The CHRONIC Care Act of 2018: Advancing Care for Adults with Complex Needs
A brief summarizes what you need to know about the new Chronic Care Act.
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Displaying 121 - 140 of 146
Designing a Health Care System for Patients with Complex Needs: Ten Recommendations for Policymakers
An international expert group offers ten policy recommendations and profiles of innovative care models.
Brief/Report
Accountable Care Atlas: A Development Guide for Competency Implementation
This resources describes the competencies organizations need to transition to value-based payment.
Implementation Tool
Competing Health Care Systems and Complex Patients: An Inter-Professional Collaboration
This paper describes competing health care systems can collaborate to improve care for overlapping patient populations.
Peer-Reviewed Article
Complex Care Models to Achieve Accountable Care Readiness: Lessons from Two Community Hospitals
Case studies of two community hospitals show how to advance accountable care.
Case Example
Nursing Student Coaches for Emergency Department Super Utilizers
Nursing students successfully coach patients with complex needs to avoid ED use.
Peer-Reviewed Article
Bending the Spending Curve: The Role of Care Management in a Pioneer ACO
ACOs have lowered costs for high-need patients through care management programs focused on modifiable spending.
Peer-Reviewed Article
Diffusion of Community Health Workers Within Medicaid Managed Care: A Strategy to Address Social Determinants of Health
New Mexico’s model to deploy community health workers is now replicated in 12 states.
Case Example
Complex Care Program Development: A New Framework for Design and Evaluation
A new framework outlines four steps to develop care management programs.
Brief/Report
Development of a Care Guidance Index Based on What Matters to Patients
The What Matters Index measures quality of life for people with chronic conditions.
Peer-Reviewed Article
Effective Care for High-Need Patients: Opportunities for Improving Value, Outcomes and Health
The National Academy of Medicine offers a synthesis of the evidence for improving care for high-needs patients.
Brief/Report
Bridging the Silos of Service Delivery for High-Need, High-Cost Individuals
A study of five programs identified key factors that support collaboration among community-based health and social services.
Peer-Reviewed Article
So Many Options, Where Do We Start? An Overview of the Care Transitions Literature
A systemic review of transitional care interventions reporting hospital readmission
Peer-Reviewed Article
Innovative Home Visit Models Associated with Reductions in Costs, Hospitalizations, and Emergency Department Use
Home visits can reach patients with complex needs before a higher level of care is needed
Peer-Reviewed Article
The Health Resilience Program: A Program Assessment
Health Resilience Specialists work with the patients to meet their personal health needs
Case Example
How High-Need Patients Experience Health Care in the United States
This 2016 survey reveals that the health care system is failing people with complex needs
Brief/Report
Challenges and Opportunities in Caring for High-Need, High-Cost Medicare Patients
Analysis of care models that serve Medicare-only individuals detailing policy barriers to providing uncovered services and supports and proposed strategies to address them.
Brief/Report
Overview of Segmentation of High-Need, High-Cost Patient Population
There are many promising strategies to segment individuals with complex needs. Here is one conceptual framework.
Implementation Tool
Proactively Identifying the High-Cost Population
Segmenting the high-cost population is the first step in matching appropriate care management strategies.
Brief/Report
Developing Care Management Programs to Serve High-Need, High-Cost Populations
Care management programs should include processes for evaluating patient-reported outcomes.
Brief/Report