As New Survey Describes Scope of Problem
Five National Health Care Foundations Identify Promising Approaches for Treating Patients With Complex Needs

Five Foundations Release ‘Playbook’ of Best Practices to Improve Care and Lower Costs for Americans Who Face Medical, Behavioral, and Social Challenges

New National Center for Complex Health and Social Needs Convenes Experts and Stakeholders to Build a Field of Complex Care

DECEMBER 9, 2016—A new nationwide survey of patients with complex medical needs shows that the health care system is failing them, with these individuals having far more unmet behavioral health and social service challenges than other adults. While nearly all of the high-need patients surveyed have consistent access to health care (95%), they nevertheless struggle to get the coordinated medical, behavioral, and social services they need to stay well and avoid costly hospital visits. Specifically, they had limited access to: care coordinators, assistance in managing functional limitations, emotional counseling, and transportation services.

The Commonwealth Fund survey of 3,009 adults (1,805 of whom are high-need) is being released as five national health care foundations—The John A. Hartford Foundation, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation, The SCAN Foundation, and The Commonwealth Fund—launch a new online resource to help health system leaders and insurers improve care for patients with complex medical and social needs.

Developed by experts at the Institute for Healthcare Improvement, The Playbook: Better Care for People with Complex Needs is an initial effort to compile and share promising approaches. The Playbook offers insights about patients with complex needs, examples of successful approaches to care, guidance on making the business case for these models, and opportunities for policy and payment reform.

The Playbook will be unveiled Friday, Dec. 9, 2016, at the inaugural meeting of the National Center for Complex Health and Social Needs, led by Jeffrey Brenner, M.D., of the Camden Coalition of Healthcare Providers. The new National Center is a first-of-its-kind hub designed to convene and grow an emerging field of experts and stakeholders including providers, health and social service systems, researchers, payers, patient and family advocates, and community leaders. Dr. Brenner, a MacArthur ‘Genius’ Award recipient, has been acclaimed for developing approaches to care that meet non-medical needs such as addiction, housing, hunger, and mental health. The Robert Wood Johnson Foundation, The Atlantic Philanthropies, and AARP are founding partners of the National Center.

Improving care for patients with complex needs is a strategic focus for an increasing number of health systems—and public and private payers—seeking to improve patient outcomes and lower overall costs of care. Researchers have estimated that although these patients represent just 5 percent of the population, they account for 50 percent of U.S. health care spending.

In addition to patients with complex needs reporting challenges getting care, the Commonwealth Fund survey shows:

  • Nearly half (47%) visited the emergency department (ED) multiple times in the past two years.
  • A majority did not have good access to services that could help them manage their conditions, such as adequate help with activities of daily living (62%) or an informed and up-to-date care coordinator (58%).
  • Almost two-thirds (62%) experienced stress about their ability to afford housing, utilities, or nutritious meals. This compares to just 32% of people without high-needs.
  • A majority (59%) worried about being a burden to family and friends. More than one-third (37%) felt lonely, left out, or isolated from others.

Patients with complex needs are a diverse group, including older adults, people with major complex chronic conditions, and younger people with disabilities. Since many are older than 65, experts say addressing this issue will become more urgent as America’s population ages.

The foundation leaders believe that with better access to care that coordinates patients’ medical, behavioral, and social needs—along with improved provider-patient communications—patients with high-needs will be less likely to delay care or seek emergency care for non-urgent issues. The five foundations releasing the Playbook will continue working both collaboratively and individually to spread promising care models, promote policy action, improve quality measurement and monitoring, and engage more stakeholders in better care for patients with complex needs.

The Playbook is available at

Methodology: The 2016 Commonwealth Fund Survey of High-Need Patients was conducted by SSRS from June 22 to Sept. 14, 2016, as a part of SSRS's weekly, nationally representative omnibus survey. The survey consisted of 15-minute telephone interviews in English or Spanish, conducted among 3,009 adults age 18 and older living in the United States. Of these, 1,805 were completed with respondents who qualified as high-need based on screening questions assessing major chronic conditions and functional limitations.

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Quotes from leaders of the five foundations

“Our research shows that when people with complex needs require medical help, they encounter a health care system that’s expensive, inefficient, and poorly coordinated. We want to better understand what works for effectively treating these patients, so we can identify gaps, reduce duplication, and accelerate what works.”
–David Blumenthal, President, The Commonwealth Fund

“Promising models already exist that improve care for Americans with complex health and daily living needs. Innovative health systems nationwide are showing better outcomes and lower use of expensive services by adopting new approaches to care, yet more is needed to replicate results and bring models to scale.”
–Bruce Chernof, President & CEO, The SCAN Foundation

“Redesigning care for patients with complex needs, especially disadvantaged older people who interact frequently with our medical system, will alleviate suffering, decrease costs, and send a message that we are serious about health equity. Working together, we can create age-friendly health systems and scale up solutions that improve outcomes for those in greatest need.”
–Terry Fulmer, President, The John A. Hartford Foundation

“Many people across different sectors are working nationwide to improve care for patients with complex health and social needs. Complex care is more than an approach to addressing the needs of a certain population. It’s a growing discipline that bridges health and health care.”
–John Lumpkin, Senior Vice President, Robert Wood Johnson Foundation

“Improving care for high-need patients is a moral, social, and economic necessity. By understanding the needs of this patient population and effectively integrating health care with social and behavioral services, we can deliver more targeted, effective care that is sustainable and affordable for the country.”
–Jeffrey Selberg, Executive Director, Peterson Center on Healthcare

CONTACT: Haydn Bush 202-868-4811;