Programs Focusing on High-Need, High-Cost Populations

August 2018

This resource provides a map and chart with an inventory of innovative complex care programs at varying stages of development throughout the United States.

  • Center for Health Care Strategies, Inc. is working with innovative programs that are testing new models of care for low-income populations with complex medical, behavioral health, and social needs.
  • Southcentral Foundation in Alaska, for example, serves Alaska Natives and American Indians in urban and rural areas, providing comprehensive medical, behavioral health, dental, case management, and advocacy services.
  • The Metro Community Provider Network Bridges to Care Program in Colorado reduces inpatient and emergency room admissions by providing care support through hot-spotting, bedside visits, and home visits from care teams. They also focus on treating behavioral health needs.
Posted to The Playbook on
Population Addressed
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • Where in the United States are innovative complex care programs located?
  • What are the key features of each program?
Level of Evidence
Expert Opinion
What does this mean?