Content Types

Displaying 1 - 20 of 58

The People Say

Website offers a qualitative database of personal narratives to support providers and policymakers in designing policies that better reflect the lived experience, needs, and priorities of older adults.

Implementation Tool

August 2025

Improving Health and Reducing Homelessness through Cross-Sector Partnerships: Insights from California

This webinar will feature a panel on cross-sector collaboration efforts in California to improve services for people who are unhoused, as well as practical strategies for sustaining these partnerships.

Webinar

December 2024

Pilot Implementation of a Nutrition-Focused Community Health Worker Intervention Among Formerly Chronically Homeless Adults in Permanent Supportive Housing

A community health worker-led program for formerly homelessness individuals living in permanent supportive housing increased food security and social connectedness.

Case Example

January 2024

The Camden Coalition Care Management Program Improved Intermediate Care Coordination: A Randomized Controlled Trial

The reanalysis of a randomized control trial evaluating the effectiveness of a care management program finds increased linkages to ambulatory care.

Peer-Reviewed Article

December 2023

Access, Utilization, and Quality of Behavioral Health Integration in Medicaid Managed Care

The transition to the Medicaid behavioral health “carve-in” model in Washington State was not associated with significant improvements in overall health outcomes.

Peer-Reviewed Article

December 2023

Association Between ICD-10 Codes for Social Needs and Subsequent Emergency and Inpatient Use

An association between Z code assignment and increased emergency and inpatient health care utilization presents opportunities for targeted interventions that address patients' social needs.

Peer-Reviewed Article

November 2023

Community-Based Organization Services Evidence Bank

Curated collection of research studies highlights the efficacy of services provided by community-based organizations, with a focus on outcomes relevant to health care partners.

Website/Resource Center

August 2023

Assessment of the Massachusetts Flexible Services Program to Address Food and Housing Insecurity in a Medicaid Accountable Care Organization

A program to connect Medicaid ACO enrollees with nutrition and housing-related services demonstrated early indications of effectiveness.

Peer-Reviewed Article

June 2023

Estimating the Workload of a Multi-Disciplinary Care Team Using Patient-Level Encounter Histories

Insights from patient-level encounter histories can support optimizing care coordination team staffing for high-need patients.

Peer-Reviewed Article

June 2023

Scaling Primary Care Social Needs Screening and Referrals in New York City’s Safety-Net Health System

An overview of NYC Health + Hospital’s implementation of a primary care-based social needs screening and referral program, including key implementation challenges and success factors.

Case Example

June 2023

Integration on the Frontlines of Medicaid Accountable Care Organizations and Associations with Perceived Care Quality, Health Equity, and Satisfaction

Integrated care in MassHealth ACOs varies greatly across primary care practice type and is associated with greater ability to improve care quality and advance health equity.

Peer-Reviewed Article

May 2023

Community Health Worker Programs in Primary Care

Curates recent evidence behind community health worker programs that support people with complex health and social needs, as well as practical strategies to support effective implementation of these programs.

Collection

April 2023

Easy to Use and Validated Predictive Models to Identify Beneficiaries Experiencing Homelessness in Medicaid Administrative Data

A validated predictive model for health care stakeholders to better identify and address homelessness and its related outcomes.

Peer-Reviewed Article

February 2023

Guide to Evidence for Health-Related Social Needs Interventions: 2022 Update

Summarizes evidence on costs of health-related social needs interventions and their impact on utilization and cost of care to inform ROI Calculator users.

Implementation Tool

September 2022

Integrating Spiritual Care in Population Health and Care Management: Two Case Examples

Including spiritual care within care management programs in outpatient, managed care, and population health settings can enhance patient care and support the effectiveness of the interdisciplinary care team.

Case Example

September 2022

State of the Science on Social Screening in Healthcare Settings

Summarizes research on the prevalence of social screening in health care settings, validity of social screening tools, and patient and provider perspectives on social screening.

Brief/Report

June 2022

Applying the ROI Calculator for Partnerships to Address Social Determinants of Health

Described how health care organizations and community-based organizations can use the ROI Calculator to explore and plan financial arrangements to fund social services for people with complex needs.

Webinar

May 2022

Housing and Health

Curates recent evidence behind housing programs and interventions, and explores practical tools and case studies on effective strategies for improving the health of people experiencing homelessness or unstable housing.

Collection

April 2022

Medical Respite Care Tool Kit

Resources to help organizations plan and implement medical respite care programs, including program development guides, case examples, and implementation tools.

Website/Resource Center

April 2022

Care Management Intervention to Address Determinants of Health for Individuals with Multiple Behavioral Health Readmission

Care management interventions for people transitioning from behavioral health inpatient care may be successful in decreasing readmissions if they address health-related social needs.

Peer-Reviewed Article

April 2022

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The People Say

Improving Health and Reducing Homelessness through Cross-Sector Partnerships: Insights from California

Pilot Implementation of a Nutrition-Focused Community Health Worker Intervention Among Formerly Chronically Homeless Adults in Permanent Supportive Housing

The Camden Coalition Care Management Program Improved Intermediate Care Coordination: A Randomized Controlled Trial

Access, Utilization, and Quality of Behavioral Health Integration in Medicaid Managed Care

Association Between ICD-10 Codes for Social Needs and Subsequent Emergency and Inpatient Use

Community-Based Organization Services Evidence Bank

Assessment of the Massachusetts Flexible Services Program to Address Food and Housing Insecurity in a Medicaid Accountable Care Organization

Estimating the Workload of a Multi-Disciplinary Care Team Using Patient-Level Encounter Histories

Scaling Primary Care Social Needs Screening and Referrals in New York City’s Safety-Net Health System

Integration on the Frontlines of Medicaid Accountable Care Organizations and Associations with Perceived Care Quality, Health Equity, and Satisfaction

Community Health Worker Programs in Primary Care

Easy to Use and Validated Predictive Models to Identify Beneficiaries Experiencing Homelessness in Medicaid Administrative Data

Guide to Evidence for Health-Related Social Needs Interventions: 2022 Update

Integrating Spiritual Care in Population Health and Care Management: Two Case Examples

State of the Science on Social Screening in Healthcare Settings

Applying the ROI Calculator for Partnerships to Address Social Determinants of Health

Housing and Health

Medical Respite Care Tool Kit

Care Management Intervention to Address Determinants of Health for Individuals with Multiple Behavioral Health Readmission