Caring for high-need, high-cost patients: what makes for a successful care management program?

Issue Brief (Commonw Fund). 2014 Aug;19:1-19.


Provider groups taking on risk for the overall costs of care in accountable care organizations are developing care management programs to improve care and thereby control costs. Many such programs target "high-need, high-cost" patients: those with multiple or complex conditions, often combined with behavioral health problems or socioeconomic challenges. In this study we compared the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. We found that effective programs customize their approach to their local contexts and caseloads; use a combination of qualitative and quantitative methods to identify patients; consider care coordination one of their key roles; focus on building trusting relationships with patients as well as their primary care providers; match team composition and interventions to patient needs; offer specialized training for team members; and use technology to bolster their efforts.

MeSH terms

  • Accountable Care Organizations
  • Behavior Therapy
  • Chronic Disease
  • Comorbidity
  • Cost Control / methods
  • Delivery of Health Care / economics*
  • Delivery of Health Care / statistics & numerical data*
  • Health Care Costs*
  • Health Services / economics*
  • Health Services / statistics & numerical data*
  • Humans
  • Needs Assessment
  • Patient Care Management / economics*
  • Program Evaluation*
  • Quality Improvement
  • Socioeconomic Factors
  • United States