Resources

A telephone-based social needs screening, referral, and navigation program that focused on patients with predicted high utilization within the Kaiser Permanente Southern Cal

This resource describes a quasi-experimental study evaluating the effect of a transitional care program that involved rapid primary care follow-up

This resource describes a study of five plans that integrate LTSS into care.

This study compared health services use and costs depending on whether the primary care provider was a physician, NP, or PA.

This resource provides guidelines for implementing Special Supplemental Benefits for the Chronically Ill (SSBCI) in a manner that improves health care for chron

This resource provides a framework for understanding the nature and extent of integration in programs that integrate LTSS with medical care and behavioral health.

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

This resource describes and evaluates a new specialist pharmacy service, called the integrated care clinical pharmacist.

At Northwestern Medical Group in Chicago, a patient-centered transitional care intervention serving patients with complex health needs that lack a usual source of care was f

This resource is a toolkit to help payers and providers understand how home-based primary care (HBPC) improves quality and reduces costs for seriously ill and home-limited o

This resource identifies challenges faced by older adults from racial and ethnic minorities, and proposes several strategies to address them.

This resource describes a randomized controlled trial to evaluate the effects of a case management intervention called V1SAGES (Vulnerable Patients in Primary Care: Nurse Ca