A telephone-based virtual senior center may help minimize social isolation and loneliness for older adults.

Promising approaches to reduce loneliness for older adults in community and institutional settings.

Adults with complex, high-cost health care needs are more likely to have experienced social adversity in childhood and adulthood.

High-need, high-cost older adult patients detail their health care goals, which may inform provider efforts to effectively engage with and care for these patients and their family caregivers.

Among high-cost Medicare enrollees, those who are seriously ill, frail, and/or had a serious mental illness experience the most potentially preventable spending.

Integrating medical, behavioral health, and social services data tells a fuller story of frequent emergency department users’ service utilization and may identify candidates for care coordination.

Individuals experiencing homelessness had health care spending 2.5 times higher than the comparison Medicaid population.

Ten common attributes for successful care management programs serving high-need, high-cost populations.

A community health worker program yielded an annual return of $2.47 for every dollar invested by a Medicaid payer.

Accountable care organizations must address key funding, community partnership, and data sharing requirements to successfully integrate social services into medical care.

Complex care management program for high-need, high-cost Medicaid patients demonstrates substantially lower spending and inpatient utilization.

Providing virtual case mentoring to outpatient care teams may reduce unnecessary hospital and emergency department visits for high-need, high-cost patients.

Connecting complex care teams with specialists through videoconferencing can increase their effectiveness in caring for high-need high-cost patients.

Randomized controlled trial of a care management intervention offers important lessons for the field of complex care.

Staff time effort in complex care coordination programs is highly variable depending on patients’ health and social needs.

Medicaid support for stable housing may reduce avoidable health care use and spending.

Using patient-self reported data instead of only utilization outcomes may enable better segmentation of older adults.

A unique cross-sector partnership involving health care, police, and emergency services improved health care utilization in this rural health system pilot.

Supportive housing placement for people with substance use disorder (SUD) who are homeless reduces SUD-related health care utilization.

Impact of social needs navigation program on future utilization of patients with prior high utilization.