Play by Play

Perspectives from leaders in the field of complex care.

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It should be great news. The US knows what kind of care to provide for older adults. We have PACE (Programs of All-Inclusive Care for the Elderly) programs in hospitals and communities, ACE (Acute Care of the Elderly) units in hospitals, and GRACE (Geriatric Resources for Assessment and Care of Elders) in hospitals, for example.

Research has shown that many people with complex health needs are  assisted by family members, who often operate as de facto care coordinators.

Yet most care delivery systems don’t proactively identify and meaningfully engage or support family caregivers in visits or care plans.

Patients with complex needs are often described as the 5 percent of patients who account for 50 percent of health care spending. Behind that oft-cited statistic are the individuals who make up that population – all of whom have their own stories and needs.

In a new Playbook video, David Blumenthal, MD, MPP, president of the Commonwealth Fund, offers insight into the individuals within the group with the story of “Mrs. D,” a patient he cared for.

Marit Tanke, MD, PhD, a Commonwealth Fund Harkness Fellow, led a research project to analyze high-need, high-cost patients across four countries — the United States, the Netherlands, Canada, and Germany.

What did she learn? The US is not the only country with a high proportion of health care spending concentrated in a small number of patients.

How can health systems improve care for patients with complex needs?

They can start by asking, “Who?”

Jose Figueroa, MD, MPH, a hospitalist at Brigham and Women’s Hospital and a health services researcher at Harvard School of Public Health and Harvard Medical School, has been researching this question: Who are patients with complex needs?

Dr. Figueroa was part of a team convened by the National Academies of Medicine (NAM) that created a model for identifying population segments within the broad category of high-need, high-cost patients.