Can we improve the health of consumers with the most complex needs while reducing costs to the United States healthcare system? Evidence suggests that we can.

Individuals with complex health and social needs don’t just experience multiple chronic diseases, they have many other complicating factors such as higher rates of addiction, mental illness and early-life trauma. These further exacerbate the already unstable ground of social structures such as housing instability, inefficient transportation systems, unemployment and criminal justice involvement. Given that primary care settings are not currently built to address these issues, care for these patients is extremely fragmented, resulting in high avoidable costs from things such as unnecessary emergency room visits, over-testing, hospital readmissions, and duplicative procedures.

By integrating previously disconnected services we are creating interdisciplinary teams to address physical, mental, and social needs. Nation-wide many experts in the burgeoning field of complex care are beginning to improve health outcomes for individuals with complex health and social needs.

Early results show cost savings for an array of stakeholders:

Health systems:

Insurance Companies/Payers:

  • Enhance cost savings by reducing the overuse of unnecessary, more expensive healthcare services like inpatient stays and ER visits (GAO, 2015PLOS, 2012)
  • Alternate ways to control costs in light of new restrictions imposed by the Affordable Care Act (CHCS 2017)
  • Create more predictable risk analysis of this population

Policymakers and Taxpayers:

  •  Financial savings to states and localities by appropriately targeting care and relieving the burden on other government service providers such as child protective services and the court system (JAMA, 2009Health Affairs, 2017)
  • Benefits to their communities in the form of lower crime, housing stability, and improved treatment access for patients with complex disease (National Alliance to End Homelessness, 2017)

Learn more and join our movement here.

Sources and Recommended Reading:

The Playbook: Better Care for People with Complex Needs

Using a Cost and Utilization Lens to Evaluate Programs Serving Complex Populations: Benefits and Limitations

A Small Share of Enrollees Consistently Accounted for a Large Share of Expenditures