There are many promising strategies to segment individuals with complex needs. Here is one conceptual framework.

Health Resilience Specialists work with the patients to meet their personal health needs

The benefits of holistic, team-based care go beyond medical needs.

Much of the evidence comes from small studies, so further testing is needed.

Key opportunities include strengthening information technology connections across service providers.

Segmenting the high-cost population is the first step in matching appropriate care management strategies.

This report presents the findings from the evaluation of Medicaid health homes, created as part of the Affordable Care Act.

Emergency department-initiated buprenorphine for opioid-dependent patients demonstrated significantly higher rates of addiction treatment engagement than interventions without buprenorphine.

Incorporating community engagement into public health interventions leads to improved health outcomes and a greater sense of self-efficacy among intervention recipients.

The approach identifies patients through chart review and data analytics coupled with the intelligence of community health workers.

This guide describes how to design, implement, and assess a program to reduce preventable ED use.

This resource presents promising ideas for more effective modes of care for persons with complex needs.

Systematic review finds that medical respite programs reduce acute care utilization outcomes for people experiencing homelessness.

A contingency management program in a community mental health clinic increased stimulant abstinence during and following treatment and reduced hospitalizations for psychiatric care.

Primary care-based community health worker program reduced emergency department use among people recently released from prison.

Prize-based contingency management in community-based substance use treatment clinics improved retention, attendance, and abstinence in individuals with stimulant use.

A mobile crisis program reduced hospitalization rates among individuals experiencing behavioral health crises.