs.

This resource describes a national survey of ACOs about initiatives to address serious illness, as well as follow-up case studies.

This resource describes an effort to apply a learning health systems approach to reducing ED utilization.

This resource describes four care management models that ACOs are using for individuals with complex needs.

This resource describes a study of the Johns Hopkins Community Health Partnership (J-CHiP), which was created as a regional approach to health care transformation in Baltimo

This resource describes a randomized quality improvement trial that assessed whether augmenting usual primary care with team-based intensive management lowers utilization and cost

This resource describes the evolution of complex care management targeting strategies in Community Care of North Carolina’s (CCNC) work with the statewide non-dual Medicaid popula

This resource provides a roadmap for health plans providing complex chronic care to improve quality and their Medic

This resource describes the background, strategy, and design of the Creating Age-Friendly Health Systems initiative.

This resource presents results from a systematic review of the international evidence on the costs, resource use, and cost-effectiveness of Clinical Nurse Specialist–l

This resource describes the Complex Care Map (CCM ©), a tool that addresses fragmentation in the health system and helps providers understand the patient’s story.

This viewpoint article argues that policy can play an important role in improving outcomes for people with complex needs in the US, and it makes several recommendations for the current federal admi