A transplant center established a mandatory education session for newly referred patients, leading to a significant increase in the percentage of patients (particularly African Americans and people of lower socioeconomic status) completing the enrollment process.
A school district's multifaceted, collaborative initiative to reduce the impact of asthma includes multiple policies and subsequent programs such as electronic monitoring, case management, and stakeholder-specific education, leading to fewer asthma-related absences and better academic performance, behavior, health, and quality of life for students with asthma.
A statewide program supports physician practices through multidisciplinary community-based health teams, preventive health expertise, easy access to needed information via electronic systems, and financial incentives, leading to lower utilization and growth in health care spending and enhanced provision of appropriate services.
A state mental health and addiction services agency implemented policies to promote integrated treatment for those with both mental health and substance use disorders, leading to enhanced access to high-quality services and positive patient outcomes.
A health plan–sponsored disease management program targeting African Americans combines home blood pressure monitoring with culturally competent education and counseling, leading to better self-monitoring and blood pressure control.
Community outreach workers identify residents at risk of nursing home placement and arrange for them to receive appropriate home- and community-based services, leading to fewer nursing home placements and significant cost savings.
Medical students operate a free primary care health clinic for visitors to a large, local soup kitchen, gaining invaluable experience and providing patients with medical care they would otherwise likely go without.
Intensive, person-centered case management, peer support, and a discretionary fund for adults with serious mental illness leads to better access to treatment, job training, and employment; fewer suicide/self-harm attempts, hospitalizations, incarcerations, and days of homelessness; and lower mental illness-related costs.
Primary care physicians order standardized bundles of tests and specialty referrals for common diagnoses, which are then managed by a care coordination team, resulting in expedited patient care and high physician satisfaction.
Pharmacists provide ongoing chronic care management support to employees and their physicians, leading to greater adherence to recommended care processes and self-management behaviors, lower costs, higher productivity, and a significant return on investment.