Patients with complex medical needs account for a significant proportion of overall health care spending, and many efforts in recent years, including some mandated by the Affordable Care Act, have sought to identify the best ways to serve such patients while also reducing the cost of doing so.

commonwealth fundA new analysis by the Commonwealth Fund analyzes promising models for serving these patients and offers six principles for improving their care. Those principles are:

  1. Identify subgroups of patients with similar needs and challenges.
  2. Shift the delivery of care for high-need patients from institutional settings to home and community settings whenever possible.
  3. Build the capacity to assess and actively manage social and behavioral health needs in addition to medical needs.
  4. Make it easier for patients, caregivers, and professionals to work in close coordination with one another.
  5. Design and deliver services that meet goals set collaboratively by patients, caregivers, and providers.
  6. Allocate resources based on the potential to have a positive impact on the quality of life of patients and caregivers.

Find the analysis here and more about the principles here.