Community health worker programs can offset program costs through reduced utilization.

Social workers on rural primary care teams may help decrease high-risk veterans’ acute care use.

California’s Whole Person Care pilot can inform cross-sector initiatives to improve care for Medicaid enrollees with complex health and social needs.

Multisector partnerships that include Area Agencies on Aging may reduce health care use and spending.

Health care systems may need to tailor screening and referral approaches for social needs, as some needs may be less likely to be met by social service organizations.

This tip sheet provides guidelines for how health plans and provider organizations can use more person-centered language.

Highlighted lessons from two recent studies to help guide future program and measurement approaches for complex care management interventions.

Accountable care organizations must address key funding, community partnership, and data sharing requirements to successfully integrate social services into medical care.

Creating a palliative care program to meet the needs of low-income communities requires solutions that are patient centered and supportive of the clinical care team.

Demonstrating return-on-investment to advance effective business relationships between community-based organizations and health care partners.

How can a community-based organization demonstrate the two-way financial benefits of partnering with a health plan?

Adults with complex, high-cost health care needs are more likely to have experienced social adversity in childhood and adulthood.

Federal home-based primary care demonstration showed mixed results on measures related to Medicare savings, care quality, and utilization for Medicare-only and dually eligible beneficiaries.

Strategies for reducing the impact of social isolation and loneliness on older adults.

Among high-cost Medicare enrollees, those who are seriously ill, frail, and/or had a serious mental illness experience the most potentially preventable spending.

High-need, high-cost older adult patients detail their health care goals, which may inform provider efforts to effectively engage with and care for these patients and their family caregivers.