Strategies

Revise health care processes and provider roles to integrate mental health and substance abuse treatment into primary care; continue to refer patients with severe conditions to specialty care

Use a case management model for frail elderly patients living independently, coordinating aspects of long-term care (LTC) such as status assessment, monitoring, advocacy, care planning, etc.

Implement multi-component efforts that include coordination of health services by multidisciplinary teams of health care professionals, patient self-management, and patient education

Provide educational and behavioral interventions that support patients’ ability to actively manage their condition(s) in everyday life

Purchase the land a home is on to lease to homeowners with low and middle incomes and require homeowners to sell the home back to the trust or to another resident with low income upon moving

Use aerobic, natural decomposition to divert food and yard waste from landfills and create a nutrient-rich soil amendment product on an individual or large scale

Increase health care providers’ skills and knowledge to understand and respond to cultural differences, value diversity, etc. via factual information, skills training, and other efforts

Tailor health care to patients’ norms, beliefs, and values, as well as their language and literacy skills

Offer debt advice from trained providers to tenants with unpaid, overdue rent to help repay debt and increase financial literacy

Replace internal combustion engine vehicles with all-electric vehicles through financial incentives, regulations, and multi-component initiatives