Resources

Although senior living organizations are primarily oriented toward housing and hospitality, there are many reasons they provide a great platform for value-based care.
This resource is a study undertaken to understand the experiences of older adults living in community settings with multiple chronic conditions. Common themes for study participants included depending...
Senior living refers to a range of service-enriched housing aimed at older adults who want specific service amenities, health care support, or help with activities of daily living (e.g., dressing). Many forms of senior living, such as assisted living, evolved to offer an alternative to nursing homes — to provide a safe version of home that prioritizes hospitality, comfort, and independence over the constant supervision and medical care of a 24-hour facility. Examples of senior living include independent and assisted living. The services offered by senior-living providers vary but can include...
HealthPartners of Minnesota, one of seven health plans in Minnesota’s state administered Minnesota Senior Health Options (MSHO) program, was highlighted for addressing a social determinant of health risk factor within their frail elderly population: lack of transportation. The report detailed both HealthPartner’s unique dedication to improving transportation quality and convenience for its members, and the benefits of state supported Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP), like MSHO.
This resource builds on the seminal Home Alone study, the first national examination at how family caregivers manage medical and nursing tasks. Major findings of this new study include: Today’s...
Person-centered care is of critical importance to the care of people with involved disabilities. This blog describes a series of video modules for health system leaders and clinicians that aims to reinvigorate the idea of person-centered care for those with complex health, social, and functional needs
In 2016, SMG began an initiative to integrate palliative care services into its primary care practices. However, after encountering challenges, SMG leaders chose to outsource palliative care to an external palliative care agency, Aspire Health. This blog post describes SMG’s experience and offers advice for other ACOs that are struggling to expand palliative care services and looking for a path forward.
This resource describes four care management models that ACOs are using for individuals with complex needs. Care management programs can involve creating patient care plans, coordinating care across...
This resource is a series of four videos (each roughly 12 minutes long) about how to transform care for people with involved disabilities according to the “independent living” model. The first video...
This resource, the Partnership Evaluation Tool, is intended to help organizations assess readiness to engage in successful value-based partnerships. It can be used to assess potential partners or for...
People with complex health and social needs frequently encounter a fragmented healthcare system and experience a lack of continuity of care. In this video series, 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.
Dr. Mark Prather, board-certified emergency physician and founder of Dispatch Health, speaks to Rob Mechanic of the Institute for Accountable Care about 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.