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Rural Health Information Hub

Rural Health
Resources by Topic: Care coordination

Making Care Primary (MCP) Model
Provides information on the Centers for Medicare & Medicaid Services (CMS) Innovation Center's Making Care Primary (MCP) Model, which offers a pathway for primary care clinicians in eight states to gradually adopt prospective, population-based payments while building infrastructure to improve behavioral health and specialty care integration and enhance equitable access to care.
Sponsoring organization: Centers for Medicare and Medicaid Services
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Rural Healthcare Payment and Reimbursement Topic Guide
Resources and information on how rural healthcare providers are reimbursed by different payers and payment systems and the impact of payment policies on rural healthcare.
Sponsoring organization: Rural Health Information Hub
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The Virtual Patient-Centered Medical Home (PCMH): A Model for Idaho's Rural and Underserved Communities
Describes the virtual Patient-Centered Medical Home (PCMH), including benefits such as reduced cost of care and increased access to and quality of care. Discusses how telehealth and community health emergency medical services (CHEMS) will be used in the PCMH model. Includes contact information for Public Health District Small Rural Hospital Improvement (SHIP) Grant Project Managers.
Sponsoring organization: Idaho Department of Health and Welfare
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Allied Health Workforce Projections, 2016-2030: Community Health Workers
Offers demand projections for community health workers (CHWs) from 2016-2030, using data from the Health Resources and Services Administration's Health Workforce Simulation Model. Includes projected statistics for various care coordination scenarios, including a rural healthcare scenario.
Sponsoring organization: Health Resources and Services Administration
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Maternal Opioid Misuse (MOM) Model
Overview of a CMS initiative focused on the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD) through state-driven transformation of the delivery system. Supports coordination of clinical care and integration of other services critical for health, well-being, and recovery.
Sponsoring organization: Centers for Medicare and Medicaid Services
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Care Management Medicare Reimbursement Strategies for Rural Providers
Information for rural healthcare providers on Medicare billing codes for services to keep beneficiaries healthy and better coordinate services to support beneficiaries at home. Addresses Annual Wellness Visits, Chronic Care Management, Transitional Care Management, Principal Care Management, and more.
Sponsoring organizations: NORC Walsh Center for Rural Health Analysis, Rural Health Information Hub
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Integrated Care Resource Center
Helps states learn about best practices for delivering coordinated healthcare to high-need, high-cost Medicaid beneficiaries. The resource center is a joint technical assistance project of the Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office and the Center for Medicaid, CHIP, and Survey & Certification (CMCS).
Sponsoring organization: Centers for Medicare and Medicaid Services
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