Scanning the Headlines: Care Management

Updated on April 28, 2017 

Click here for Care Management Archive Bibliography

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Links to full-text articles are provided where available.
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Penm, J., and others.  (2017, Mar./Apr.).  Minding the gap:  Factors associated with primary care coordination of adults in 11 countries.  The Annals of Family Medicine.  15(2):113-119.  Retrieved from:

Sinaiko, A., Meyers, D., and Rosenthal, M.  (2017, Mar. 28).  To The Point:  Review of Medical Homes Shows Reduction in Spending for High-Risk Patients, But Design and Implementation Matter.  New York City:  The Commonwealth Fund.  Retrieved from:

Hostetter, M., and Klein, S., and McCarthy, D.  (2017, Mar. 28).  CareMore: Improving Outcomes and Controlling Health Care Spending for High-Needs Patients.  New York City:  The Commonwealth Fund.  Retrieved from:

Driessen, Ph.D., J., and Zhang, Ph.D., Y.  (2017, Mar. 1).  Trends in the inclusion of mental health providers in Medicare shared savings program ACOs.  Psychiatric Services. 68(3):303-305.  Retrieved from:

Sinaiko, A., and others.  (2017, Mar.).  Synthesis of research on patient-centered medical homes brings systematic differences into relief.  Health Affairs.  36(3):500-508.  Retrieved from:

Shah, R.  (2017, Mar.).  Starting small with population health management.  Healthcare Financial Management Association.  Retrieved from:

(2017, Feb. 21).  Care Redesign Guide: Better Health and Lower Costs for Patients with Complex Needs.  Cambridge, MA:  Institute for Healthcare Improvement.  Retrieved from:

Toyin, I.  (2017, Jan. 25).  Weaving whole-person health throughout an accountable care framework:  The social ACO.  Health Affairs Blog.  Retrieved from:

Sederstrom, J.  (2017, Jan. 23).  ACOS:  Improving care through nonmedical services.  Managed Care.  Retrieved from:

Powers, B., Donoff, B., and Jain, S.  (2017, Jan. 19). Bridging the dental divide:  Overcoming barriers to integrating oral health and primary care.  Health Affairs Blog.  Retrieved from:

Bhattacharya, D., and Bhatt, J.  (2017).  Seven foundational principles of population health policy.  Population Health Management.  Retrieved from:

Mileski, M., and others. (2017). An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: A systematic review. Clinical Interventions in Aging, 12, 213-222.Retrieved from:

Conway, P. (2016, Sept. 13).  New data:  49 states plus DC reduce avoidable hospital readmissions.  CMS Blog.  Retrieved from:

Boccuti, C., and Casillas, G.  (2016, Sept.).  Aiming for Fewer Hospital U-Turns:  The Medicare Hospital Readmission Reduction Program.  Menlo Park, CA:  Henry J. Kaiser Family Foundation.  Retrieved from:

Chase, J.  (2016, July 22).  "Communicating Wisely":  Design, Implementation and Outcomes of an Email-Based Care Transitions Bundle.  San Diego, CA:  Society of Hospital Medicine.  Retrieved from:

Pearl, R., and Loftus, B.  (2016, June 22).  How multi-specialty hubs fills a major gap in the care continuum.  New England Journal of Medicine.  Retrieved from:

Cheney, C.  (2016, June 20).  How bundled payments ratchet readmission rates downward.  HealthLeaders Media.  Retrieved from:

Larson, L.  (2016, June 10).  How community health workers can improve patient outcomes.  H&HN.  Retrieved from:\

Kliff, S.  (2016, June 1).  Unpaid, stressed, and confused:  patients are the health care system's free labor.  Vox Media, Inc. Retrieved from:

Mace, S.  (2016, May 3).  At Houston Methodist, population health is the real deal.  HealthLeaders Media.  Retrieved from:

Rau, J.  (2016, May 2).  Hospital discharge:  It's one of the most dangerous periods for patients.  Kaiser Health News.  Retrieved from:

Budryk, Z.  (2016, Apr. 22).  Best practices for care coordination [Special Report].  FierceHealthcare.  Retrieved from:

Zuckerman, R., Sheingold, S., Orav, J., and others.  (2016, Apr. 21).  Readmissions, observation, and the hospital readmissions reduction program.  New England Journal of Medicine. 374:1543-1551.  Retrieved from:

Dale, S., Ghosh, A., and Peikes, D.  (2016, Apr. 13).  Two-year costs and quality in the comprehensive primary care initiative.  New England Journal of Medicine.  Retrieved from:

Luthra, S.  (2016, Apr. 11).  Hospitals eye community health workers to cultivate patients' successes.  Kaiser Health News.  Retrieved from:

(2016, Apr. 11).  Comprehensive Primary Care Plus (CPC+) Fact Sheet.  Baltimore, MD:  Centers for Medicare & Medicaid Services.  Retrieved from:

Commins, J.  (2016, Apr. 6).  Readmissions penalties still don't account for patient demographics.  HealthLeaders Media.  Retrieved from:

Pecci, A.  (2016, Apr. 5).  Readmission prediction score validated in multi-country study.  HealthLeaders Media.  Retrieved from:

(2016, Apr.).  Patient Centered Medical Home Resource Center.  Rockville, MD:  Agency for Healthcare Research Center.  Retrieved from:

