This case study analyzes a successful example of a medical group partnering with a home health agency to provide community-based palliative care for high-risk members of their accountable care organization.

Details the main elements of a hospital-based addiction care consultation team.

Care model that integrates home-based primary care and palliative care for patients with serious illness reports reduced health care utilization and improved patient care experience.

Fostering a culture of caring for veterans takes interdisciplinary teams focused on comprehensive, trusting and reliable relationships through open and frequent communication and ongoing education.

A hospitalist model for complex care.

The case conference approach to caring for complex patients.

This resource describes the benefits of community health workers for people with multiple chronic conditions.

The VA shares lessons on workforce learning and development.

How to improve the cost benefits of case management.

New Mexico’s model to deploy community health workers is now replicated in 12 states.

Clinical Nurse Specialists are playing a greater role in palliative care, but evidence on their cost-effectiveness is mixed.

Home visits can reach patients with complex needs before a higher level of care is needed

Details the key considerations for providers considering integrating peer services for behavioral health into their health care organizations.

Nursing students successfully coach patients with complex needs to avoid ED use.

A home-based palliative care program using an interdisciplinary care team reduces hospital costs and unnecessary health care utilization for Medicare Advantage beneficiaries.

Stanford Coordinated Care provides university employees with complex health needs better care at a lower cost

Interdisciplinary teams provide support for Medicaid beneficiaries with mental illnesses, addictions, and other needs.

A home-based primary care program decreases costs and utilization for high-risk Medicare enrollees in Washington D.C.

A novel approach to home visiting delivers cost reduction and better care

A framework describes how to train the health care workforce to care for people with multiple chronic conditions.