Resources

This resource is a toolkit highlighting innovative care coordination strategies used by Medicare ACOs.

This resource is a toolkit for identifying patients with various physical, functional, emotional, social, and spiritual needs.

This resource, the Accountable Care Atlas, is intended to help health care delivery systems identify and prioritize the

This resource is a Disability-Competent Care Self-Assessment Tool.

To help improve care for people with multiple chronic conditions, the U.S.

This resource offers a structured improvement process for redesigning care for people with complex needs and high health care costs.

This resource describes how to develop and implement a model called the Intensive Outpatient Care Program, which uses a multidisciplinary team-based approach to address medical, behavioral, and soc

This resource harvests the lessons learned from eight health care organizations that successfully developed programs for individuals with multiple chronic conditions and functional limitations.

This resource describes how to design, implement, and assess a “super-utilizer” (SU) program to address inappropriate care and reduce costs.