Gray, E., and Aronovich, R.  (2016, Apr.).  Producing an ROI with a patient-centered medical home.  Healthcare Financial Management.  Retrieved from:

Kroch, E., Duan, M., and Martin, J., and others.  (2016, Mar./Apr.).  Patient factors predictive of hospital readmissions withing 30 days.  Journal for Healthcare Quality.  38(2):106-115.  Retrieved from:

Compton-Phillips, A.  (2016, Mar. 31).  Care redesign report:  Why population health management is undervalued.  New England Journal of Medicine Catalyst.  Retrieved from:

Andrews, M.  (2016, Mar. 25).  Study:  Primary care doctors often don't help patients manage depression.  Kaiser Health News.  Retrieved from:

Boyle, M.  (2016, Mar. 23).  Collaboration With Chronic Disease Groups Optimizers Outcomes for Payers and Patients.  Health Affairs Blog.  Retrieved from:

Budryk, Z.  (2016, Mar. 17).  Healthcare miscommunications contribute to a quarter of readmissions.  FierceHealthcare.  Retrieved from:

Sisk, T.  (2016, Mar. 4).  Rural Hospitals embrace population health in quest for relevance.  North Carolina Health News.  Retrieved from:

Distel, E., Casey, M., and Prasad, S.  (2016, Mar.).  Reducing Potentially-Preventable Readmissions in Critical Access HospitalsPolicy Brief #43.  The Flex Monitoring Team.  Retrieved from:

(2016, Mar.).  Medicaid Accountable Care Organizations:  State Update.  Trenton, NJ:  CHCS Center for Health Care Strategies, Inc.  Retrieved from:

(2016, Mar.).  Creating Patient-Centered, Team-Based Primary Care.  Rockville, MD:  Agency for Healthcare Research Center. Retrieved from:

Dickens, C., Weitzel, D., and Brown, S.  (2016, Mar.).  Mr. G and the revolving door:  Breaking the readmission cycle at a safety-net hospital.  Health Affairs.  35(3):540-543.  Retrieved from:

Caspi, H.  (2016, Feb. 29).  HHS study finds reduced readmissions real, not masked as observation stays.  Healthcare Dive.  Retrieved from:

Zuckerman, R., Sheingold, S., Orav, J., and others.   (2016, Feb. 24).  Readmissions, observation, and the hospital readmissions reduction program.  New England Journal of Medicine.  Retrieved from:

Commins, J.  (2016, Feb. 18).  Dartmouth atlas:  Evidence-based, coordinated care for seniors elusive.  HealthLeaders Media.  Retrieved from:

Bynum, J., Meara, E., Chang, C., and Rhoads, J.  (2016, Feb. 17).  Our Parents, Ourselves:  Health Care for an Aging Population.  LeBanon, NH:  Dartmouth Institute.  Retrieved from:

Pecci, A.  (2016, Feb. 10).  A payer and a partner make the case for extensivists.  HealthLeaders Media.  Retrieved from:

Mason, D.  (2016, Feb. 10).  JAMA forum:  Is 'firing" the patient an unintended consequence of value-based payment?  Journal of the American Medical Association.  Retrieved from:

Letourneau, R.  (2016, Feb. 10).  3 payer-driven strategies to transform care models.  HealthLeaders Media.  Retrieved from:

(2016, Feb.).  White Paper:  Developing Care Management Programs to Serve High-Need, High-Cost Populations.  St. Paul, MN:  Health Care Transformation Task Force.  Retrieved from:

Nielsen, M., Buelt, L., Patel, K., and others.  (2016, Feb.).  The Patient-Centered Medical Home's Impact on Cost and Quality.  New York:  Milbank Memorial Fund.  Retrieved from:'s%20Impact%20on%20Cost%20and%20Quality%2C%20Annual%20Review%20of%20Evidence%2C%202014-2015.pdf

Letourneau, R.  (2016, Jan. 20).  PCMH model soaring, despite funding challenges.  HealthLeaders Media.  Retrieved from:

DiChiara, J.  (2016, Jan. 19).  Accountable Care Organizations Renew Hospital Reimbursement; Accountable Care Organizations May Benefit Revenue Cycle Management, Especially for the Rural Hospital Community. Critical Access Hospitals May Even Become Profit Centers.  Danvers, MA:  Xtelligent Media, LLC.  Retrieved from:

(2016, Jan. 11).  Significant Costs Involved with Converting Primary Care Medical Practices to 'Medical Homes'.  Santa Monica, CA:  Rand Corp.  Retrieved from:

Sheingold, S., Zuckerman, R., Shartzer, A.  (2016, Jan).  Understanding Medicare hospital readmission rates and differing penalties between safety-net and other hospitals.  Health Affairs.  35(1):124-131.  Retrieved from: 

Fu, N.  (2016).  Once A Cure;  Second A Waste.  Santa Monica, CA:  Rand Corporation.  Retrieved from:

(2016).  Committee on Educating Health Professionals to Address the Social Determinants of Health.  A Framework for Educating Health Professionals to Address the Social Determinants of Health.  Washington:  National Academies Press.  Retrieved from:

(2016).  Committee and Accounting for Socioeconomic Status in Medicare Payment Programs and others.  Systems Practices for the Care of Socially At-Risk Populations.  Washington:  The National Academies Press.  Retrieved from:


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