Overview of Segmentation of High-Need, High-Cost Patient Population There are many promising strategies to segment individuals with complex needs. Here is one conceptual framework. Implementation Tool January 2016
Targeting Socially Isolated Older Adults: A Process Evaluation of the Senior Centre Without Walls Social and Educational Program A telephone-based virtual senior center may help minimize social isolation and loneliness for older adults. Peer-Reviewed Article December 2015
Supporting a Culture of Health: Opportunities to Improve Models of Care for People with Complex Needs Key opportunities include strengthening information technology connections across service providers. Brief/Report September 2015
Utilization of Hot Spotting to Identify Community Needs and Coordinate Care for Patients in Memphis, TN The approach identifies patients through chart review and data analytics coupled with the intelligence of community health workers. Peer-Reviewed Article February 2014
Medical Respite Programs for Homeless Patients: A Systematic Review Systematic review finds that medical respite programs reduce acute care utilization outcomes for people experiencing homelessness. Peer-Reviewed Article May 2013
Six Features of Medicare Coordinated Care Demonstration Programs that Cut Hospital Admissions A study showed that some programs reduced hospitalizations by 8 to 33 percent. Peer-Reviewed Article June 2012