Opportunities to Improve Models of Care for People with Complex Needs

With rapid health care transformation efforts underway across the nation, there is increasing attention on improving outcomes and reducing avoidable health care costs for the small subset of individuals who account for the majority of health care spending. Significant gaps in understanding remain—including how to identify and engage individuals, segment populations into meaningful subgroups with tailored interventions; measure quality outcomes, and align financial incentives across systems. This report aims to identify those opportunities that warrant further exploration, with hopes of targeting future investments and pilot activities to help fill the gaps that remain.