With rapid health care transformation efforts underway across the nation, there is increasing attention on strategies to improve outcomes and reduce avoidable costs for the small subset of individuals who account for the majority of health care spending. As innovative models emerge, policymakers, payers, and providers are eager to identify and scale effective approaches for serving high-need, high-cost patients.

This report and literature review, developed by the Center for Health Care Strategies (CHCS) through support from the Robert Wood Johnson Foundation, examines emerging evidence to shed light on what works to drive better health outcomes and reduce costs for individuals with complex needs. The analysis identifies critical gaps that must be addressed to improve care, with a particular focus on social determinants of health and opportunities to more effectively integrate health and social services.

  • Report – Draws from interviews with experts across the country and a comprehensive literature review to explore promising approaches for high-need populations ranging from pilot projects to statewide efforts. It identifies key opportunities for further research and program development across six domains: (1) care model enhancements; (2) financing and accountability; (3) data and analytics; (4) workforce development; (5) governance and operations; and (6) policy and advocacy.
  • Literature Review – Identifies: (1) evidence-based strategies for improving outcomes and lowering costs for high-need, high-cost populations; and (2) gaps in the evidence that must be addressed to develop more effective and replicable models of care for this population. It summarizes key findings from more than 80 studies focused on patients with complex needs.

The findings from these analyses can help guide more successful implementation efforts as well as inform future investments to improve care for high-need, high-cost patients.

This report and literature review will inform CHCS’ efforts to advance models that better integrate health and social services for individuals with complex needs. The work is made possible by the Robert Wood Johnson Foundation to support a Culture of Health for high-need, high-cost populations.