Care team models with more nurse practitioners and physician assistants than physicians are associated with increased primary care and geriatrics services provision and reduced labor costs.

Segmentation framework with publicly available code files identifies specific and actionable patient cohorts with complex needs.

Understanding the values of patients with complex health and social needs can help providers improve care.

CAPABLE, a home-based care program that provides interdisciplinary services for older adults, leads to reductions in disability as well as cost savings.

Person-centered integrated care models designed to respond to the priorities of people dually eligible for Medicare and Medicaid are more likely to increase and sustain enrollment.

Looked at the provider and payer relationship and discussed how successful partnerships between these two stakeholders can create sustainable and efficacious home and community based palliative care programs.

A cross-sector partnership to enroll older adults experiencing homelessness in permanent supportive housing led to meaningful reductions in health care costs.

Analysis of 310 health systems showed gaps in opioid receipt between Black and white patients, especially on dosage, which may be related to racial bias among clinicians.

Contains practical guides, tools, and other resources for developing complex care programs.

Profile of a geriatric emergency department model for older adults with complex needs includes sample policies and workflows as well as recommendations to support effective implementation.

Community health worker-led interventions for older adults with complex needs show evidence of improving participant mood and functional outcomes.

Aligned D-SNP enrollment was associated with more efficient service use among some dually eligible beneficiaries.

Clearly defining characteristics of complex populations is essential for effective complex care intervention design.

Case studies and lessons from evidence-based interventions to address social isolation and loneliness in older adults.

Home-based program provided by a community health and social worker reduces acute care use and improves care for older adults with complex health and social needs.

A care coordination and palliative care intervention for adults with complex needs was associated with significantly reduced short-term mortality.

Includes patient- and staff-reported measures to help complex care programs better understand the impacts of interventions.

Health care organizations can use population-level data sources about the experiences of people with disabilities to improve care.

Tools, tips, and vignettes for incorporating telehealth into home-based primary care models.

Downloadable tools, tip sheets, sample forms, and how-to guides on home-based primary care, with a focus on clinical and operational best practices.