Providing quality care for individuals with complex care needs is one of the most pressing challenges facing the United States health care system. The Bipartisan Policy Center, with the support of The SCAN Foundation, The Robert Wood Johnson Foundation, The Peterson Center on Healthcare, and The Commonwealth Fund, has been working since 2013 to develop policy solutions focused on how to finance and deliver quality care to individuals with complex care needs.
This report draws from six previous reports to identify a roadmap of policy solutions that can begin to tackle the barriers to financing and delivering high-quality, person- and family-centered, coordinated health and social services and supports to individuals with complex care needs.
Individuals with complex care needs have been a population of focus as policymakers have worked to develop and implement program-wide health care delivery system reforms in Medicare. In 2010, 37 percent of Medicare beneficiaries had four or more chronic conditions. These beneficiaries accounted for 90 percent of Medicare hospital readmissions in 2010. Medicare beneficiaries with four or more chronic conditions also comprised 74 percent of Medicare program spending in 2010. Challenges for high-need people can be even greater for low-income older adults and individuals with disabilities who are eligible for both Medicare and Medicaid coverage. Many of these so-called “dual-eligible” beneficiaries have higher medical acuity, significant cognitive and functional impairments, and a greater need for care coordination and assistance with activities of daily living (ADLs).