Medical Care at Home Comes of Age
Provides an overview of home-based medical care models, the patients that they serve, and their robust evidence base.
Brief/Report
All Resources
All Resources
Topics
Populations
Audiences
Content Types
“Eyes in the Home”: Addressing Social Complexity in Veterans Affairs Home-Based Primary Care
Home-based primary care programs enable care teams to gain insights on a variety of social factors that impact older adults’ health, which allows them to better tailor care to meet patient needs.
Peer-Reviewed Article
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
Core Competencies for Frontline Complex Care Providers
Describes core competencies that convey the essential knowledge, skills, and attitudes of complex care practitioners and teams to improve care for people with complex needs.
Brief/Report
The PACE Response to COVID-19 Calls for Policy Actions Increasing Access and Affordability
Highlights PACE programs’ efforts to redesign care during the COVID-19 pandemic and presents policy options that may help to expand access to the programs in the future.
Blog
October 2020
A Systematic Review of Intensive Outpatient Care Programs for High-Need, High-Cost Patients
Demonstrates that intensive outpatient care programs show promise in reducing utilization and costs and improving patient outcomes for high-need, high-cost populations.
Peer-Reviewed Article
Practice Considerations for Trauma-Informed Care at End of Life
Applying principles of trauma-informed care for patients at end of life.
Peer-Reviewed Article
Evidence and Implementation Tools for Community Health Worker Programs: A Brief Resource Review
Shares a diverse set of recent resources for health care organizations interested in developing or expanding community health worker programs.
Blog
August 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
Improving Care for High-Need, High-Cost Patients: The View from a Community Health Worker and a Social Worker
A community health worker and social worker from CareMore Health share their perspective on the importance of their roles in lowering costs and improving outcomes for high-need patients.
Blog
July 2020
Effects of a Standardized Community Health Worker Intervention on Hospitalization Among Disadvantaged Patients with Multiple Chronic Conditions: A Pooled Analysis of Three Clinical Trials
Using community health workers can reduce hospitalizations in high-risk patients.
Peer-Reviewed Article
Age-Friendly Health Systems: Guide to Using the 4Ms in the Care of Older Adults
Step-by-step guide with robust tools for health systems to apply the 4Ms framework to deliver age-friendly, evidence-based care for older adults.
Implementation Tool
Caring for Older Adults with Complex Needs in the COVID-19 Pandemic: Lessons from PACE Innovations
Highlighted innovations adopted by PACE organizations during the pandemic to provide care for older adults with complex needs.
Webinar
Use of General Primary Care, Specialized Primary Care, and Other Veterans Affairs Services Among High-Risk Veterans
Integrated health care systems can better support high-risk patients by embedding high-risk patient care within general primary care and mental health care.
Peer-Reviewed Article
Demonstrated Health Care Cost Savings for Women: Findings from a Community Health Worker Intervention Designed to Address Depression and Unmet Social Needs
CHW intervention reduced health care costs and utilization for low-income women with depression.
Peer-Reviewed Article
The Effects of an Enhanced Primary Care Model for Patients with Serious Mental Illness on Emergency Department Utilization
Enhanced primary care for Medicaid enrollees with serious mental illness can help decrease emergency department use over time.
Peer-Reviewed Article
Embedding Social Workers In Veterans Health Administration Primary Care Teams Reduces Emergency Department Visits
Social workers on rural primary care teams may help decrease high-risk veterans’ acute care use.
Peer-Reviewed Article
Where is the Break-even Point for Community Health Workers? Using National Data and Local Programmatic Costs to Find the Break-even Point for a Metropolitan Community Health Worker Program
Community health worker programs can offset program costs through reduced utilization.
Peer-Reviewed Article
Impact of Complex Care Management on Spending and Utilization for High-Need, High-Cost Medicaid Patients
Complex care management program for high-need, high-cost Medicaid patients demonstrates substantially lower spending and inpatient utilization.
Peer-Reviewed Article
Beyond the Camden Coalition’s Randomized Controlled Trial: Lessons for the Complex Care Field on Addressing Patient Needs
Features David Labby, MD, health strategy advisor for Health Share of Oregon, who provides insights on the recently released report on Camden Coalition's randomized controlled trial on the Camden Core Model.
Blog
February 2020