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Complex Care 'Playbook' Addresses Medical, Social Needs

News  |  By John Commins  
   December 12, 2016

The newly formed National Center for Complex Health and Social Needs identifies best practices for improving care and lowering costs for patients facing myriad medical, behavioral, and social challenges.

Health systems, medical professionals and payers looking for effective ways to treat high-utilization patients that have complex medical and social needs have a new online resource.

Drafted at the Institute for Healthcare Improvement, The Playbook: Better Care for People with Complex Needs compiles and shares examples of successful approaches to care, guidance on making the business case for these models, and opportunities for policy and payment reform.

The playbook was unveiled Friday at the inaugural meeting of the National Center for Complex Health and Social Needs, led by Jeffrey Brenner, MD, of the Camden Coalition of Healthcare Providers.

"The care of complex patients is still in its infancy. We're still bloodletting people," says Brenner, a 2013 recipient of a MacArthur Foundation "genius grant," who has developed care models that address non-medical needs such as addiction, housing, hunger, and mental health.

"We have a system of misaligned incentives and incorrectly trained professionals," Brenner says. "We can transplant hearts and lungs, and cure cancer, but we haven't caught up to all that complexity. There is a human side to all of this that we just haven't figured out. We have a lot of implicit bias in our medical model about how we think about care, and we are missing some elements in that model."

Big Backers
The playbook has the backing of five national healthcare foundations—The John A. Hartford Foundation, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation, The SCAN Foundation, and The Commonwealth Fund.

In a joint media release, the foundation leaders said that improved access to care that coordinates patients' medical, behavioral, and social needs means that high-needs complex patients will be less likely to delay care, or go to the emergency room for non-urgent care.

Patients with complex needs include older adults, people with major complex chronic conditions, and younger people with disabilities. Since many are older than 65, addressing this issue will become more urgent as the nation's population ages.

By some estimates, complex care patients represent just 5% of the population but account for 50% of national healthcare spending.

"Our research shows that when people with complex needs require medical help, they encounter a healthcare system that's expensive, inefficient, and poorly coordinated," says 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."

Survey Data
In conjunction with the release of the playbook, The Commonwealth Fund released a survey on Friday of 3,009 adults (1,805 of whom are high-need) and found that:

  • Nearly half (47%) visited the emergency department multiple times in the past two years.
  • A majority did not have good access to services that could help them manage their conditions, such as adequate help with activities of daily living (62%) or an informed and up-to-date care coordinator (58%).
  • Almost two-thirds (62%) experienced stress about their ability to afford housing, utilities, or nutritious meals. This compares to just 32% of people without high-needs.
  • A majority (59%) worried about being a burden to family and friends. More than one-third (37%) felt lonely, left out, or isolated from others.

Brenner says the playbook is a work in progress that will adapt and adopt as new strategies and tactics are tested and proven in the field.

"We are building a field and a movement for the care of complex patients, and we are going to set up the next generation of young providers, nurses, doctors, and social workers, to succeed," he says. "We weren't set up for success. Many generations have worked on this problem, but we are going to finally get it right with this generation."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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