By Mark Humowiecki, Senior Director for National Initiatives at the Camden Coalition of Healthcare Providers

It was wonderful to see so many new and familiar faces in Memphis last November for our fourth annual Putting Care at the Center conference. I left Putting Care at the Center 2019 full of optimism about the future of the field of complex care, and I hope that you did too. 

We learned from local complex care ecosystems, from the work of our 2019 conference co-host, Regional One Health, in Memphis, to robust structures in Baltimore, San Diego, Hennepin County, Minnesota. Learning from these innovators really brought the conference theme It takes an ecosystem: Complex care across the community to life, showing us inspirational pathways and opportunities.

Because no single program can adequately address the complex needs of the population we serve, developing strong complex care ecosystems in our communities is the way forward for our field. Without robust services and supports available to connect individuals to, and a data and governance infrastructure to coordinate and align them, programs focused on care management, coordination, or navigation will struggle to meaningfully improve their patients’ well-being.

This is a lesson we have learned at the Camden Coalition through our work over the past 17 years and which was borne out in the recently-published randomized controlled trial (RCT) evaluating the Camden Core Model’s effect on hospital readmissions. In response to what we have heard from our patients and care teams before, during, and after the RCT study period, we have focused much of our work here in Camden around strengthening our own complex care ecosystem. Housing, behavioral health, and legal and social services have been particularly crucial to prioritize here.

Furthermore, we have seen time and again how important peer learning can be as we create our complex care ecosystems. The National Center was launched to provide us all with the opportunity to learn from and alongside others across the nation. As we enter our fifth year, we have five exciting opportunities to connect, learn, and contribute. 

1. Quality measures for complex care

Complex care is not measured solely by readmissions and claim costs. Yet our field has not defined how to measure the improved health and well-being, stronger ecosystems, and achievement of personal goals that we contribute to every day. As a field, we lack standard metrics that appropriately measure the human (non-financial) value of services and supports. 

On behalf of the newly formed Field Coordinating Committee, the Institute for Healthcare Improvement was commissioned to review the literature, current activities, and expert opinion around quality measurement for complex care. Many of you participated in interviews or a standing room-only session at the conference. We look forward to sharing their report and recommendations in the upcoming months and taking the next steps to advance standardized measurement for our field. 

2. Complex care core competencies

Last fall, the Field Coordinating Committee selected a diverse, interprofessional expert panel to undertake the development of complex care core competencies. This group, which I chair with vice-chairs Anna Doubeni of the University of Pennsylvania and Consumer Scholar Sara Reid of Boston Healthcare for the Homeless, has been meeting monthly and is preparing for its first in person session in February. We have compiled extensive research on core competencies, spoken with dozens of complex care experts as well as representatives of professional and educational associations, and explored the unique knowledge, skills, and attitudes required to support individuals with complex needs. 

We expect to produce a set of draft competencies to share later this spring for feedback, and to publish the report in advance of Putting Care at the Center 2020

3. New resources for the field

Through working with dozens of health systems and community organizations to launch, refine, and scale complex care programs and ecosystems, the National Center has formalized approaches that can be used and adapted in different communities. With support from the Robert Wood Johnson Foundation, we have started to codify these tools, resources, and processes into a resource library. These include resources drawn from the experience and operating manuals of mature sites across the country that will help new adopters accelerate their design and implementation of complex care programs. 

We will be asking you in the coming months to share your best tools and resources with the community. We also will announce an opportunity to be part of a small learning community and receive free technical assistance implementing the ecosystem tools in your community, starting this autumn. 

4. 2020 Regional complex care convenings

Last year, we piloted a new regional convening program to help local communities catalyze the development and strengthening of their complex care ecosystems. Successful events were held in eastern Washington and in Atlanta, with our final event coming next month in Los Angeles. Topics included strategies for serving rural aging populations, deepening connections between healthcare and social services, and integrating peer specialists and community health workers into care teams. Events include representation from across sectors and people with lived expertise. 

Inspired by the popularity and success of the inaugural regional convenings, we are doubling the size of this year’s program and will look forward to sharing the tools and lessons developed in each community. Applications are open now and close February 29.

5. Putting Care at the Center 2020

We are thrilled to bring the annual Putting Care at the Center conference back to our home region of Philadelphia for its fifth anniversary on October 28-30, 2020. Based on your feedback, this year’s event will feature expanded content with five workshop timeslots, more storytelling opportunities, content developed by the National Consumer Scholars, and another rockin’ dance party. We will unveil the new core competencies and dig into the skills and knowledge required of the complex care workforce.

Early registration and calls for presentation proposals will open next month — look out for new group rates and discounts for smaller community-based organizations. 

Looking ahead
As we noted in the Blueprint for Complex Care, “early innovation is leading us toward a body of knowledge and replicable practices. Yet, the work of transforming care for those with the most complex needs is itself complex and requires new skills, collaborative structures, and sustained commitment from a wide array of stakeholders.” This work isn’t easy, and our success hinges on our creativity, flexibility, and resilience — individually, organizationally, in our communities, and as a field. We are fortunate to be part of such a dedicated and talented community. I can’t wait to see what we build together in 2020 and beyond.