This resource is based on phone interviews with health plans, policymakers, researchers, clinicians, and community-based organizations.

• The report synthesizes successful strategies in six domains: care model enhancements, financing and accountability, data and analytics, workforce development, governance and operations, and policy and advocacy.
• Key opportunities include strengthening information technology connections across service providers, providing patients with better support in navigating the system, and creating risk-adjustment methods that account for social as well as medical needs.