States and health plans focused on engaging and sustaining the community health worker (CHW) workforce can use this blog post to understand emerging evidence around CHW programs for older adults.

Features a conversation with José Figueroa, MD, MPH, that explores emerging evidence behind integrated care programs and what is known about the impact of these programs on the populations they serve.

Profiles the Household Model, which creates home-like environments for nursing home residents to offer greater dignity, autonomy, and infection control, as well as establishes closer, more family-type relationships between residents and staff.

Features a conversation with two Southcentral Foundation leaders to learn how their approach to patient engagement has evolved over the years and the role it plays in improving care and advancing equity across their system.

Describes a new federal rule released in November 2023 to increase transparency in nursing home operations.

Explores how looking more deeply at the results of an underpowered randomized controlled trial using alternative analysis methods can uncover nuanced results or inform a program redesign.

Explores the challenges in data access and exchange in contracting between community-based organization networks and health care entities.

Stakeholders seeking to learn more about the evidence base and implementation tools for street medicine programs can explore the following Playbook resource summaries.

Explores intersectionality — the interaction of social identities and experiences — and its importance in addressing LGBTQ+ caregivers’ needs.

Examines how eliminating biased language in patient charts is a key step towards helping patients better engage in care and improve health equity.

Profiles a Boston Medical Center research program aimed at addressing disparity is substance use disorder treatment among Black patients.

Profiles Central City Concern, an FQHC in Portland, Oregon, that is providing services for people experiencing homelessness with substance use disorder — including primary care, behavioral health treatment, housing, and other supports.

Dawn Wiest, PhD, Director for Research and Evaluation at the Camden Coalition, discusses findings from an analysis of Camden Coalition’s care management program, which found that the program led to a significant reduction in hospital readmissions among engaged program participants.

Carl Rush, policy advisor on community health worker (CHW) initiatives in more than 20 states, discusses the CHW program policy landscape and what policymakers can do to advance these efforts for people with complex needs.

Highlights the Care Transitions Intervention (CTI), an evidence-based, short-term model that helps prevent unnecessary hospital readmissions and emergency department visits and reduce unnecessary spending.

Arianna Campbell, director and co-principal investigator for CA Bridge, discusses how the bridge model came about and how it works.

The Playbook’s summer reading list offers a selection of blog posts and evidence summaries that showcase innovative strategies for improving care for people with complex needs.

Aditi Vasan, MD, MSHP, a health services researcher, delved into how community health workers can be helpful to patients with complex health and social needs, based on current evidence.

Explores the evidence behind harm reduction strategies and shares practical steps for adopting this approach in health care settings.

Jennifer Babcock of the Association of Community Affiliated Plans discusses state efforts to promote sustainable financing for Medicaid health plans to address health-related social needs and how these efforts can result in better outcomes for people with complex care needs.