Designing a Health Care System for Patients with Complex Needs: Ten Recommendations for Policymakers

September 2017

This resource describes the findings of the International Experts Working Group on Patients with Complex Needs. The Commonwealth Fund established this group in 2014 to outline the components of a high-performing health care system for high-need, high-cost patients and to identify promising relevant international innovations.


  • This report reviews the group's top 10 recommendations, which include making care coordination a high priority; identifying patients in greatest need of proactive, coordinated care; and training more primary care physicians and geriatricians. 
  • All 10 recommendations present challenges, and some recommendations require paradigm shifts - for instance, away from disease-specific care delivery and toward patient-centered approaches.
  • Successful implementation of the recommendations has the potential to transform care and quality of life for millions of people.
  • This report also includes profiles of selected international models that follow the recommendations, from countries including Canada, England, France, and Israel.
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Level of Evidence
Expert Opinion
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