Resources

Blueprint for Complex Care: Advancing the Field of Care for Individuals with Complex Health and Social Needs

This resource outlines the current state of complex care and recommendations for the future. 

A New Hospitalist Model for Managing High-Cost, High-Need Patients

This resource describes a promising new hospitalist model for inpatient treatment of complex care patients.

Going Beyond Clinical Care to Reduce Health Care Spending

This resource describes a study of the Johns Hopkins Community Health Partnership (J-CHiP), which was created as a regional approach to health care transformation in Baltimo

Patient Engagement in ACO Practices and Patient-Reported Outcomes Among Adults with Co-Occurring Chronic Disease and Mental Health Conditions

This resource describes a study assessing the effects of patient activation and engagement strategies on patient-reported outcomes for patients with diabetes and/or cardiovascular

Patterns of Collaboration among Health Care and Social Services Providers in Communities with Lower Health Care Utilization and Costs

This resource describes a study of how health care providers and social services providers coordinate their work in communities that achieve relatively low health care utili

Impact of Primary Care Intensive Management on High-Risk Veterans’ Costs and Utilization

This resource describes a randomized quality improvement trial that assessed whether augmenting usual primary care with team-based intensive management lowers utilization and cost

Case Managers for High-Risk, High-Cost Patients as Agents and Street-Level Bureaucrats

This resource reviews the literature on case management programs published over the past 17 years, arguing that application of two theories (agency and street-level bureaucratic t

Medicare Advantage Flexibility: Improving Care for Seriously Ill Beneficiaries

This resource describes recent changes in Medicare Advantage (MA) and their implications for plans.

Persistence and Drivers of High-Cost Status Among Dual-Eligible Medicare and Medicaid Beneficiaries

This resource analyzes the drivers of cost for Medicare-Medicaid beneficiaries, particularly looking at the differences between persistent and transient high costs.

Academic Medical Centers and High-Need, High-Cost Patients: A Call to Action

This resource reviews efforts of academic medical centers (AMCs) to improve care for patients with complex needs, and the opportunities for AMCs to contribute to better care throu

Active Redesign of a Medicaid Care Management Strategy for Greater Return on Investment: Predicting Impactability

This resource describes the evolution of complex care management targeting strategies in Community Care of North Carolina’s (CCNC) work with the statewide non-dual Medicaid popula

Integrating Health Care for High-Need Medicaid Beneficiaries With Serious Mental Illness and Chronic Physical Health Conditions at Managed Care, Provider, and Consumer Levels

This resource assesses HealthChoices HealthConnections, an integration pilot program for Medicaid beneficiaries with SMI and co-occurring chronic conditions in t

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Find curated resources about promising approaches to improving care for people with complex needs.