Required Reading: Complex Care

Patients with multiple chronic conditions and complex medical and social needs require a different kind of care team, one that manages them holistically and breaks down silos across institutions, organizations, and provider types. Across the country, many organizations are testing approaches and models to better provide and coordinate care for these complex patients. The resources below synthesize the early learning in this evolving field.

General Resources

Complex Care Management Toolkit (PDF)
First-of-its-kind toolkit that offers practical steps and numerous resources to develop or improve a complex care program. (California Quality Collaborative and California Health Care Foundation)

Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program?
This study compares the operational approaches of 18 successful programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. (The Commonwealth Fund)

Informational Bulletin on Targeting Medicaid Super-Utilizers, July 2013 (PDF)
A summary of programs targeting Medicaid super-utilizers to decrease costs and improve quality. (Center for Medicaid and CHIP Services [CMCS])

Super-Utilizer Summit
This summary from a February 2013 event explores the common themes among complex care management programs, with a focus on those that care for individuals with Medicaid coverage. (Robert Wood Johnson Foundation)

The Synthesis Project: Care Management of Patients with Complex Health Care Needs
Primers on the definition and key components of care management for complex patients. (Robert Wood Johnson Foundation)

Data Symposium on High Utilizers of Medi-Cal Services, March 2015
Presentation materials from a one-day symposium in Sacramento, CA, to discuss new research by state officials and university partners on the characteristics, health care usage, and costs associated with Medi-Cal's high-cost populations, as well as research emerging from Washington state. Staff from the California Department of Health Care Services (DHCS) and other experts joined to discuss the implications for program design and policy development. (California Health Care Foundation)

For Further Reading

Finding a Match: How Successful Complex Care Programs Identify Patients, March 2015
This brief summarizes methods that successful complex care management (CCM) programs use to identify patients for their programs. The brief discusses a wide variety of strategies identified during in-depth interviews with leaders at 20 well-established CCM programs and includes case examples and a list of useful takeaways for organizations seeking to create or improve a CCM program. (California Health Care Foundation)

Strategies for Hiring and Training Care Managers in Integrated Programs Serving Medicare-Medicaid Beneficiaries, February 2015
This brief shares strategies for hiring and training care managers for health plans with integrated care programs serving Medicare-Medicaid beneficiaries. It offers lessons from five health plans with integrated care products to inform other health plans and states. A link to a webinar presentation of the findings is also available. (Center for Health Care Strategies)

CIN Quarterly Partner Report: Complex Care Programs, Oct. 2011 (PDF)
Brief presentations from Humboldt-Del Norte Medical Foundation, HealthCare Partners, and Monarch HealthCare kick off a conversation about how patient and family understanding and involvement in a complex care plan provide keys to success. (California Health Care Foundation)

CIN Quarterly Partner Report: Care Models for Complex (and Costly) Populations, June 2012 (PDF)
Brief presentations from CareMore and Health Care Partners kick off a conversation about identifying the highest need patients, engaging them in their own care, and preventing unnecessary hospitalizations. (California Health Care Foundation)

Care Coordination Model: Better Care at Lower Cost for People with Multiple Health and Social Needs
White paper outlining methods to better coordinate care for individuals with complex needs, with a focus on a homeless population. (Institute for Healthcare Improvement)