Resources

While Medicare Advantage (MA) plans have new flexibility to target and cover supplemental benefits that address health-related social needs, few plans provided these types o

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

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.

This resource analyzes preventable ED visits and identifies mechanisms for preventing them.

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 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

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

This resource is a study evaluating an alternative in-hospital assessment to determine the need for continuing care after discharge.