Evidence-based intervention at a behavioral health home improved health outcomes for patients with co-occurring type 2 diabetes and serious mental illness.

Personalized patient navigation supports for people with comorbid substance use disorders reduced rates of hospital readmissions and emergency department use.

Primary care and alternative payment models that reduce emergency department use and increase access to care for high-need populations share core components for success.

An affordable housing program in Baltimore generates between $1.30-$1.92 of “social return” in the community for every dollar invested annually.

Literature review examines the roles and contributions of community health workers in improving dementia care.

Discusses the benefits and challenges of tele-social care and offers practical tips for providers administering telehealth services for social care activities.

Patients with dementia are more likely to be discharged to hospice from hospitals that offer palliative care programs.

Evaluates the evidence on interventions for people living with dementia, their care partners, and caregivers to help identify what interventions are ready for broad implementation.

Enhanced primary care for adults with serious mental illness led to increases in primary care visits and health screenings as well as decreases in inpatient utilization.

Provides an overview of home-based medical care models, the patients that they serve, and their robust evidence base.

Initiative successfully implemented several evidence-based and promising addiction care models across multiple medical settings, including an inpatient addiction consult team, a low-threshold bridge clinic, peer recovery coaches, and office-based addiction treatment nurses.

Health care organizations can use population-level data sources about the experiences of people with disabilities to improve care.

Describes core competencies that convey the essential knowledge, skills, and attitudes of complex care practitioners and teams to improve care for people with complex needs.

Demonstrates that intensive outpatient care programs show promise in reducing utilization and costs and improving patient outcomes for high-need, high-cost populations.

Offers a practical framework for safety-net health systems to better identify and segment patients with complex needs, and tailor care models to meet their needs.

A complex care transitions pilot designed through a stakeholder-driven process led to decreased hospital utilization and costs.

Training for caregivers of veterans living with dementia may help them remain in their home longer, but may lead to increased health care costs.

Integrated health care systems can better support high-risk patients by embedding high-risk patient care within general primary care and mental health care.

Toolkit offers health care stakeholders in rural areas with practical information to support the design, implementation, and evaluation of community paramedicine programs.

A randomized clinical trial of an 18-month comprehensive intervention showed significant reductions in cardiovascular disease risk in adults with serious mental illness.