Displaying 1 - 20 of 30

Improving Diabetes Control in a Medicaid Managed Care Population With Complex Needs

A primary care-based integrated care team supports patients with type 1 or type 2 diabetes in reducing A1c levels.

Peer-Reviewed Article

December 2023

Evaluating the Impact of a Mobile Integrated Health‒Community Paramedicine Program on Health-Related Social Needs and Hospital Readmissions.

Addressing care coordination and medication-related needs within a mobile integrated health care-community paramedicine program leads to a reduction in hospital readmissions.

Peer-Reviewed Article

November 2023

Catalyzing Alignment and Systems Transformation Through Cross-Sector Partnerships: Findings from the California Accountable Communities for Health Initiative

A multi-sector collaboration in California that included community members improved organizational partnerships and create systems change.

Peer-Reviewed Article

September 2023

Assessing the Impact of Recovery Housing on Healthcare Utilization in Portland, Oregon

Use of recovery housing leads to decreases in readmissions and emergency department visits among individuals recovering from substance use disorder, as well as increased use of primary care.

Peer-Reviewed Article

September 2023

Addressing Healthcare Utilization and Costs for Older Adults with Limited Mobility Through a Multidisciplinary Home-Based Primary Care Program

An interdisciplinary home-based primary care program for older adults with limited mobility leads to reductions in health care utilization and costs.

Peer-Reviewed Article

August 2023

Redesign of a Primary Care-Based Housing Intervention to Address Upstream Housing Needs

A primary care practice redesigned its social needs screening and patient triage process to allow specialized staff to spend more time supporting patients with more intensive housing needs.

Case Example

July 2023

Addressing the Complex Needs of Older Adults through Strong Community-Based Organization and Health Plan Partnerships

This webinar highlighted one successful CBO-health plan partnership model to explore why they entered into a partnership, how they put their contract into practice, and outcomes of the partnership so far.

Webinar

June 2023

Addressing Health-Related Social Needs Via Community Resources: Lessons From Accountable Health Communities

Barriers to community social services to address health-related social needs persist despite screening and referral programs in clinical settings.

Peer-Reviewed Article

May 2023

Community Health Worker Programs

Curates recent evidence behind community health worker programs that support people with complex health and social needs, as well as practical strategies to support effective implementation of these programs.

Collection

April 2023

Community Health Worker Integration with and Effectiveness in Health Care and Public Health in the United States

Community health worker interventions are effective for improving health behaviors and outcomes and reducing health care costs for people with chronic disease.

Peer-Reviewed Article

April 2023

Lifting the Veil How Networks Form Operate Struggle and Succeed

This report highlights challenges of network-based contracting between health care entities and community-based organizations and shares tips for successful implementation.

Brief/Report

April 2023

Building Bi-Directional Referral and Communication Pathways Across the Community-Clinic Divide Experiences from a Systems-Informed Innovation Project in Los Angeles

Well-designed bidirectional community and referral pathways may help bridge the community-clinic divide.

Case Example

March 2023

Community Health Worker Model Best Practice Toolkit for Designing, Implementing and Showing Impact

Toolkit provides best practices and practical tools for designing, implementing, and evaluating the impact of community health workers.

Implementation Tool

March 2023

Results of a Peer Navigator Program to Address Chronic Illness Among Persons Experiencing Homelessness

Embedded peer navigators provide support and mentorship for people experiencing homelessness, leading to increases in chronic disease screening and referrals.

Peer-Reviewed Article

February 2023

Observational Analysis of a Generalized, Health Plan-led Community Health Worker Intervention in Medicaid

Medicaid health plan-led community health worker program showed moderate evidence for increased outpatient care and primary care use.

Peer-Reviewed Article

January 2023

High Touch, High Trust: Using Community Health Advocates and Lawyers to Address ED High Utilizers

Social and legal services to address health care costs and utilization may be most effective for individuals with moderately high utilization who are less clinically complex.

Peer-Reviewed Article

July 2022

Street Medicine and Outreach: Bringing Care to People Where They Are

Report explores the definition and components of street medicine and outreach, as well as provides best practices for delivering this type of care.

Brief/Report

June 2022

Medical Respite Care Tool Kit

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

Implementation Tool

April 2022

Mechanisms for Community Health Worker Action on Patient-, Institution-, and Community-Level Barriers to Primary Care in a Safety-Net Setting

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.

Peer-Reviewed Article

January 2022

From the Hospital to the Streets: Bringing Care to the Unsheltered Homeless in Los Angeles

A street medicine program increased post-hospitalization follow-up care for unsheltered individuals experiencing homelessness in Los Angeles.

Case Example

September 2021

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Improving Diabetes Control in a Medicaid Managed Care Population With Complex Needs

Evaluating the Impact of a Mobile Integrated Health‒Community Paramedicine Program on Health-Related Social Needs and Hospital Readmissions.

Catalyzing Alignment and Systems Transformation Through Cross-Sector Partnerships: Findings from the California Accountable Communities for Health Initiative

Assessing the Impact of Recovery Housing on Healthcare Utilization in Portland, Oregon

Addressing Healthcare Utilization and Costs for Older Adults with Limited Mobility Through a Multidisciplinary Home-Based Primary Care Program

Redesign of a Primary Care-Based Housing Intervention to Address Upstream Housing Needs

Addressing the Complex Needs of Older Adults through Strong Community-Based Organization and Health Plan Partnerships

Addressing Health-Related Social Needs Via Community Resources: Lessons From Accountable Health Communities

Community Health Worker Programs

Community Health Worker Integration with and Effectiveness in Health Care and Public Health in the United States

Lifting the Veil How Networks Form Operate Struggle and Succeed

Building Bi-Directional Referral and Communication Pathways Across the Community-Clinic Divide Experiences from a Systems-Informed Innovation Project in Los Angeles

Community Health Worker Model Best Practice Toolkit for Designing, Implementing and Showing Impact

Results of a Peer Navigator Program to Address Chronic Illness Among Persons Experiencing Homelessness

Observational Analysis of a Generalized, Health Plan-led Community Health Worker Intervention in Medicaid

High Touch, High Trust: Using Community Health Advocates and Lawyers to Address ED High Utilizers

Street Medicine and Outreach: Bringing Care to People Where They Are

Medical Respite Care Tool Kit

Mechanisms for Community Health Worker Action on Patient-, Institution-, and Community-Level Barriers to Primary Care in a Safety-Net Setting

From the Hospital to the Streets: Bringing Care to the Unsheltered Homeless in Los Angeles