 Cycle 1 focuses on the impact of notices about ED encounters and hospitalizations derived from billing data that are sent to care managers for all 47,000 patients in the Northern Piedmont Community Care Network NPCCN. Cycle 2 explores the impact of letters sent to patients, and care event reports sent to a patients medical home in addition to notices sent to care managers about ED encounters, hospitalization and specialty care based on ADT Admission Discharge Transfer and billing data on 4,600 patients with complex health needs. 