Across the country, more and more states, health plans, and provider organizations are focusing on improving care management for low-income individuals with complex medical and social needs. As complex care programs grow, it is imperative to establish which models are most effective. While funding decisions for complex care programs often center on cost and utilization, these measures may provide an overly simplified definition of success or failure.
This brief acknowledges the merits of using a cost and utilization framework to evaluate complex care programs, but takes a close look at the limitations in relying solely on this narrow lens. It reviews alternative, non-traditional metrics for assessing the value of complex care models, including whether programs: (1) produce reduced costs or positive impacts elsewhere in the community (e.g., housing stability); (2) improve patient experience of care, health status and associated satisfaction; and/or (3) offer the potential to demonstrate more robust cost and utilization results over a longer term.
This brief, a product of the Center for Health Care Strategies’ Complex Care Innovation Lab made possible by Kaiser Permanente Community Benefit, is the first in a series exploring opportunities to improve evaluation of complex care programs. Look for more briefs shortly.