This report highlights challenges of network-based contracting between health care entities and community-based organizations and shares tips for successful implementation.

An interdisciplinary home-based primary care program for older adults with limited mobility leads to reductions in health care utilization and costs.

An expert panel proposed key principles for designing care navigation programs for persons living with dementia and their caregivers.

Homeless-tailored primary care clinics within Veterans Affairs facilities improved depression care for people experiencing homelessness.

A primary care practice redesigned its social needs screening and patient triage process to allow specialized staff to spend more time supporting patients with more intensive housing needs.

Insights from patient-level encounter histories can support optimizing care coordination team staffing for high-need patients.

Secondary analysis of Camden Coalition randomized controlled data found that care management participants who were the most likely to engage with the intervention had significantly lower readmission rates.

Care coordination services in primary care clinics are shown to reduce avoidable hospitalizations among persons living with dementia.

Curated collection of research studies highlights the efficacy of services provided by community-based organizations, with a focus on outcomes relevant to health care partners.

Randomized controlled trial measuring the impact of a community paramedicine model implemented in two rural counties shows reduction in emergency department visits.

Implementation of a high-dose care management intervention for patients with complex health and social needs can reduce hospitalization rates.

Enhanced primary care for adults with serious mental illness led to increases in primary care visits and health screenings as well as decreases in inpatient utilization.

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

Peer recovery coaches in emergency departments (ED) decreased subsequent ED utilization for patients with substance use disorders.

Barriers to community social services to address health-related social needs persist despite screening and referral programs in clinical settings.

Implementation of enhanced primary care can improve cardiometabolic health for people with serious mental illness.

This webinar highlighted one successful CBO-health plan partnership model to explore why they entered into a partnership, how they put their contract into practice, and outcomes of the partnership so far.

Primary care-based interventions that integrate community health and social care services can reduce the rate of avoidable hospitalizations.

The Patient-Centered Medical Home model shows positive impacts in health center settings including improved quality of care.

Screening, brief intervention, and referral to treatment combined with recovery management checkups can connect primary care patients to substance use disorder treatment.