Resources

This resource describes a new model that moves high-need patients out of the emergency department and into a network of social supports.

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

The Massachusetts Health Policy Commission's Community Hospital Acceleration, Revitalization, and Transformation (CHART) investment program has engaged 25 community hospitals to a

​​​​This resource describes a program in New Mexico that employs community health workers (CHWs) to address social determinants of health, as well as how that program was implemented and spread.

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 ac

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.

,

This resource reviews the case for segmenting patients with complex needs and different ways of segmenting, as well as challenges and limitations.

This resource is a case study of the Program of All-Inclusive Care for the Elderly (PACE), focusing on On Lok, the original program.

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 is a case study of the Hospital at Home program at Presbyterian Healthcare Services in Albuquerque, New Mexico, which offers patients who require hospitalization for conditions with w