Displaying 21 - 36 of 36

Substance Use Disorders and Diabetes Care: Lessons From New York Health Homes

A Medicaid health home care management program led to improved diabetes care, benefitting people with co-occurring substance use disorders and diabetes.

Peer-Reviewed Article

June 2021

The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization

Home-based palliative care program implemented within an accountable care organization created cost savings through reduced hospital admissions and increased hospice length of stay.

Peer-Reviewed Article

September 2021

A Practical Guide to Expanding Home-Based Primary Care with Telehealth

Tools, tips, and vignettes for incorporating telehealth into home-based primary care models.

Implementation Tool

December 2019

“At Home, with Care”: Lessons from New York City Home-Based Primary Care Practices Managing COVID-19

Home-based primary care programs made rapid care delivery adaptations in response to the COVID-19 pandemic, and this flexibility may support new opportunities to care for older, medically complex patients safely in their homes.

Case Example

January 2021

Evaluation of the Independence at Home Demonstration: An Examination of the First Five Years

Federal home-based primary care demonstration showed mixed results on measures related to Medicare savings, care quality, and utilization for Medicare-only and dually eligible beneficiaries.

Brief/Report

March 2020

Supporting Acute Advance Care Planning with Precise, Timely Mortality Risk Predictions

Implementing a predictive model in acute settings can more reliably identify patients with high mortality risk, which can assist providers in prioritizing advance care planning.

Peer-Reviewed Article

March 2021

Operational Guide to Identify, Understand, and Treat High-Need Patients

Offers a practical framework for safety-net health systems to better identify and segment patients with complex needs, and tailor care models to meet their needs.

Implementation Tool

September 2020

Aligning Social and Health Care Services: The Case of Community Care Connections

Demonstrates that a program assisting older adults with complex needs in navigating medical and social services may lower acute care utilization.

Peer-Reviewed Article

November 2020

Establishing Partnerships between Health Systems and Community-Based Organizations to Address Social Needs: First-Hand Perspectives from New York City

Features perspectives from leaders at Mount Sinai Health System and AIRnyc, a community-based organization that employs community health workers, on the opportunities and challenges of their partnership when it comes to addressing social needs.

Blog

December 2020

How Community Health Workers and Promotores Can Support Individuals with Complex Needs amid COVID-19

Explored opportunities for health systems and plans to work with CHW/Ps to support high-need individuals, with a focus on addressing the long-term impacts of the COVID-19 pandemic.

Webinar

July 2020

A Beacon for Dark Times: Palliative Care Support During the Coronavirus Pandemic

Hospital system call line expands access to palliative care supports amid COVID-19.

Peer-Reviewed Article

May 2020

Identifying Patients with Increased Risk of Severe Covid-19 Complications: Building an Actionable Rules-Based Model for Care Teams

Provider-based model identifies patients at highest risk for complications from COVID-19.

Peer-Reviewed Article

May 2020

Impact of Supportive Housing on Substance Use-Related Health Care Utilization Among Homeless Persons who are Active Substance Users

Supportive housing placement for people with substance use disorder (SUD) who are homeless reduces SUD-related health care utilization.

Peer-Reviewed Article

April 2019

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

Toward a Serious Illness Program Design and Implementation Framework

This framework can help you design programs for patients with serious illnesses.

Peer-Reviewed Article

August 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

Search

Search

Topics

Population

Audiences

Content Type

State

Substance Use Disorders and Diabetes Care: Lessons From New York Health Homes

The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization

A Practical Guide to Expanding Home-Based Primary Care with Telehealth

“At Home, with Care”: Lessons from New York City Home-Based Primary Care Practices Managing COVID-19

Evaluation of the Independence at Home Demonstration: An Examination of the First Five Years

Supporting Acute Advance Care Planning with Precise, Timely Mortality Risk Predictions

Operational Guide to Identify, Understand, and Treat High-Need Patients

Aligning Social and Health Care Services: The Case of Community Care Connections

Establishing Partnerships between Health Systems and Community-Based Organizations to Address Social Needs: First-Hand Perspectives from New York City

How Community Health Workers and Promotores Can Support Individuals with Complex Needs amid COVID-19

A Beacon for Dark Times: Palliative Care Support During the Coronavirus Pandemic

Identifying Patients with Increased Risk of Severe Covid-19 Complications: Building an Actionable Rules-Based Model for Care Teams

Impact of Supportive Housing on Substance Use-Related Health Care Utilization Among Homeless Persons who are Active Substance Users

Strengthening Medicaid Long-Term Services and Supports: A Toolkit for States

Toward a Serious Illness Program Design and Implementation Framework

Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Annual Report - Year Three