Who are people with complex needs?

High-need individuals have clinically complex needs, functional limitations, and/or behavioral health conditions, and incur high health care costs or are likely to in the near future. This is a diverse population, ranging from frail older adults to people with behavioral health and social needs.

Rates of hospitalizations, emergency department visits, and home health services are significantly higher for these individuals than the nation at large. However, despite higher utilization and associated spending, they are significantly more likely to report unmet needs. 

There is no “one-size-fits-all” approach to support people with complex needs. To effectively meet their needs, the first step is for providers to identify subgroups (or segments) with similar needs and/or service use patterns in order to tailor interventions appropriately.

The population subgroups identified in the Playbook were derived from work by the National Academies of Medicine (NAM).