Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences One in five high-need adults reported having an unmet medical need. Brief/Report August 2016
Project ECHO’s Complex Care Initiative: Building Capacity to Help “Superutilizers” Interdisciplinary teams provide support for Medicaid beneficiaries with mental illnesses, addictions, and other needs. Case Example August 2016
Guided Care: A Structured Approach to Providing Comprehensive Primary Care for Complex Patients Guided Care is designed to strike a balance between telephone-based and interdisciplinary team-based care management programs. Case Example October 2016
Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis Much of the evidence comes from small studies, so further testing is needed. Brief/Report October 2015
The Return on Investment (ROI) Calculator: The Business Case and Person-Centered Care A calculator that can help build and present business case for serving adults with complex needs. Implementation Tool November 2016
Person-Centered Care: A Definition and Essential Elements This resource provides a definition and essential elements of person-centered care. Peer-Reviewed Article December 2015
Generating Hypotheses about Care Needs of High Utilizers: Lessons from Patient Interviews This resource presents promising ideas for more effective modes of care for persons with complex needs. Peer-Reviewed Article September 2013
The Hospital at Home Model: Bringing Hospital-Level Care to the Patient The program offers a lower-cost alternative to the hospital for patients who can be safely treated at home. Case Example August 2016
Hennepin Health: A Care Delivery Paradigm for New Medicaid Beneficiaries By closing gaps in care, a safety-net ACO has reduced medical costs for Medicaid patients with complex needs. Case Example October 2016
Bringing Primary Care Home: The Medical House Call Program at MedStar Washington Hospital Center Providing the frail elderly with 24/7 access to an interdisciplinary care team reduced expected spending by 20 percent. Case Example July 2016
High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? There is considerable variation in use and spending among high-need adults, suggesting this population should be segmented into subgroups. Brief/Report August 2016
How High-Need Patients Experience the Health Care System in Nine Countries The U.S. had the highest rate of cost-related access problems. Brief/Report January 2016
Attributes Common to Programs That Successfully Treat High-Need, High-Cost Individuals Targeting is important, even within the high-need patients enrolled in the program. Peer-Reviewed Article November 2015
The Care Transitions Intervention The Care Transitions Intervention was co-designed with patients and evaluated using randomized trials. Implementation Tool November 2016
Supporting a Culture of Health: Opportunities to Improve Models of Care for People with Complex Needs Key opportunities include strengthening information technology connections across service providers. Brief/Report September 2015