A literature review describes the most important success factors for integrated care programs.

This resource describes the benefits of community health workers for people with multiple chronic conditions.

The National Academy of Medicine offers a synthesis of the evidence for improving care for high-needs patients.

This resource describes the value of navigators for Medicaid beneficiaries with mental illness.

Evaluation of state Medicaid health home model programs details approaches for implementation and outcomes for enrolled members.

Including caregivers in the discharge planning process reduces the risk of hospital readmission for older adults.

Home-based primary care program reduced hospitalizations for older adults with diabetes, especially those with higher levels of medical complexity.

CareMore’s business model identifies high-risk patients and surrounds them with coordinated services

Home visits can reach patients with complex needs before a higher level of care is needed

A new framework outlines four steps to develop care management programs.

Cost considerations for the expansion of mobile integrated health care and community paramedicine programs.

The staff position of care coordinator is crucial to success.

A program to help clinics deliver comprehensive care may decrease mortality and hospitalization rates.

The Care Transitions Intervention was co-designed with patients and evaluated using randomized trials.

People with multiple chronic conditions and disabilities enrolled in home-based primary care experienced persistent reduced acute care utilization.

By closing gaps in care, a safety-net ACO has reduced medical costs for Medicaid patients with complex needs.

Stanford Coordinated Care provides university employees with complex health needs better care at a lower cost

Guided Care is designed to strike a balance between telephone-based and interdisciplinary team-based care management programs.

Difficulty with activities of daily living is a major cost driver in health care that is typically overlooked.

Experts describe how delivery systems can effectively serve adults with complex needs.