The Opioid Use Disorder Prevention Playbook Strategies for preventing opioid use disorder. Implementation Tool February 2019
How a Population-Based Approach Can Improve Dementia Care Improving Dementia Care Case Example May 2019
Towards a Learning Health System to Reduce Emergency Department Visits at a Population Level Predictive modeling to reduce ED utilization. Peer-Reviewed Article December 2018
Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study The psychological benefits of case management. Peer-Reviewed Article May 2018
A case study exploring the effectiveness of an innovative “5Q Care Test” to determine whether patients with complex needs require health or social care Assessing post-discharge needs. Peer-Reviewed Article November 2019
Experiences of community-dwelling older adults living with multiple chronic conditions: a qualitative study Challenges and opportunities for older adults with multiple chronic conditions. Peer-Reviewed Article September 2019
Home Alone Revisited: Family Caregivers Providing Complex Care Includes national survey data on family caregivers and their experiences in managing complex medical and nursing tasks for their family members at home, as well as recommendations to improve the supports for family caregivers. Brief/Report April 2019
Identifying and Designing the Right Care Management Program: Insights from ACOs Four care management models for ACOs. Implementation Tool April 2019
Health Care Transformation Task Force Value Partnership Evaluation Tool A tool for assessing readiness for value-based partnerships. Implementation Tool March 2019
Outcomes of a Citywide Campaign to Reduce Medicaid Hospital Readmissions with Connection to Primary Care Within 7 Days of Hospital Discharge The importance of timely primary care follow-up. Peer-Reviewed Article January 2019
High-Need, High-Cost Personas An in-depth overview of different personas. Implementation Tool February 2019
Quick Reference Guide to Promising Care Models This resource is an updated quick reference guide to promising models for people with complex needs. Brief/Report February 2019
Outpatient Complex Case Management: Health System-Tailored Risk Stratification Taxonomy to Identify High-Cost, High-Need Patients Maximizing the impact of outpatient complex case management. Peer-Reviewed Article November 2018
Impact of a Complex Chronic Care Patient Case Conference on Quality and Utilization The case conference approach to caring for complex patients. Peer-Reviewed Article May 2018
Systematic Review of High-Cost Patients’ Characteristics and Healthcare Utilisation An international analysis of high-cost patients. Peer-Reviewed Article July 2018
Engaging High-Need Patients in Intensive Outpatient Programs: A Qualitative Synthesis of Engagement Strategies Overcoming barriers to patient engagement. Peer-Reviewed Article August 2018
How ACOs Are Caring for People with Complex Needs An analysis of the National Survey of ACOs Brief/Report December 2018
Interventions for Frequently Hospitalized Patients and Their Effect on Outcomes: A Systematic Review Mixed evidence for efforts to reduce rehospitalizations. Peer-Reviewed Article December 2018
Trauma-Informed Care Implementation Resource Center An online guide to trauma-informed care. Website/Resource Center January 2019