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The American Journal of Accountable Care December 2018
The Cost of Not Taking Our Medicine: The Complex Causes and Effects of Low Medication Adherence
Ellen Harrison, MBA, RN, vice president, HMS
Analysis of 2016 Connecticut ACO Medicare Shared Savings Program Data to Identify Opportunities for Population Health Pharmacist Services
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Cost of Delivering Centralized and Decentralized Reminder/Recall for Vaccinations to Children and Adolescents in an ACO
Melanie D. Whittington, PhD; Dennis Gurfinkel, MPH; Laura P. Hurley, MD; Steven Lockhart, MPH; Brenda Beaty, MSPH; Miriam Dickinson, PhD; Heather Roth, MA; and Allison Kempe, MD, MPH
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Darrell L. Hudson, PhD, MPH; Melvin S. Blanchard, MD; Cassandra Arroyo-Johnson, PhD, MS; Laurel Milam, MA; Kimberly A. Kaphingst, ScD; and Melody S. Goodman, PhD, MS
Increased Healthcare Utilization and Expenditures Associated With Chronic Opioid Therapy
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Currently Reading
The Blueprint for Complex Care: Laying the Groundwork to Build a Field Across Sectors
National Center for Complex Health and Social Needs; Center for Health Care Strategies; and Institute for Healthcare Improvement

The Blueprint for Complex Care: Laying the Groundwork to Build a Field Across Sectors

National Center for Complex Health and Social Needs; Center for Health Care Strategies; and Institute for Healthcare Improvement
Complex care is cross-sector and person-centered, and it could bend America’s healthcare cost curve. The Blueprint for Complex Care gives this new field a national framework.
The American Journal of Accountable Care. 2018;6(4):28-31
Two data points have preoccupied the national discussion on healthcare spending over the past several years: (1) that a small percentage of the US population drives a disproportionate amount of healthcare spending1 and (2) that the United States has the highest per capita healthcare spending among “high-income” countries.2 So far, results of efforts to bend the cost curve are mixed, at best. A third data point, which shows that spending on social services in the United States is lowest among industrialized nations compared with healthcare spending,3,4 is driving new thinking in the emerging field of complex care.

In recent years, we have seen increasing numbers of programs that radically redesign the delivery of healthcare and social services around the needs of individuals with complex health and social needs.5-7 Many share a commitment to person-centered, equitable care that bridges sectors, is delivered by interprofessional teams, and is driven by cross-sector data. Some health systems are already implementing large-scale screening and referral programs to address social drivers of health, but more targeted interventions are needed.

The vibrant innovation and variation among complex care models have drawn growing interest from large health systems, payers, and government agencies. In order for these successful models to spread and scale up, the field needs to move toward the development of clear standards of practice, shared research agendas, and clearer policy and payment solutions that create durable funding streams. To lead this effort, 3 organizations—the Camden Coalition of Healthcare Providers’ National Center for Complex Health and Social Needs, the Center for Health Care Strategies, and the Institute for Healthcare Improvement—joined together to create a framework to advance the field of complex care, namely, the Blueprint for Complex Care.8

The effort was supported by The Commonwealth Fund, the Robert Wood Johnson Foundation, and The SCAN Foundation.

Seeking Consensus on Complexity

The Blueprint is organized along the Strong Field Framework,9 a methodology developed by the Bridgespan Group for assessing any given field of activity using 5 specific components. Emerging fields such as complex care must (1) unite around a shared identity, (2) advance standards of practice, (3) build a collective knowledge base, (4) bolster leadership and grassroots support, and (5) solidify funding and supporting policy. The framework recognizes that a key strategy for realizing social change is developing a field and its workforce. The Strong Field Framework was designed to illuminate complex care’s strengths and weaknesses and help structure the development of the Blueprint’s recommendations for the field.

In addition to the Blueprint’s cross-organizational leadership, the development process was designed to be as inclusive as possible. The analysis of the current state of the field and the recommendations for its advancement were informed by interviewing complex care innovators, convening complex care model builders, and surveying nearly 400 individuals with an interest in complex care. The Blueprint’s authors also sought to learn from other recently developed fields, such as palliative care, hospital medicine, and tobacco cessation.

Defining Complex Care

One of the major gaps identified by stakeholders was the lack of a shared definition and common language to describe complex care. Many definitions of complex care rely solely on high cost and high utilization patterns as the 2 main gauges of complexity,10 but there is increasing interest in more comprehensive descriptions that include behavioral health and social needs as additional key indicators of complexity. Stakeholder input was invaluable in leading the Blueprint authors to propose a definition that will bring much-needed clarity to the field. The Blueprint defines complex care as follows:
Complex care is a person-centered approach to address the needs of people who experience a combination of medical, behavioral health, and social challenges that result in extreme patterns of healthcare utilization and cost. Complex care coordinates individuals’ care while reshaping ecosystems of care to deliver integrated services for those whose root causes of poor health defy existing boundaries among sectors, fields, and professions. These programs seek to be person-centered, equitable, cross-sector, team-based, and data-driven.8

Although the intended population of complex care programs can vary significantly from program to program, the Blueprint proposes that complex care shares these common traits:
Complex care seeks to improve the health and well-being of a relatively small, heterogenous group of individuals who are repeatedly cycling through multiple healthcare, social service, and other systems but who do not derive lasting benefit from those interactions.8

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