New Mexico’s model to deploy community health workers is now replicated in 12 states.

This report presents the findings from the evaluation of Medicaid health homes, created as part of the Affordable Care Act.

The National Academy of Medicine offers a synthesis of the evidence for improving care for high-needs patients.

A study of five programs identified key factors that support collaboration among community-based health and social services.

Difficulty with activities of daily living is a major cost driver in health care that is typically overlooked.

Improving care for high-need, high-cost patients is a key lever to decrease national health spending.

There are many promising strategies to segment individuals with complex needs. Here is one conceptual framework.

Examines a unique program that seeks to integrate medical, behavioral health, and social services for dual eligible individuals with serious mental illnesses, substance abuse problems, or disabilities.

Dual-eligible beneficiaries are often more sick, have greater functional and cognitive impairments, and require more care coordination.

Provider incentives must be based on Triple Aim outcomes.

Experts describe how delivery systems can effectively serve adults with complex needs.

The U.S. had the highest rate of cost-related access problems.

By closing gaps in care, a safety-net ACO has reduced medical costs for Medicaid patients with complex needs.

Successful long-term services and supports programs have a single point of accountability, such as a care manager.

A three-pronged strategy can help manage care for Medicare beneficiaries.

A study showed that some programs reduced hospitalizations by 8 to 33 percent.

Interdisciplinary teams provide support for Medicaid beneficiaries with mental illnesses, addictions, and other needs.

Key opportunities include strengthening information technology connections across service providers.