Building Complex Care Programs: A Road Map for States This guide for state leaders offers lessons about state-level approaches to complex care. Implementation Tool October 2017
Care Management Contracting for Complex Populations: Best Practices and Tools This resource offers guidance on contracting for populations with complex needs. Implementation Tool July 2018
Medicaid Managed Care Best Practices Compendium This resource collects the most innovative initiatives in Medicaid managed care that emerge each year. Brief/Report January 2017
Investing in Social Services as a Core Strategy for Healthcare Organizations: Developing the Business Case This resource explains how to invest in social services as a business strategy. Implementation Tool March 2018
Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patients This brief describes new ways for health care to address social determinants of health. Brief/Report January 2018
Leveraging the Social Determinants of Health: What Works? This literature review assesses the impact of social service interventions. Peer-Reviewed Article August 2016
Ten Questions to Better Understand and Serve Your Complex Care Population California is asking Medicaid patients these ten questions about social and functional needs. Brief/Report April 2018
Strengthening Medicaid Long-Term Services and Supports: A Toolkit for States This resource explains how states can improve their Medicaid LTSS systems. Implementation Tool March 2019
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. Brief/Report March 2018
Compendium of Five Case Studies: Lessons for Interprofessional Teamwork The VA shares lessons on workforce learning and development. Brief/Report September 2017
Laying the Groundwork for Trauma-Informed Care How organizations can transition to trauma-informed care. Brief/Report January 2018
Restoring Dignity for Vulnerable Populations: Changing the System for Complex Patients The benefits of holistic, team-based care go beyond medical needs. Case Example January 2016
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 September 2017
Accountable Care Atlas: A Development Guide for Competency Implementation This resources describes the competencies organizations need to transition to value-based payment. Implementation Tool November 2017
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 June 2017
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 March 2018
Nursing Student Coaches for Emergency Department Super Utilizers Nursing students successfully coach patients with complex needs to avoid ED use. Peer-Reviewed Article January 2017
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 May 2017
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 July 2017
Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Annual Report - Year Three This report presents the findings from the evaluation of Medicaid health homes, created as part of the Affordable Care Act. Brief/Report July 2015