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Complex Care Management: A Tool for Improving Quality and Lowering Costs

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Care management programs that focus on patients with complex health and social needs are increasingly viewed by health systems and payers as essential to lowering the overall costs of care. In a new Commonwealth Fund issue brief, researchers Clemens S. Hong, M.D., Allison L. Siegel, and Timothy G. Ferris, M.D., compare the approaches of 18 successful programs to identify best practices to guide providers, payers, and policymakers across the U.S.

In each of the complex care management  programs highlighted, specially trained teams of physicians, nurses, pharmacists, mental health professionals, and others coordinate closely with primary care providers. These teams address the needs of patients, most of whom have multiple chronic conditions or advanced illness and face social or economic barriers to accessing services.

In an accompanying perspective in the New England Journal of Medicine, authors Hong and Ferris and the Fund’s Melinda Abrams note that while complex care management may seem beyond the capacity of smaller physician practices, many can build effective programs by sharing key resources like patient registries, staff, and health IT. “Successful [complex care management] not only pays for itself,” they say, “it also directly addresses our goal of lower costs, improved care, and improved patient experience.”

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