There are many promising strategies to segment individuals with complex needs. Here is one conceptual framework.

Segmenting the high-cost population is the first step in matching appropriate care management strategies.

Care management programs should include processes for evaluating patient-reported outcomes.

Examines a unique program that seeks to integrate medical, behavioral health, and social services for dual eligible individuals with serious mental illnesses, substance abuse problems, or disabilities.

The approach identifies patients through chart review and data analytics coupled with the intelligence of community health workers.

Dual-eligible beneficiaries are often more sick, have greater functional and cognitive impairments, and require more care coordination.

Provider incentives must be based on Triple Aim outcomes.

Experts describe how delivery systems can effectively serve adults with complex needs.

There is considerable variation in use and spending among high-need adults, suggesting this population should be segmented into subgroups.

The U.S. had the highest rate of cost-related access problems.

By closing gaps in care, a safety-net ACO has reduced medical costs for Medicaid patients with complex needs.

Less “activated” patients are more likely to benefit from care coordination.

Successful long-term services and supports programs have a single point of accountability, such as a care manager.

Interdisciplinary teams provide support for Medicaid beneficiaries with mental illnesses, addictions, and other needs.

Much of the evidence comes from small studies, so further testing is needed.

A calculator that can help build and present business case for serving adults with complex needs.

Key opportunities include strengthening information technology connections across service providers.