Care Ecosystem Toolkit
Details implementation guidance for the evidence-based Care Ecosystem model, which improves supports for people with dementia and their caregivers.
Implementation Tool
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Displaying 81 - 98 of 98
Experiences of Three States Implementing the Medicaid Health Home Model to Address Opioid Use Disorder — Case Studies in Maryland, Rhode Island, and Vermont
Qualitative study highlights success factors and implementation challenges for state opioid health home programs.
Peer-Reviewed Article
Community Health Worker Support for Disadvantaged Patients with Multiple Chronic Diseases: A Randomized Clinical Trial
This resource describes the benefits of community health workers for people with multiple chronic conditions.
Peer-Reviewed Article
Integrating Health Care for High-Need Medicaid Beneficiaries With Serious Mental Illness and Chronic Physical Health Conditions at Managed Care, Provider, and Consumer Levels
This resource describes the value of navigators for Medicaid beneficiaries with mental illness.
Peer-Reviewed Article
CareMore: Improving Outcomes and Controlling Health Care Spending for High-Needs Patients
CareMore’s business model identifies high-risk patients and surrounds them with coordinated services
Case Example
Innovative Home Visit Models Associated with Reductions in Costs, Hospitalizations, and Emergency Department Use
Home visits can reach patients with complex needs before a higher level of care is needed
Peer-Reviewed Article
The Business Case for Community Paramedicine: Lessons from Commonwealth Care Alliance’s Pilot Program
Cost considerations for the expansion of mobile integrated health care and community paramedicine programs.
Case Example
Intensive Outpatient Care Program Toolkit
The staff position of care coordinator is crucial to success.
Implementation Tool
Care Management Plus: Strengthening Primary Care for Patients with Multiple Chronic Conditions
A program to help clinics deliver comprehensive care may decrease mortality and hospitalization rates.
Case Example
Hennepin Health: A Care Delivery Paradigm for New Medicaid Beneficiaries
By closing gaps in care, a safety-net ACO has reduced medical costs for Medicaid patients with complex needs.
Case Example
Guided Care: A Structured Approach to Providing Comprehensive Primary Care for Complex Patients
Guided Care is designed to strike a balance between telephone-based and interdisciplinary team-based care management programs.
Case Example
Home-Based Care Program Reduces Disability and Promotes Aging in Place
Difficulty with activities of daily living is a major cost driver in health care that is typically overlooked.
Peer-Reviewed Article
The Core of Care Management: The Role of Authentic Relationships in Caring for Patients with Frequent Hospitalizations
This study links “authentic healing relationships” with patient motivation and active health management.
Peer-Reviewed Article
Developing Care Management Programs to Serve High-Need, High-Cost Populations
Care management programs should include processes for evaluating patient-reported outcomes.
Brief/Report
House Calls: California Program For Homebound Patients Reduces Monthly Spending, Delivers Meaningful Care
A novel approach to home visiting delivers cost reduction and better care
Peer-Reviewed Article
Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis
Much of the evidence comes from small studies, so further testing is needed.
Brief/Report
Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program?
A comparison of 18 complex care management programs reveals best practices.
Brief/Report
Effect of a Community-Based Nursing Intervention on Mortality in Chronically Ill Older Adults: A Randomized Controlled Trial
Indicates that a community-based nurse care management model reduced all-cause mortality for older adults with chronic conditions.
Peer-Reviewed Article