By Mark Humowiecki, Senior Director

It’s been eight months since we released the Blueprint for Complex Care, a national strategic plan for strengthening an emerging field, and we are excited to report on what has been happening this year, as well as on several key activities launching this fall.

The Blueprint rollout has been strong

The Blueprint aligns the disparate efforts of experts and organizations around a unified vision that enables collective action and facilitates the spread of complex care across the country.  Developed in partnership with the Institute for Healthcare Improvement (IHI) and the Center for Health Care Strategies (CHCS) and funded by members of the Six Foundation Collaborative, the Blueprint reflects the input of more than 500 experts who are working each day to provide better care to individuals with the most complex health and social needs. These individuals experience patterns of extreme utilization because the traditional healthcare system is not designed to meet their physical, behavioral, and social needs.

The Blueprint lays out eleven recommendations to strengthen the field of complex care, and there is amazing work already in progress within organizations across the country. For example, All In: Data for Community Health and Academy Health have been working with communities to promote innovative cross-sector data sharing structures (Recommendation 3), while organizations like Nonprofit Finance Fund, Alliance for Strong Families and Communities, and Center for Health Care Strategies are creating resources and providing technical assistance to build the capacity of community based organizations in the human services sector to collaborate with healthcare payers and providers in serving people with complex needs (Recommendations 7 and 9).

The Blueprint is not just a document to read, but instead a catalyst for real change and care delivery improvements across the country. Its release has been a unifying event for a field still in formation, and response since its release has been tremendous. More than 75 organizations have become Complex Care Champions — individual and organizational endorsers of the Blueprint’s findings and recommendations who pledge to help make them a reality. The National Center’s following has grown by more than a third since December.

New projects launching this fall will solidify the field

In our role as a convener for the field, the National Center is bringing together experts and launching a series of projects this fall funded by the Robert Wood Johnson Foundation that address more than half of the Blueprint recommendations.

Complex care core competencies: The Blueprint’s first recommendation focuses on developing standards for the complex care workforce. In developing the Blueprint, complex care experts noted a qualified workforce shortage and a significant gap between traditional healthcare practice and the skills required to effectively serve those with complex needs. The first step to address this is to articulate the requisite core competencies around which training and certification programs can eventually be built.

In response, this fall we will be launching a core competency working group that will define the foundational knowledge, skills, and approaches necessary to provide effective complex care. In this process, more than fifty people were nominated from diverse backgrounds, including physicians, nurses, social workers, community health workers, and even a prosecutor. People with lived experience will be essential members of the group, fulfilling the charge from the sixth Blueprint recommendation to “value the leadership of people with lived experience to address the systemic issues facing this population.”

Early interviews have revealed excitement about defining what sets complex care apart — the attention to trauma, the focus on relationships, the appreciation for behavioral health and social determinants, as well as an acknowledgment of structural issues like racism and poverty — as the first step to building the complex care workforce of the future.

Quality measurement: In light of concerns from the complex care community about both the lack of standard metrics beyond cost and utilization and the mismatch between complex care goals and the quality measurements often used to determine success, the second Blueprint recommendation calls for quality measures specific to complex care. The field seeks a set of measures that more accurately capture the value of complex care programs.

In partnership with the National Center, IHI will be undertaking an assessment of quality measurement within complex care to gather current efforts and broad themes, with the goal of launching an expert field committee to define principles and standards for quality measurement for the field.

Field Coordinating Committee: A Field Coordinating Committee — consisting of the Blueprint’s organizational authors (National Center, IHI, and CHCS), with the addition of Community Catalyst’s Center for Consumer Engagement in Healthcare Innovation and the Alliance for Strong Families and Communities  — will oversee both the core competencies and quality measurement projects mentioned above. These two additional members were added to strengthen the voices of consumers and the human services sectors. The Field Coordinating Committee will work to ensure collaboration and alignment among various field-building efforts and promote new projects to address identified gaps where additional work is required.

Consumer engagement: Defined as “radically person-centered care,” complex care is built around the input of those with complex needs. The person with lived experience must not only be at the center of their own care, but also a key contributor to the design of programs and the development of field frameworks.  Since its inception, the National Center has managed a Consumer Scholars program that brings individuals with complex needs from across the country together to participate in the annual Putting Care at the Center conference. Through this program, we have met some incredibly talented and inspiring individuals, some of whom have joined our National Advisory Committee, led workshops, and contributed to major policy changes in their local communities. 

Our partnership with RWJF has allowed us to expand this program in exciting new ways. We just selected a new cohort of 15 Consumer Scholars who will be part of a formal peer learning collaborative that will meet monthly for 18 months. All participants have significant experience advocating for system change in their own communities. For example, 2019 Consumer Scholar Stephanie Burdick is participating in advocacy efforts around Medicaid expansion in Utah as part of the Utah Health Policy Project, where she works with former Consumer Scholar Stacy Stanford. Stephanie will also be speaking at Putting Care at the Center 2019 as part of a consumer-led plenary entitled Power and Accountability in Authentic Storytelling. The Consumer Scholars have also been working with a professional storyteller to hone their own stories and advocacy skills.

Each participant will contribute to field development in different ways, including participation in expert working groups, such as the core competencies and quality measurement ones mentioned above, as well as development of training curriculum. They join Consumer Scholar alumni and other consumer leaders on our Advisory Committee as part of a growing group of consumer leaders playing critical roles in building the field of complex care.

Ecosystem development: Effective complex care requires a restructuring of how we think about and deliver care. In essence, we need to create complex care ecosystems that weave together multiple organizations and services in new ways using integrated data, cross-sector collaboratives, and process improvements. Over the years, we have supported numerous local communities in developing their own complex care ecosystems.

With RWJF’s support, the National Center is codifying its approach to developing complex care ecosystems and curating a wide range of practical resources to assist communities that are embarking on new programs. The project’s main goal is to avoid reinventing the wheel and to guide them away from some of the pitfalls and mistakes of others. The National Center will be seeking contributions to this project in the form of model documents: job descriptions, MOUs, workflows, and other tools that complex care programs have already successfully developed. We will use these new tools to assist at least three communities in implementing their local complex care ecosystems.

Join us in Memphis

The Blueprint sets a bold vision of a transformed healthcare system designed to meet the full scope of health needs of the most vulnerable. We are inspired by the work of organizations throughout the country and privileged to lead collective efforts to define and shape our field. We invite you to join us at our annual convening —  Putting Care at the Center 2019—  in Memphis, Tennessee on November 13-15. It is the perfect place to come together to share progress and lessons and recommit to building a system that is truly person-centered.