Resources

Melanie Bella, former director of the Medicare-Medicaid Coordination Office at the Centers for Medicare & Medicaid Services, explores implications of COVID-19 to influence the future landscape for integrating Medicare and Medicaid services.
Whole Person Care (WPC) pilots, under California’s Medicaid Section 1115(a) waiver demonstration, integrate medical, behavioral health, and social needs services to improve the health and wellbeing of...
Health care organizations are increasingly partnering with Area Agencies on Aging (AAAs) to provide social needs support for older adults in the community who are identified with high health risks...
Effective patient-centered case management interventions can potentially improve health and social outcomes for individuals experiencing homelessness or housing instability. This literature review...
When the COVID-19 pandemic struck, One Community Health partnered with OCHIN to rapidly transform its care delivery model, implementing new virtual care tools to safely and effectively serve vulnerable patients with complex needs through the pandemic and beyond.
Across the nation, health care stakeholders — including providers, purchasers, health care systems, and community-based organizations — are changing how they operate to confront COVID-19...
To improve health outcomes and reduce health care costs and utilization for people with complex needs, it is important to understand the underlying social and behavioral issues that may be driving...
Engaging patients in shared decision-making requires providers to integrate patient-identified goals into patient-provider communications. This qualitative study explored how high-need, high-cost...
Features a conversation with Terry Fulmer, president of the John A. Hartford Foundation, who discusses potential solutions for older adults experiencing social isolation and loneliness — both during and after the COVID-19 pandemic.
Many older adults experience loneliness, which can lead to harmful impacts on mental as well as physical health. This literature review evaluated the effectiveness of published studies of...
While high-cost patients include diverse subgroups with varying clinical and social needs, efforts to improve the efficiency of care and target interventions have been limited by the lack of knowledge...
Many older adults in the United States experience social isolation and loneliness, which are associated with increased risks for premature mortality, dementia, and other poor health outcomes. Since...