11 recommendations for advancing complex care
By Amy Yuen
In urban and rural pockets across the country, healthcare organizations have been pioneering new models to improve care for people with complex health and social needs. Many of these innovations are happening in isolation, with little opportunity for organizations to learn from each other and advance best practices. But that fragmentation will soon be a thing of the past. The Blueprint for Complex Care, a guide for collectively advancing the field of complex care, is laying the groundwork for complex care innovators to unite and advance the emerging complex care field.
Authored by the National Center for Complex Health and Social Needs, the Center for Health Care Strategies, and the Institute for Healthcare Improvement with support from The Commonwealth Foundation, the Robert Wood Johnson Foundation, and The SCAN Foundation, the Blueprint presents a comprehensive picture of the complex care field and a set of recommendations for building on existing work. The report was released on December 6 at the opening of the third annual Putting Care at the Center conference in downtown Chicago.
“It’s our hope that the Blueprint will drive the strategy to advance the emerging field of complex care, and provide actionable recommendations based on strong data and shared experience,” said Mark Humowiecki, Senior Director of National Initiatives at the Camden Coalition. “The American healthcare system is beginning to recognize that people suffering from multiple chronic illnesses along with serious social barriers to care like homelessness aren’t benefiting from one-size-fits-all solutions. It’s going to take many organizations working together in the same direction to advance the field of complex care, and the Blueprint is a framework to do that.”
The Blueprint draws from experts and stakeholders across the country to assess the current state of the complex care field and outlines actionable recommendations to help the field reach its full potential for improving care for the nation’s most vulnerable patients. The report provides the following recommendations for strengthening the field of complex care:
- Develop core competencies and practical tools to support their use. Complex care requires a diverse workforce with the knowledge, skills, and abilities to support intersecting, complex needs. Identifying competencies allows for the development of standardized educational programs and resources. Over time, the core competencies could evolve to become formal practice standards that are measured, tested, and formally certified.
- Further develop quality measures for complex care programs. Standard measures for complex care can accelerate learning and quality improvement, and enable providers to demonstrate value to payers and other stakeholders. While cost and utilization are common metrics, the health and well-being measures vary considerably. This contributes to over-reliance on cost and utilization as the primary way to define success, and insufficient attention to complex care’s positive impact on patient well-being and overall health.
- Enhance and promote integrated, cross-sector data infrastructures. Improved access to integrated, cross-sector data is critical to building the field’s knowledge and its ability to serve people with complex health and social needs. Efforts must address the financial, legal, and technical barriers to data integration.
- Identify research and evaluation priorities. While there has been a proliferation of research and evaluation work related to complex care, significant gaps remain. Some of these gaps have already been identified—such as deeper understanding of subpopulations, effective implementation strategies, and designing new payment systems—but additional work is necessary. Convening a research community can help accelerate progress.
- Engage allied organizations and healthcare champions through strategic communication and partnership. Complex care must collaborate with overlapping fields and communities that are aligned (or beginning to align) with the values, principles, and tactics that complex care employs and serve the same population. Potential partners include: criminal justice, community development, social services, palliative care, primary care, addiction medicine, population health, patient advocacy groups, and public health.
- Value the leadership of people with lived experience. Individuals’ personal experiences and insights into the systemic issues impacting people with complex needs, as well as potential solutions, are powerful assets that are not adequately represented in the field. The field must prioritize and support their involvement in continued field development.
- Strengthen local cross-sector partnerships. The local complex care ecosystem requires robust, equitable, and effective multi-sector partnerships. Heightened attention to social determinants and health equity has generated a lot of interest and activity in cross-sector relationships, yet true collaboration remains difficult. Tools and coaching can help teach leaders critical elements of effective partnerships.
- Promote expanded public investment in innovation, research, and service delivery. Dedicated public funding for innovation, research, and program implementation focused on populations with complex health and social needs has slowed over the last several years. Achieving increased funding will require coalition building and federal advocacy.
- Leverage alternative payment models to promote flexible and sustainable funding. Value-based purchasing creates incentives to invest additional resources in individuals with complex needs, particularly addressing social needs. More work, in close collaboration with payers and accountable care organizations, is required to build and test sustainable payment models.
- Create a field coordination structure that facilitates collective action and systems-level change. To create accountability to the field, we recommend the development of a multi-organizational coordinating structure convened by the National Center for Complex Health and Social Needs. This structure would convene stakeholders, monitor and organize major field-building activities, and serve as an entry point for individuals and organizations who want to contribute to the field.
- Foster peer-to-peer connections and learning dissemination. The field should also invest in infrastructure to connect individuals and organizations directly to one another and facilitate discussion and shared learning. As the field is building its foundational elements, access to individuals, and organizations with common experience can provide essential advice, support, and camaraderie for new members.
A growing list of more than 45 leading organizations in healthcare innovation, policy, and delivery from across the country have endorsed the Blueprint for Complex Care, including Johns Hopkins Healthcare, Kaiser Permanente, and the National Governors Association. This broad coalition of support is a testament to the maturing field of complex care as it evolves from an emerging approach to an essential component of our healthcare system. We’re looking for more organizations interested in signing on as Complex Care Champions, supporting the Blueprint’s recommendations, and sharing the document with individuals and organizations in their networks. Learn more and apply at: nationalcomplex.care/blueprint.