A collaborative interprofessional dementia care program significantly improved the timeliness of diagnosis compared to traditional clinics and achieved high satisfaction rates among staff, patients, and caregivers.

Medicaid enrollees in a community health worker program had fewer emergency department visits and more outpatient ambulatory care use than beneficiaries who received usual care.

Shared practical implementation considerations that can support health plans and provider groups in developing community-based models of care that use the strengths of social workers and community health workers.

Resources to help organizations develop and improve medical respite programs for people experiencing homelessness.

State investments in enhanced primary care for older and chronically ill individuals recently released from incarceration yielded a $2.55 return on investment for Medicaid and criminal justice combined.

This study identifies facilitators and barriers of hospital- and community-based harm reduction collaboration efforts and highlights hospital-based opportunities to better serve people who use drugs.

Care management interventions for people transitioning from behavioral health inpatient care may be successful in decreasing readmissions if they address health-related social needs.

Community-based care management programs for patients with complex health and social needs have the potential to reduce hospitalizations and inpatient costs.

Virtual collaborative care intervention demonstrates an approach to improve medication adherence and health outcomes.

Patients with complex needs were more satisfied with in-home urgent care delivered by community paramedics than with emergency department urgent care.

Primary care medical home improved use of preventive services, chronic illness care, care experience, psychotic symptoms, and mental health-related quality of life for people with serious mental illness.

Peer recovery coaching intervention for hospitalized people with substance use disorder led to mixed acute care utilization outcomes.

Describes a primary care organization’s approach to using machine learning versus provider judgement to assign primary care visit frequency and better identify future risk of hospitalization and medical cost.

A hospital successfully integrated a harm reduction services intervention for patients whose substance use goals did not include abstinence.

A hospital-based program showed that peer recovery coaching can be seamlessly integrated into the workflow of busy emergency departments to address the longer-term needs of people with substance use disorders.

Behavioral health home model is associated with long-term changes in health services utilization for people with serious behavioral health conditions.

Interdisciplinary primary care models can help reduce acute care use for individuals with histories of high emergency department use, homelessness, or substance use disorder.

Care management interventions demonstrated improvements in mental health, quality of life, and patient satisfaction as well as reduced psychiatric inpatient days for people with serious mental illness.

Patients and community health workers (CHWs) share perspectives on the impact of CHW services provided within a primary care setting to address barriers to equitable care.

A participatory design approach created a nurse-driven screening process to better identify and treat people with opioid use disorder in the emergency department.