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

This webinar highlighted one successful CBO-health plan partnership model to explore why they entered into a partnership, how they put their contract into practice, and outcomes of the partnership so far.

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

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.

A county health department, in collaboration with community-based organizations, conducts community listening sessions to identify priorities for health equity policies.

A guide for health care organizations on evidence-based strategies to implement food and nutrition security programs.

California leveraged Medicaid waiver authority to cover targeted pre-release services with the goal of improving the health of people reentering the community after incarceration.

Recommendations for policymakers, health plans, and providers on implementing medically tailored meals programs.

This report highlights challenges of network-based contracting between health care entities and community-based organizations and shares tips for successful implementation.

Well-designed bidirectional community and referral pathways may help bridge the community-clinic divide.

Embedded peer navigators provide support and mentorship for people experiencing homelessness, leading to increases in chronic disease screening and referrals.

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

Social and legal services to address health care costs and utilization may be most effective for individuals with moderately high utilization who are less clinically complex.

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.

Partnerships between health care organizations and AAAs can benefit from a clear understanding of internal capabilities and external environmental factors.

Accountable care organization leaders share perspectives on payment mechanisms used with social service organizations, challenges experienced, and the impacts of these partnerships.

AAAs and other community-based organizations can take key steps to improve their capacity for cross-sector partnerships to address health-related social needs of older adults.