I wasn’t sure what to expect when I became lead for IHI’s work on redesigning care for individuals with complex needs and high health care costs four years ago.

While it was an exciting opportunity to combine my clinical career in safety net and community settings with my experience using the science of improvement, I had concerns. Would we really provide better care at lower costs or would systems just take expensive health care away?

I needn’t have worried. I worked with amazing faculty members for the Better Health and Lower Costs for Patients with Complex Needs collaborative. We built on a solid foundation of work started by the 30 organizations in the “high-risk, high-cost” Triple Aim Learning Community workgroup. Both the collaborative and the workgroup focused on restructuring care for those with complex needs (including chronic physical and mental illness, poverty, and social isolation) and high health care costs —  the 1 to 10 percent of individuals who drive approximately 50 percent or more of health care costs in the United States.  

Some lessons we learned four years ago still hold true now:

• We know a lot, but not nearly enough to give a “recipe” for redesigning care for this population segment.
• Organizations need to use strong quality improvement methods to take ideas that work elsewhere and learn if and how they work in their context. There is no magic bullet.
• It is hard to demonstrate cost savings beyond “regression to the mean,” meaning that the cost curve will decrease over time, even if patients receive “usual care” (no special intervention or enhanced services).
• The most common cause for failure is wholesale adoption of a program without learning how to adapt it to the organization.

Additionally, we synthesized the lessons learned from working with 50+ organizations and turned them into a kind of “roadmap.” Thanks to a grant from The Commonwealth Fund, the Better Health and Lower Costs for Patients with Complex Needs care design method is now an online Care Redesign Guide.

The web-based guide offers a structured improvement process to enhance health outcomes for individuals with complex health, behavioral, and social needs and with high health care costs. It uses quality improvement science and provides recommendations from the literature and successful programs. It is not a recipe, but offers substantive guidance we hope others will find useful. 

Cory Sevin was director for IHI’s Better Health Lower Costs Collaborative.

You may also be interested in:

The Playbook: Better Care for People with Complex Needs

More resources on improving care for individuals with complex health and social needs