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Finding a Match: How Successful Complex Care Programs Identify Patients

Clemens S. Hong, Andrew S. Hwang, and Timothy G. Ferris

Complex care management programs can help patients while minimizing unnecessary cost — but only if matched with the patients most likely to benefit from these services.

The challenges of caring for high-need, high-cost patients have led increasingly to the use of specially trained complex care management (CCM) teams that identify and engage high-risk patients, assess their needs, and intervene rapidly to changes in their health status.

For these resource-intensive programs to succeed, they must identify the most appropriate patients to enroll. There are two key aspects to patient identification: (1) predicting risk in specific patients along the dimensions or outcomes such as inpatient admissions or recurrent, unnecessary ED visits and (2) predicting care sensitivity — the likelihood that a particular high-risk patient will respond to the interventions available within the program.

In the On Deck at CHCF video below, Dr. Clemens Hong discusses how building trust and developing relationships also help in these cases.

The various methods that CCM programs use to identify patients are generally grouped into quantitative, qualitative, and hybrid approaches. This issue brief discusses a wide variety of strategies — including their strengths and weaknesses — that were identified during in-depth interviews with leaders at 20 well-established CCM programs. Also included are case examples of successful strategies and a list of useful takeaways for organizations seeking to create or improve a CCM program.

The complete issue brief is available under Document Downloads.

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