Evidence Bank Contract Data Form

The Evidence Bank is a collection of research studies on common services provided by community-based organizations (CBOs) that demonstrate outcomes attractive to a health care partner. A common barrier to contracting between CBOs and health care entities is a lack of data on the effectiveness of their programs. The purpose of the Evidence Bank is to provide a collection of research studies that CBOs can pull from to bolster their own pitches to health care entities. We are looking for outcomes from successful contracts to add to the Evidence Bank.

Question Title

* 1. A member of our team may reach out to you for more details on the program. Please fill in your contact information below.

Name *

Organization Name *

City/Town

State/Province *

Email Address *

Phone Number

Question Title

* 2. Please select the designation that best describes your organization.

Area Agency on Aging

Center for Independent Living

Advocacy organization

Supportive service provider (e.g., home-delivered meals, home care, transportation, 211)

Government department of health, aging, disability, mental/behavioral health, human services or similar department (but not a AAA)

Network of community-based organizations/Management services organization

Other nonprofit organization (e.g., Easterseals, Red Cross, United Way)

Other (please specify)

Question Title

* 3. Provide a description of the program you are providing. Please include what services are included and what the goal of the program is (e.g., falls prevention, reducing readmissions).

Question Title

* 4. Please describe the target population of your program (e.g., older adults, people with disabilities).

Question Title

* 5. Please provide the type of health care entity you contracted with to provide this program (e.g., Medicaid managed care plan, Medicare Advantage plan, hospital or health system, Accountable Care Organization).

Question Title

* 6. What results has this program achieved (i.e., reduction in hospital
readmissions, improved health outcomes for the populations served, reduced emergency department visits, lower costs, reduction in health disparities, response to COVID-19, etc.)? Please be as specific as you can.

Question Title

* 7. If you have a report detailing your results, please upload it here.

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Evidence Bank Contract Data Form

Question Title

* 1. A member of our team may reach out to you for more details on the program. Please fill in your contact information below.

Question Title

* 2. Please select the designation that best describes your organization.

Question Title

* 3. Provide a description of the program you are providing. Please include what services are included and what the goal of the program is (e.g., falls prevention, reducing readmissions).

Question Title

* 4. Please describe the target population of your program (e.g., older adults, people with disabilities).

Question Title

* 5. Please provide the type of health care entity you contracted with to provide this program (e.g., Medicaid managed care plan, Medicare Advantage plan, hospital or health system, Accountable Care Organization).

Question Title

* 6. What results has this program achieved (i.e., reduction in hospital readmissions, improved health outcomes for the populations served, reduced emergency department visits, lower costs, reduction in health disparities, response to COVID-19, etc.)? Please be as specific as you can.

Question Title

* 7. If you have a report detailing your results, please upload it here.

* 6. What results has this program achieved (i.e., reduction in hospital
readmissions, improved health outcomes for the populations served, reduced emergency department visits, lower costs, reduction in health disparities, response to COVID-19, etc.)? Please be as specific as you can.