Displaying 1 - 20 of 122

Making the Value Case for Complex Care

This webinar will explore how complex care stakeholders can incorporate a multi-factor approach to measure and demonstrate the value of complex care programs for diverse stakeholders.

Webinar

December 2021

High-Need, High-Cost Segmentation Framework

Segmentation framework with publicly available code files identifies specific and actionable patient cohorts with complex needs.

Implementation Tool

October 2021

Strengthening the Payer-Provider Relationship for Value-Based Success in Home- and Community-Based Palliative Care

Will look at the provider and payer relationship and discuss how successful partnerships between these two stakeholders can create sustainable and efficacious home and community based palliative care programs.

Webinar

September 2021

The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization

Home-based palliative care program implemented within an accountable care organization created cost savings through reduced hospital admissions and increased hospice length of stay.

Peer-Reviewed Article

September 2021

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

The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients with Multimorbidity

Advance care planning more than one month prior to death is associated with decreased acute care utilization at the end of life and in-hospital death for people with serious illness.

Peer-Reviewed Article

August 2021

Racial Inequality in Prescription Opioid Receipt — Role of Individual Health Systems

Analysis of 310 health systems showed gaps in opioid receipt between Black and white patients, especially on dosage, which may be related to racial bias among clinicians.

Peer-Reviewed Article

July 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

Assessing the Impact of Complex Care Models: Opportunities to Fill in the Gaps

Includes patient- and staff-reported measures to help complex care programs better understand the impacts of interventions.

Brief/Report

May 2021

Rural Community-based Palliative Care: Improving Health and Reducing Disparities in Access and Services

Presents a framework and tools to help health care organizations and communities design a community-based palliative care program to meet patient needs in rural settings.

Implementation Tool

April 2021

Use of Latent Class Analysis and k-Means Clustering to Identify Complex Patient Profiles

Creating clinically meaningful profiles of patients with medically complex needs can support the delivery of more tailored interventions.

Peer-Reviewed Article

March 2021

Supporting Acute Advance Care Planning with Precise, Timely Mortality Risk Predictions

Implementing a predictive model in acute settings can more reliably identify patients with high mortality risk, which can assist providers in prioritizing advance care planning.

Peer-Reviewed Article

March 2021

Evidence for the 4Ms: Interactions and Outcomes Across the Care Continuum

The 4Ms approach developed for the Age-Friendly Health System model — what matters, medication, mentation, mobility — has a robust evidence base for providing quality care to older adults.

Peer-Reviewed Article

February 2021

Interventions at Hospital Discharge to Guide Caregivers in Medication Management for People Living with Dementia: A Systematic Review

Medication management interventions that support caregivers of people with dementia at care transitions can help reduce readmissions, caregiver burden, and use of high-risk medication.

Peer-Reviewed Article

February 2021

Implementation of Specialist Palliative Care and Outcomes for Hospitalized Patients with Dementia

Patients with dementia are more likely to be discharged to hospice from hospitals that offer palliative care programs.

Peer-Reviewed Article

February 2021

Meeting the Challenge of Caring for Persons Living with Dementia and Their Care Partners and Caregivers: A Way Forward

Evaluates the evidence on interventions for people living with dementia, their care partners, and caregivers to help identify what interventions are ready for broad implementation.

Brief/Report

February 2021

Money Moves the Mare: The Response of Community‐Based Organizations to Health Care’s Embrace of Social Determinants

Suggests that community-based organizations are responding to Medicaid redesign efforts that prioritize social determinants of health by adopting practices similar to health care organizations.

Peer-Reviewed Article

January 2021

Medical Care at Home Comes of Age

Provides an overview of home-based medical care models, the patients that they serve, and their robust evidence base.

Brief/Report

January 2021

Medicare-Medicaid Integration: A Reference Guide to Emerging Evidence and Technical Assistance Tools

This reference guide summarizes a set of curated resources to help key stakeholders better understand both the needs of the dually eligible population and emerging evidence and practical approaches for advancing Medicare-Medicaid integration.

Implementation Tool

January 2021

All Resources

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Content Types

Making the Value Case for Complex Care

High-Need, High-Cost Segmentation Framework

Strengthening the Payer-Provider Relationship for Value-Based Success in Home- and Community-Based Palliative Care

The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization

Building the Value Case for Complex Care Toolkit

The Association of Advance Care Planning Documentation and End-of-Life Healthcare Use Among Patients with Multimorbidity

Racial Inequality in Prescription Opioid Receipt — Role of Individual Health Systems

HCCIntelligence: Tools and Tip Sheets

Complex Care Startup Toolkit

Assessing the Impact of Complex Care Models: Opportunities to Fill in the Gaps

Rural Community-based Palliative Care: Improving Health and Reducing Disparities in Access and Services

Use of Latent Class Analysis and k-Means Clustering to Identify Complex Patient Profiles

Supporting Acute Advance Care Planning with Precise, Timely Mortality Risk Predictions

Evidence for the 4Ms: Interactions and Outcomes Across the Care Continuum

Interventions at Hospital Discharge to Guide Caregivers in Medication Management for People Living with Dementia: A Systematic Review

Implementation of Specialist Palliative Care and Outcomes for Hospitalized Patients with Dementia

Meeting the Challenge of Caring for Persons Living with Dementia and Their Care Partners and Caregivers: A Way Forward

Money Moves the Mare: The Response of Community‐Based Organizations to Health Care’s Embrace of Social Determinants

Medical Care at Home Comes of Age

Medicare-Medicaid Integration: A Reference Guide to Emerging Evidence and Technical Assistance Tools