Effectively caring for high-need, high-cost patients requires providers to think beyond the clinical setting and tackle the social determinants of health. Yet integrating social services into health care can be a daunting challenge that requires a clear understanding of the target population, available resources, and...

As the health care system shifts from a fee-for-service structure to value-based payment programs, appropriate provision of services across the care management continuum can increase value and improve outcomes for patients, while effectively reducing unnecessary care and acute care episodes requiring high-cost interventions. The Health Care...