Findings from a literature review and state interviews share experiences and outcomes of implementing Medicaid accountable care organization programs.

A food bank-based intervention improved food security and health status for individuals at risk for type 2 diabetes.

A produce prescription program leads to improvements in blood pressure and A1c levels and reductions in food insecurity for people with or at risk of type 2 diabetes.

Evaluation of a diabetes-focused medically tailored meals pilot demonstrates improved health outcomes and provides examples of key implementation tools.

Nurse assessments of discharge readiness for older patients with multiple chronic conditions can help identify patients at high risk for hospital readmission.

Recommendations to inform the design and implementation of a new Medicaid Advisory Committee.

A primary care-based integrated care team supports patients with type 1 or type 2 diabetes in reducing A1c levels.

A care management model designed to center patients’ health priorities shows promising results.

A home-based primary care program for homebound older adults leads to reductions in health care utilization and overall cost savings.

A street medicine program increased post-hospitalization follow-up care for unsheltered individuals experiencing homelessness in Los Angeles.

Rethinking eligibility, beyond cost and utilization, offers a more equitable approach to identify high-need individuals for care management.

Randomized controlled trial of a person-centered housing intervention for older adults shows improved health outcomes for formerly homeless adults living in permanent supportive housing.

Well-designed bidirectional community and referral pathways may help bridge the community-clinic divide.

A health plan-led telepsychiatry program for older adults can address the shortage of psychiatrists to improve outcomes related to depression and access to mental health care.

Study details permanent supportive housing program implementation and how this impacts outcomes and costs.

One health plan’s approach to addressing racial and ethnic disparities in medication adherence rates offers insights on levers to address racial inequities.

Case managers noted establishing trust, fostering mindset changes, and increasing stability and independence can be measures of success when working with people with complex needs.

Guide for hospitals to address housing instability by understanding the evidence, evaluating different approaches, and exploring case studies of health system-led programs.

Shared practical implementation considerations that can support health plans and provider groups in developing community-based models of care that use the strengths of social workers and community health workers.

Patients and community health workers (CHWs) share perspectives on the impact of CHW services provided within a primary care setting to address barriers to equitable care.