Identifying and Designing the Right Care Management Program: Insights from ACOs
Four care management models for ACOs.
Implementation Tool
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Displaying 321 - 340 of 409
Effectiveness of Medication Assisted Treatment for Opioid Use in Prison and Jail Settings: A Meta- Analysis and Systematic Review
Medication-assisted treatment in correctional settings improves substance use treatment engagement and reduces illicit opioid use post-release.
Peer-Reviewed Article
Association Between Receipt of a Medically Tailored Meal Program and Health Care Use
Medically tailored meals significantly reduced admissions to hospitals and nursing homes for people with complex health and social needs.
Peer-Reviewed Article
The Complex Care Hospitalist Program at Boston Medical Center
Caroline Morgan Berchuck, MD, describes a promising new complex care hospitalist model that aims to address this fragmentation and support people with complex needs in realizing better health outcomes.
Blog
March 2019
Dispatch Health: Reducing Avoidable Emergency Department Use Through On-Demand Acute Care Delivered to Patients in Their Homes
Dr. Mark Prather, emergency physician and founder of Dispatch Health, shares how his organization provides on-demand home visits in 10 metropolitan areas and provided nearly visits to nearly 100,000 visits to patients last year.
Blog
March 2019
Tools to Support Hospital-Based Addiction Care: Core Components, Values, and Activities of the Improving Addiction Care Team
Details the main elements of a hospital-based addiction care consultation team.
Case Example
Quick Reference Guide to Promising Care Models
This resource is an updated quick reference guide to promising models for people with complex needs.
Brief/Report
Re-envisioning Care for People with Involved Disabilities
Video series details how health systems can redesign primary care, including through home-based primary care programs, to better meet the needs of people with disabilities.
Implementation Tool
The Holston Medical Group Extensivist Clinic: Delivering Hospital-Level Care in an Ambulatory Setting
Dr. Neglia and The Holston Medical Group have established a unique program that cares for acutely ill patients in an ambulatory setting even though their illnesses would qualify for an inpatient hospitalization.
Blog
January 2019
Dedicated to the Mission: Strategies US Department of Veterans Affairs Home-Based Primary Care Teams Apply to Keep Veterans at Home
Fostering a culture of caring for veterans takes interdisciplinary teams focused on comprehensive, trusting and reliable relationships through open and frequent communication and ongoing education.
Peer-Reviewed Article
Outcomes of a Citywide Campaign to Reduce Medicaid Hospital Readmissions with Connection to Primary Care Within 7 Days of Hospital Discharge
The importance of timely primary care follow-up.
Peer-Reviewed Article
The Current State of Telehealth Evidence: A Rapid Review
Telehealth interventions had similar outcomes to in-person care for different services and populations, but did not consistently impact utilization such as physician or emergency department visits.
Peer-Reviewed Article
Blueprint for Complex Care: Advancing the Field of Care for Individuals with Complex Health and Social Needs
This resource outlines the current state of complex care and recommendations for the future.
Implementation Tool
How ACOs Are Caring for People with Complex Needs
An analysis of the National Survey of ACOs
Brief/Report
Atrius Health’s Medically Home Program Integrates Acute Hospitalization and Post-Discharge Care
A new care delivery model of providing hospital-level services in the home (sometimes referred to as “home hospitalization” or “hospital at home”) has been launching with pilots at a number of health systems nationally.
Blog
November 2018
Academic Medical Centers and High-Need, High-Cost Patients: A Call to Action
This resource describes how academic medical centers can reshape the health system for patients with complex needs.
Peer-Reviewed Article
Outpatient Complex Case Management: Health System-Tailored Risk Stratification Taxonomy to Identify High-Cost, High-Need Patients
Maximizing the impact of outpatient complex case management.
Peer-Reviewed Article
A New Hospitalist Model for Managing High-Cost, High-Need Patients
A hospitalist model for complex care.
Case Example
PACE 2.0: A Prime Opportunity for Delivery Systems and Payers
The Program of All-Inclusive Care for the Elderly provides comprehensive, compassionate medical care and long-term services and supports to older adults with persistent complex needs who are eligible for nursing home care. Yet, PACE reaches less than two percent of those who could benefit from its services.
Blog
September 2018