‘Playbook’ has best practices for patients with complex needs

Team of doctors talking
Patients with complex needs struggle to get the coordinated medical, behavioral and social services they need.

The healthcare system has failed patients with complex medical needs, according to a new national survey. 

While 95% of these high-need patients have consistent access to healthcare, they struggle to get the coordinated medical, behavioral and social services they need to maintain their health and avoid costly hospital visits, according to the survey announcement (PDF). Those patients—including older adults, patients with complex chronic conditions and younger people with disabilities—often experience limited access to care coordinators, assistance in managing functional limitations, emotional counseling and transportation services, according to the survey of more than 3,000 adults by The Commonwealth Fund.

To help solve that problem, five national healthcare foundations have identified promising approaches to treat these patients and today released a "playbook" of best practices to improve care and lower costs. The five foundations—The John A. Hartford Foundation, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation, The SCAN Foundation and The Commonwealth Fund—launched the new online resource to help health system leaders and insurers improve care for patients with complex medical and social needs.

“Our research shows that when people with complex needs require medical help, they encounter a healthcare system that’s expensive, inefficient, and poorly coordinated,” said David Blumenthal, president of The Commonwealth Fund. "We want to better understand what works for effectively treating these patients, so we can identify gaps, reduce duplication and accelerate what works."

Health plans that have member populations with complex care needs face challenges that require these organizations’ leaders to think differently. For example, CareMore President and CEO Sachin H. Jain, M.D., found that when working with homeless individuals their primary health concern was foot care, not mental health.

The Playbook includes examples of successful approaches to care, guidance on making the business case for these models and opportunities for policy and payment reform. A new National Center for Complex Health and Social Needs has also been formed to convene experts and stakeholders in the growing field of complex care.