This resource harvests the lessons learned from eight health care organizations that successfully developed programs for individuals with multiple chronic conditions and functional limitations.
- Ten key questions can help you find out if you’re ready to redesign care for individuals with complex needs.
- The resource lists key steps in redesigning care: identifying target patients, designing a complex care management model, assigning roles to the care team, engaging physicians and office staff, enrolling and engaging patients, and developing a measurement plan.
- For each step, the guide recommends changes to try and identifies resources for further reading.
- How can I implement a care management program for individuals with complex needs?
- How can I improve an existing program for these individuals?
- What resources and tools are available to help?