Complex care programs across the country use varied criteria to identify people with complex health and social needs and measure the effectiveness of subsequent interventions. Greater standardization of measures will help evaluate the effectiveness of these programs. This report assesses the current state of quality measures in the complex care field and identifies opportunities to refine measures.
The first step to measuring the impact of complex care programs is identifying who is included in these programs. Common inclusion criteria are cost/utilization, risk score, chronic conditions, insurance status, social needs, behavioral health, referral, and age — but these criteria have limitations. Data sources and availability, which vary widely across organizations, also impact how eligible participants are identified and how programs are evaluated. Notably, integrating collection of patient-reported data into existing workflows presents a challenge to many programs. This report outlines five consistent complex care measurement domains that may help guide and standardize future measure development: effectiveness/quality of services, equity, health and well-being, service delivery, and cost/utilization.
The report proposes eight recommendations designed to improve measurement and identification of people with complex health and social needs and begin the process of standardizing measures of complex care program effectiveness. A companion brief, developed by the National Center for Complex Health and Social Needs, summarizes the findings from the report, categorized in four areas — defining the population, data availability and potential sources, measurement domains, and measures and measure concepts — along with the eight recommendations for next steps the field can take to develop a standard set of quality measures.