We are at a pivotal point in the field of complex care. More than ever before, large health systems, payers, state governments, and federal agencies are recognizing the benefits of complex care approaches and incorporating them into their care delivery, policy, and payment models. At the ground level, innovators around the country are pushing the boundaries of complex care, building bridges between sectors like healthcare, law enforcement, and housing, and bringing care into communities and neighborhoods.
The theme for our third annual conference, Putting Care at the Center 2018, will be Complex Care, Today and Tomorrow. As we move toward a unified field of complex care, how are we learning from the field’s trailblazers and setting the stage for future innovations?
Complex care today
Some components of today’s complex care models, like home visits and community health worker programs, have existed for a long time, but it is only more recently that they have been combined with elements like data sharing, care coordination, interprofessional teaming, and risk stratification to become what we call complex care: care specifically designed to improve the wellbeing of people with complex health and social needs.
Many early trailblazers in complex care, like the PACE model and the nurse-led Transitional Care Model focus on elderly consumers with complex health and social needs. Some well-established programs focus on a more narrowly targeted population, like veterans experiencing homelessness (H-PACT), or people experiencing depression and other mental health challenges (IMPACT), while others like Hennepin Health, Denver Health, and the Washington State Department of Social and Health Services have integrated complex care approaches into their overall population health strategies.
Opportunities to improve models of care for people with complex needs (Center for Health Care Strategies, 2015)
Effective care for high-needs patients (National Academy of Medicine, 2017)
Building complex care programs: A roadmap for states (National Governor’s Association, 2017)
The Better Care Playbook
Complex care tomorrow
People with complex health and social needs often face poverty, homelessness, addiction, and mental illness. Many have also experienced early life trauma. As a result, individuals often interact with multiple human service systems like healthcare, criminal justice, and housing. But because these systems are so siloed, the root causes behind utilization are rarely addressed in a coordinated, efficient way. As we continue to highlight and scale up established complex care models, an area of growing innovation is cross-sector collaboration.
One system that has emerged as a common cross-sector partner is the criminal justice system. The Camden Coalition of Healthcare Providers is piloting a program called Camden RESET to help individuals who have frequent contact with healthcare and criminal justice to gain the skills and support they need to avoid arrests and preventable hospital admissions. In Iowa City, the police department is working with the Laura and John Arnold Foundation’s Data-Driven Justice Initiative to harness the power of data across the healthcare and criminal justice sectors in designing more effective support systems for vulnerable populations.
Housing is another common area of collaboration. While Housing First and other supportive housing models have long been a part of addressing the complex health and social needs of individuals experiencing homelessness, Los Angeles County Department of Health Services’ Housing for Health branch has combined public and private funding sources in its Flexible Housing Subsidy Pool to take these models to scale and demonstrate the huge impact that housing has on health.
People with complex health and social needs, like all people, spend the majority of their time in their communities, not their healthcare systems. Many new programs and models are deepening their presence in the community. Cityblock Health, an emerging startup that spun off from Google’s parent company Alphabet, is forming Neighborhood Health Hubs to serve people in their local neighborhoods through trusted community partners rather than in traditional hospitals and clinics. Community paramedicine and first responder programs like Colorado CARES (see NGA Roadmap, p. 45) are using existing infrastructure— 911 dispatch, first responders, and social workers — to address the needs of frequent emergency department users where they are.
Complex care and you
One of the most important assets that the field of complex care has is the people who work in it— providers, consumers, researchers, administrators, and policymakers who are passionate, creative, and dedicated to transforming our systems of care.
At Putting Care at the Center, complex care innovators from across the country and across sectors learn from each other, sharing models, practices, tools, and more for better care for people with complex health and social needs. What emerging directions are you seeing in complex care? What do you think is missing from our current set of practices and techniques? What’s working in your community? Have you been able to replicate or scale an evidence-based model? How does policy impact complex care practice? We hope that you’ll help move the field forward by applying to be a conference presenter at Putting Care at the Center 2018 and sharing your vision for complex care, today and tomorrow.