Transitional housing, combined with co-located substance use disorder care, facilitates access to permanent housing and increases engagement in substance use treatment.

A multi-sector collaboration in California that included community members improved organizational partnerships and create systems change.

Toolkit offers guidance for corrections and health care professionals on evidence-based interventions to support the reentry needs of people with behavioral health needs.

Randomized controlled trial shows that a collaborative dementia care model leads to reduction in costs among a sample of Medicare patients.

Use of recovery housing leads to decreases in readmissions and emergency department visits among individuals recovering from substance use disorder, as well as increased use of primary care.

Curated collection of research studies highlights the efficacy of services provided by community-based organizations, with a focus on outcomes relevant to health care partners.

Pharmacy liaison-patient navigator programs offer a promising approach to streamline screening and system navigation efforts related to health-related social needs.

An interdisciplinary home-based primary care program for older adults with limited mobility leads to reductions in health care utilization and costs.

Analysis of street medicine programs reveals differences in behavioral health services across programs, highlighting key facilitators and challenges to better integration of these services within street medicine.

Having onsite care coordinators may significantly improve the quality of patient care, while centralized coordination is associated with increased information sharing.

A primary care practice redesigned its social needs screening and patient triage process to allow specialized staff to spend more time supporting patients with more intensive housing needs.

This webinar highlighted one successful CBO-health plan partnership model to explore why they entered into a partnership, how they put their contract into practice, and outcomes of the partnership so far.

Insights from patient-level encounter histories can support optimizing care coordination team staffing for high-need patients.

Home-delivered meals reduced rates of 30-day rehospitalization and death for Medicare Advantage members post hospitalization.

Barriers to community social services to address health-related social needs persist despite screening and referral programs in clinical settings.

California leveraged Medicaid waiver authority to cover targeted pre-release services with the goal of improving the health of people reentering the community after incarceration.

Recommendations for policymakers, health plans, and providers on implementing medically tailored meals programs.

Randomized controlled trial of a person-centered housing intervention for older adults shows improved health outcomes for formerly homeless adults living in permanent supportive housing.

Featured presenters with on-the-ground experience implementing the Transitions Clinic Network model, which provides patient-centered care for people with a history of incarceration and supports reentry into communities.