The state of the field of complex care 2022

Building the complex care field

By Mark Humowiecki, General Counsel and Senior Director for National Initiatives; Carter Wilson, Associate Director for National Center for Complex Health and Social Needs

2021 was a year of both challenges and progress for the field of complex care. The ongoing pandemic continues to restrict in-person engagements, overload professional and family care providers, and threaten the physical and economic health of individuals with complex health and social needs. Community-based organizations, healthcare delivery institutions, and public health agencies have worked to promote equity in vaccine distribution and ensure service access, but challenges persist as the pandemic enters it’s third year. Despite these challenges, the field has made significant advancements toward implementing the recommendations in The Blueprint for Complex Care. Released in 2018 and funded by The Commonwealth Fund, The SCAN Foundation, and the Robert Wood Johnson Foundation, the Blueprint provides a strategic plan to guide the maturing field toward the ultimate goal of making high quality, person-centered care available to all people with complex health and social needs. 

See this brief for progress on implementing the 11 recommendations in the Blueprint and priority next actions. 

The following are trends that impacted the field of complex care on the national level in 2021.

Deepening commitment to address health inequities 

In 2020, fueled by the Black Lives Matter movement and the emergence of the COVID-19 pandemic, public awareness of the deep impact of racism and health inequities grew, as did commitment across sectors to address these inequities. In 2021, we saw expanded action to substantially advance health equity. Organizations throughout the country, including the new federal administration and its healthcare agencies, as well as the medical profession, health systems, and health plans, have elevated their focus on health equity and made meaningful investments to promote equity within their institutions and throughout society. 

For complex care to flourish and spread, we need to continue to communicate a compelling vision of what complex care is and how it advances health equity. By focusing on individuals and populations with poor health outcomes, complex care provides a valuable platform for identifying and understanding the root causes of health disparities among racial and other marginalized groups. Furthermore, its cross-sector and person-centered care connects these populations to the services and supports that can meaningfully improve health while advocating for larger system and policy changes to significantly address health disparities. 

Expanding definitions of value within healthcare 

Stakeholders throughout healthcare have further emphasized equity as a core objective and healthcare organizations are partnering with competitors, community-based organizations, and consumer groups to advance care for complex populations. There is increasing recognition among leaders in healthcare that to address disparities, measurement must go beyond cost and utilization to include health and well-being, health equity, and patient experience. There is a broad effort to build a person-centered research agenda to guide complex care efforts that prioritize the experiences and expertise of patients with complex health and social needs. For example, a project led by the Center for Health Care Strategies and funded by the Patient-Centered Outcomes Research Institute (PCORI) seeks to prioritize key research questions, identify measurement domains, and propose approaches to implementation.  

Increasing focus on the social drivers of health 

Stakeholders throughout healthcare are increasingly focused on addressing health-related social needs and the social determinants of health (SDoH). All health plans surveyed by the Institute for Medicaid Innovation screen populations for social needs and provide targeted SDoH interventions. There are increasing state Medicaid initiatives to pay for related social care services (eg., North Carolina, California, etc.) and there is rapid adoption of technology platforms that support these programs.  At the federal level, multiple pieces of legislation have been introduced in Congress to address SDoH. In July 2021, the House launched the Congressional Social Determinants of Health Caucus to “explore opportunities to improve the impact of services delivered to address social determinants with the support of federal funding.” The Centers for Medicare and Medicaid Services has included related goals in their strategic plan for the coming decade.

Development of the complex care workforce 

There is increased recognition that complex care teams need dedicated training and clear standards to ensure that the most vulnerable populations are receiving the highest quality care. Employers see value in developing their complex care teams, reducing absenteeism and burn-out, and creating system-wide language and approaches. Organizations have varying capacities to develop and manage training programs, requiring a range of support modalities. Driven by the demand in practice, academic institutions are incorporating complex care content into existing curriculum and developing care coordination/management courses.

As we enter 2022, the field is positioned to continue to accelerate progress on a variety of fronts, including the development of a comprehensive curriculum grounded in the core competencies for frontline complex care providers and the release of a complex care messaging guide to move toward common shared language and communication in the field. 

This blog and the attached brief were developed with support from the Complex Care Field Coordinating Committee (FCC). Established in 2019, The FCC coordinates and aligns activities to advance the field of complex care, satisfying recommendation #10 in the Blueprint: Create a field coordination structure that facilities collective action and system-level change.