Complex Care Innovation In Action

resource Center for the Urban Child and Healthy Family at Boston Medical Center: A New Pediatric Care Model to Help Children and Families Thrive Describes the Center for the Urban Child and Healthy Family at Boston Medical Center’s Pediatric Practice of the Future,...

April 2022

resource Hill Country Community Clinic: Integrating Substance Use Treatment and Support into Primary Care Highlights Hill Country Community Clinic’s approach to whole-person care integrates substance use disorder (SUD) services into primary care by...

April 2022

resource Johns Hopkins HealthCare and Johns Hopkins Children’s Center: Expanding Interdisciplinary Teams to Care for Patients with Complex Needs Shares how programs at Johns Hopkins HealthCare and Johns Hopkins Children’s Center employ community health workers, case managers, and...

April 2022

resource Developing Relationships with Patients through Care Management Assessments Details the creation of a relationship-centered, comprehensive care management screening process at Maimonides Medical Center’s Department of Population Health...

January 2022

resource Uncovering Community Priorities for Improving Health Care by Involving Residents in the Research Process: Community Care of Brooklyn Describes Community Care of Brooklyn’s approach for engaging community members to more effectively identify local challenges and collaboratively develop...

January 2020

resource Housing for Health: Creating a Permanent Supportive Housing Program to Help People with Complex Conditions Experiencing Homelessness Outlines Housing for Health’s approach to improve health outcomes for people experiencing homelessness by integrating housing supports with primary...

January 2020

resource Piloting Voice Technology to Improve Care and Independence for People with Complex Needs Highlights Commonwealth Care Alliance’s Digital Health Pilot that is using voice technology to improve health care access, safety, and...

January 2020

resource Southwestern Pennsylvania: Peers Help People with Substance Use Disorders Move Toward Recovery Explores how Allegheny County is successfully using people in recovery to build rapport and coordinate outpatient treatment for individuals...

July 2018

resource AccessHealth Spartanburg: Wrap-Around Community Support for South Carolina’s Most Vulnerable Patients Focuses on AccessHealth’s community case managers, who connect uninsured adults in Spartanburg County, South Carolina, to primary care providers...

May 2018

resource ThedaCare: Leveraging Community Paramedics to Bridge Persistent Gaps in Care Features ThedaCare’s community paramedicine program, which deploys paramedics to the homes of medically and socially complex patients to review...

May 2018

resource Virginia Commonwealth University Health System: Beyond the Walls and Into Communities Examines VCU Health’s TakeCCARE program, which uses “hotspotting” and “coldspotting” techniques to identify areas in Richmond, Virginia, for targeted...

October 2017

resource Mountain-Pacific Quality Health Pilot: Closing the Gaps in Rural Complex Care Looks at Mountain-Pacific’s ReSource Team program, which uses technology to remotely connect high-need patients in Montana's hard-to-reach rural and...

October 2017