The proportion of low-income, frail, and medically complex individuals enrolled in Medicare Advantage is increasing.

Provider-based model identifies patients at highest risk for complications from COVID-19.

California’s Whole Person Care pilot can inform cross-sector initiatives to improve care for Medicaid enrollees with complex health and social needs.

Multisector partnerships that include Area Agencies on Aging may reduce health care use and spending.

Health care systems may need to tailor screening and referral approaches for social needs, as some needs may be less likely to be met by social service organizations.

Demonstrating return-on-investment to advance effective business relationships between community-based organizations and health care partners.

How can a community-based organization demonstrate the two-way financial benefits of partnering with a health plan?

Adults with complex, high-cost health care needs are more likely to have experienced social adversity in childhood and adulthood.

A community health worker program yielded an annual return of $2.47 for every dollar invested by a Medicaid payer.

Tips on integrating community health workers into quality improvement teams to address patients’ social needs.

The value of community health workers in advancing health equity.

Impact of social needs navigation program on future utilization of patients with prior high utilization.

A unique cross-sector partnership involving health care, police, and emergency services improved health care utilization in this rural health system pilot.

Recommendations for integrating social and health care to improve the nation’s health.

Community approaches to reducing care utilization and costs.

Moving patients out of the ED and into community support.

Guide for hospitals to address housing instability by understanding the evidence, evaluating different approaches, and exploring case studies of health system-led programs.

A permanent supportive housing program did not improve most measures related to physical health for individuals experiencing chronic homelessness, but did improve access to and trust in primary care.

An initiative to distribute tablets to high-need veterans successfully reached individuals with barriers to health care access.

A tool helps providers capture essential information when interviewing people experiencing unsheltered homelessness to support effective treatment planning.