post Beyond Health Care: An Analysis of Cross-Sector Utilization and Costs among Hennepin County Medicaid Expansion Enrollees

Within publicly financed health care, there is a growing consensus that cross-sector collaboration is a necessary ingredient for improving beneficiary outcomes and reducing costs. This is driven by the recognition that there is a subset of individuals who touch multiple public systems — including Medicaid, food assistance, homelessness, housing supports, criminal justice, etc. — and… Read more »

October 2017
post Evaluating Complex Care Programs: Is It a Zero-Sum Game?

Complex populations in health care are often defined as groups of individuals with co-occurring medical and behavioral health diagnoses as well as significant social challenges. Large sums of money have been devoted to developing interventions focused on “bending the cost curve” by attenuating the rapidly rising costs of caring for these populations. Whether such programs actually save health… Read more »

May 2017
post Community Paramedicine: Taking Care into the Home for Complex Populations

In 2014, Massachusetts-based Commonwealth Care Alliance (CCA) partnered with EasCare Ambulance Services (EasCare) to launch Acute Community Care (ACC), a community paramedicine pilot program. Made possible under a state-granted Special Project Waiver, the program expanded the scope of practice of paramedics by allowing them to assess and treat individuals in the home rather than transport them to… Read more »

May 2017
post Engaging the Community Through Personal Relationships: Collaborating to Address Health Disparities in East Baltimore

Baltimore, like many other major cities, is home to an appalling health disparity: life expectancy differs by more than 20 years between its most affluent and lowest-income neighborhoods. To help combat this inequality, Johns Hopkins Health System received a three-year Health Care Innovation Award from the Centers for Medicare & Medicaid Services to increase health… Read more »

November 2016
post Innovating in Complex Care

Coming into our Complex Care Innovation Lab meeting last month, we knew full well that the Medicaid health care delivery system is transforming itself — sometimes at breakneck speed — in recognition of the fact that health status is not all about medical care. On average, it accounts for less than 20 percent of our… Read more »

October 2016
post Getting Started in Complex Care: Expert Advice

“Learning the medicine is what doctors do when they’re young . . . over time, it becomes important to figure out how to disrupt systems to get patients the other things they need.”  Karen Nelson, MD, MPH, Maimonides Medical Center With increasing focus across the health care delivery system on how to better serve high-need, high-cost patients, providers… Read more »

November 2015
post Hotspotting: The Driver Behind the Camden Coalition’s Innovations

The Camden Coalition of Healthcare Providers (CCHP) works to improve the health of Camden, New Jersey residents through innovative approaches to increase quality, capacity, and accessibility within the city’s health care system. At the core of CCHP’s work is the concept of “hotspotting” — a data-driven process for timely identification of extreme patterns of health care use…. Read more »

September 2014
post Improving Care, Ensuring Patient Privacy: Hennepin Health Data-Sharing Case Study

Hennepin Health is an accountable care organization serving adult Medicaid expansion enrollees with complex needs in Minneapolis, Minnesota.  A central premise of Hennepin Health — a partnership including Hennepin County’s health system and hospital; outpatient clinics; human services and public health department; and managed care organization — is to address social determinants to improve health outcomes and lower… Read more »

June 2014