Research review finds that incorporating community health workers into primary care reduced A1c levels and improved self-management and satisfaction among older adults with diabetes.

Accountable care organization leaders share perspectives on payment mechanisms used with social service organizations, challenges experienced, and the impacts of these partnerships.

Patients and community health workers (CHWs) share perspectives on the impact of CHW services provided within a primary care setting to address barriers to equitable care.

State policy recommendations to improve the recruitment, retention, and training of the direct care workforce.

This report identifies policy strategies for states to expand access to respite care for caregivers.

Recommendations for how managed long-term services and supports plans can better raise awareness of and increase support for family caregivers.

Guidance and tools for food banks to partner with health care organizations to address food insecurity and improve health outcomes.

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

Advancing more equitable access to telehealth may require care coordination strategies deployed alongside telehealth.

A health-related quality of life measure can be a leading indicator for future adverse health outcomes for older adults.

Varying structures of cross-sector partnerships between health care organizations, social service agencies, and local government bodies have distinct strengths and serve different functions.

Study details permanent supportive housing program implementation and how this impacts outcomes and costs.

Differing patterns of care utilization and mortality outcomes within subgroups of a complex patient population can help inform more targeted care interventions.

Systematic review of programs to improve care for patients with complex needs details evidence base across multiple settings.

Explored how health care organizations can incorporate a segmentation framework into population health management using simple algorithms.

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

Global budgets for hospitals reduced expenditures and utilization for some Medicare subpopulations with complex health and social needs, yet disparities existed for some subgroups.

Using segmentation to address clinical and social needs for Medicaid patients with complex needs and costly utilization can improve the effectiveness of complex care programs.

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

This toolkit can support health care organizations in creating the business case for complex care programs.