In many high-income countries, a small number of patients with complex needs account for a significant share of total health and social care spending. Many countries have begun adopting innovative programs that engage these patients and their caregivers to address both social and health care needs.
Writing in Health Affairs with support from the Commonwealth Fund, researchers at the University of Toronto led by Geoffrey Anderson identified 30 health and social care programs, across 11 countries, that are delivering integrated care in innovative ways. The researchers then surveyed program leaders to identify which strategies and activities they were using to identify high-need patients, coordinate care, and engage patients and caregivers.
Most integrated health and social care programs have well-defined eligibility criteria for identifying and targeting high-need patients, and many use their intake processes to better understand the specific needs of patients and their caregivers.
What the Study Found
- The programs contained several common features: Most programs have well-defined eligibility criteria for identifying and targeting high-need patients, and many use their intake processes to better understand the specific needs of patients and their caregivers. Most programs also have a strong role for primary care providers. Shared decision-making and self-management among patients and caregivers is consistently prioritized.
- There are also key differences: Some programs rely on passive intake, letting patients come to them, while others work in the community to identify and recruit high-need patients. Programs also differ based on the target populations they serve: for example, programs serving frail elderly people adopted different innovations than those serving patients with chronic medical conditions or patients with mental health conditions or substance use disorders.
The Big Picture
The consistent use of targeting, coordination, and patient and caregiver engagement across these programs suggests that there is some international agreement on core components of innovative integrated health and social care. Yet the variations reflect that programs should be designed to fit the target populations they serve. Researchers could build on this common approach to describing innovative programs to facilitate international policy exchange, and policymakers could use this understanding of core and adaptable components to spread and scale up the interventions. An important next step will be to develop high-quality evaluation protocols to assess the effectiveness of the interventions.
The Bottom Line
In the United States and other high-income countries, patients with complex needs drive much of medical and social care spending. A survey of innovative programs enacted to target these high-need patients discovered some common features and certain variations in how they deliver integrated care. These findings could influence future study and expansion of these innovations.