Natural language processing of patient visit notes can help providers identify social factors that may lead to health care utilization for older adults with multiple chronic conditions.

Patients with higher ACEs scores or positive PTSD screenings felt stress when seeking medical care, but indicated trauma-informed treatment approaches would relieve this stress.

Describes a primary care organization’s approach to using machine learning versus provider judgement to assign primary care visit frequency and better identify future risk of hospitalization and medical cost.

Summarizes research on the prevalence of social screening in health care settings, validity of social screening tools, and patient and provider perspectives on social screening.

Analytical approach for randomized controlled trials may be valuable for understanding the impact of complex care interventions and the subpopulations that may benefit from them.

Black caregivers of people with dementia share their perspectives on a care coordination intervention.

Partnerships between health care organizations and AAAs can benefit from a clear understanding of internal capabilities and external environmental factors.

Virtual collaborative care intervention demonstrates an approach to improve medication adherence and health outcomes.

Case managers noted establishing trust, fostering mindset changes, and increasing stability and independence can be measures of success when working with people with complex needs.

While the Medicare hospice benefit has historically been designed to meet the needs of patients with cancer, people with dementia and their caregivers experience better outcomes when enrolled in hospice.

A short-term emergency department navigator program helped address acute care utilization for individuals with low baseline utilization through primary care follow up appointments and assistance with social needs.

Medicaid enrollees in a community health worker program had fewer emergency department visits and more outpatient ambulatory care use than beneficiaries who received usual care.

Medicare beneficiaries with dementia, especially Black and Hispanic patients, often receive poor quality end-of-life care.

A "virtual-first" transitional care program with an interdisciplinary care team can support reduced readmissions.

Details how two health plans in California developed programs to transition dually eligible members from institutional settings back into their communities.

With the steep increase in use of telehealth and video visits in the last few years, the reliance on technology-enabled medicine may heighten disparities in health care access.