Nearly 12 million individuals are enrolled in both Medicare and Medicaid. This “dually eligible” population face significant challenges in receiving well-coordinated care that is aligned with their needs.

Dr. Neglia and The Holston Medical Group have established a unique program that cares for acutely ill patients in an ambulatory setting even though their illnesses would qualify for an inpatient hospitalization.

For the past 20 years, the fundamentals of health care delivery have remained largely unchanged. Health plans rely on cost-shifting and utilization management to bend the cost curve, and doctors and hospitals accept lower prices in exchange for increased patient volumes.

Andrew McClure of Senior Whole Health, a Magellan company, discusses his work around aligning quality measurement and improvement and offers insight on what drove the success of this partnership between medical group providers and this special needs health plan.

Describes the implications of Title III of the Bipartisan Budget Act of 2018, which containes a series of landmark provisions for advancing the integration of Medicare and Medicaid and for improving care for persons with complex chronic conditions.

A new care delivery model of providing hospital-level services in the home (sometimes referred to as “home hospitalization” or “hospital at home”) has been launching with pilots at a number of health systems nationally.

To achieve the quality and cost outcomes we seek, Medicare and Medicaid services must be coordinated through one unified plan. And in some cases, this is already happening.

Walks through some of the most common barriers to treating and referring patients with substance abuse disorder in the emergency department and how to address these challenges.

Looks at how the Keystone ACO partnership, serving residents of 41 primarily rural Pennsylvania counties as well as parts of New York, New Jersey and Maryland, is using community health workers to improve the quality and cultural competence of service delivery.

The Program of All-Inclusive Care for the Elderly provides comprehensive, compassionate medical care and long-term services and supports to older adults with persistent complex needs who are eligible for nursing home care. Yet, PACE reaches less than two percent of those who could benefit from its services.

The dialogue on caring for patients with complex needs has moved beyond a recognition that social factors like housing or nutrition have an outsize impact on health to practicalities. Now, health care providers are asking: what can we actually do to help?

Explores how complex care program leaders can make a case for the value of their programs to senior management, and how to initiate a conversation with payers on how funding these programs can be beneficial for both parties.

The program, known as Community Aging in Place — Advancing Better Living for Elders (CAPABLE), is a client-directed home-based intervention to increase mobility, functionality, and capacity to “age in place” for older adults.

Congress recently passed a federal budget incorporating the CHRONIC Care Act that capitalizes on and grows early successes in many of these programs.

Many studies have highlighted the importance of effective interprofessional care teams to improve health outcomes for people with complex needs. But many programs do not take advantage of the special training of social workers to meet these needs on their primary health care teams.

It is relatively common knowledge among those that treat patients in a hospital setting that addiction-related issues are the number-one driver of extended length of stay, 30-day readmissions, and job-related dissatisfaction and burnout.

Effective complex care means first understanding the individual and the challenges they face in their day-to-day lives. Here are two stories of patients in the CareMore Touch program for people with institutional special needs.

Addiction is a chronic neurobiological disorder that is predictable, identifiable, and treatable. Dr. Corey Waller explains why evidence-based treatment needs to be in hospitals, primary care, stand-alone rehabs, and throughout the ecosystem of health care.

Organizations, whether non-profit or for-profit, need a return on investment in order to carry this work forward and continue to invest in innovation.

Discusses the Blueprint for Complex Care — a joint project of the National Center for Complex Health and Social Needs, the Center for Health Care Strategies, and the Institute for Healthcare Improvement — which is acting as a strategic plan for the emerging field of complex care.