There is increasing recognition that the US healthcare system fails individuals with the most complex health and social needs, including many who repeatedly cycle through multiple healthcare, social service, and other systems without lasting improvements to their health or wellbeing. To see different results we must deliver care differently: care must be flexible, interdisciplinary, evidence-based, and centered on the needs, goals, and circumstances of the individual.
Complex care is a person-centered approach to address the needs of people whose combinations of medical, behavioral health, and social challenges result in extreme patterns of healthcare utilization and cost. Complex care works at the individual and systemic levels: it coordinates better care for individuals while reshaping ecosystems of services and healthcare. By better addressing complex needs, complex care can reduce unnecessary spending in both healthcare and social services sectors.
At its heart, complex care seeks to be:
- Person-centered: Individuals’ goals and preferences guide all aspects of care. Care delivery is designed around the whole person, their needs, and their convenience, rather than the delivering institutions’ priorities. Providers develop authentic healing relationships with individuals and are sensitive to the ongoing impact of adverse life experiences.
- Equitable: Complex care addresses the consequences of systemic issues such as poverty and racism. Individuals with complex needs and their communities have valuable insights into the structural barriers that affect their lives and should be partners in developing solutions.
- Cross-sector: In order to address individuals’ array of needs, complex care works at the system level to break down the silos dividing fields, sectors, and specialties. Cross-sector collaboration is critical for creating the systemic changes necessary to provide whole-person care.
- Team-based: Complex care is delivered through interprofessional, non-traditional, and inclusive teams. These teams incorporate peers, community health workers, the individual themselves, and loved ones whom the individual chooses to include, in addition to medical, behavioral health, and social service providers.
- Data-driven: Timely, cross-sector data are freely shared across all care team members and are used to identify individuals with complex needs, enable providers to effectively meet the needs of their patients, and evaluate success.
The National Center for Complex Health and Social Needs serves as a professional home for the growing field of complex care. Want to learn more? Read our Blueprint for Complex Care.