Resources

This resource reviews emerging payer and provider partnerships that incentivize value-based payment models. Key points and recommendations include: The highest-need, highest-cost population is ever...
This resource is a case study of Care Management Plus (CM+), a health care delivery model designed to improve the quality and coordination of care for older adults and other patients with multiple...
This resource offers recommendations for federal policymakers to help finance LTSS, the clinical and social services that assist individuals with limited ability to care for themselves. In 2013...
This resource is a case study of Commonwealth Care Alliance (CCA), a Boston-based Medicare Advantage plan and care delivery network that seeks to integrate medical, behavioral health, and social...
There is currently no single statement of what a delivery system must have to effectively serve adults with complex care needs. The SCAN Foundation convened a working group of diverse experts...
This resource is a slide set outlining a project to adapt the Camden Coalition of Healthcare Providers high-utilizer care coordination model to four other sites. Enrollment criteria for the Camden...
This resource explores whether individuals’ levels of engagement in their care — referred to as “patient activation” — correlates with their use of services and status as “high need, high cost.”...
This resource is a case study of the Program of All-Inclusive Care for the Elderly (PACE), focusing on On Lok, the original program. On Lok Senior Health Services was founded in 1971 in the San...
Based on a review of peer-reviewed and gray literature and interviews, this resource identified eight common attributes of many successful programs that provide better care for people with high needs...
This resource is a case study of MedStar Washington Hospital Center’s Medical House Call Program, which offers home-based primary care to patients who are too sick, frail, or disabled to come to a...
Two-thirds of Medicare dollars are spent on ten percent of older patients who live with five or more chronic illnesses. Effective primary care can improve older adults’ health and manage these costs...
This resource compares the operational approaches of 18 successful CCM programs for high-need, high-cost patients to offer guidance on best practices. CCM programs must be tailored to their particular...