As we grapple with unsustainable health care spending and an aging and increasingly chronically-ill population in the United States, we need new strategies for organizing and improving the efficiency of health care delivery. One particularly promising strategy is complex care management (CCM) in which specially trained, multidisciplinary teams engage and address the complex needs of a subset of the most complex, high-cost patients. CCM, when designed and implemented appropriately, can improve health outcomes and reduce unnecessary utilization and costs. In fact, CCM initiatives can pay for themselves.
GHDonline is pleased to welcome an exciting group of experts to share their experience in designing and implementing successful complex care management programs:
• Ken Coburn MD, MPH, co-founder, CEO and Medical Director of Health Quality Partners
• Steve Counsell MD, Founding Director IU Geriatrics, a John A. Hartford Foundation Center of Excellence in Geriatric Medicine, Indiana University
• Clemens Hong MD, MPH, Instructor of Medicine, Harvard Medical School and Chief Science and Innovation Officer at Anansi Health,
• Rebecca Ramsay BSN, MPH, Director of Community Care, CareOregon
• Jan Van der Mei RN, MS, ACM, Ambulatory Care Management Director, Sutter Health Sacramento-Sierra Region
During our week-long discussion, panelists will address the following questions:
• How are you approaching the care of the most complex, high-need, high-risk patients in your health delivery context? How have you specifically adapted your approach for your context or selected population?
• Evidence for complex care management is inconsistent, which may be due to sub-optimal strategies to address key steps in complex care management. What approaches have been most successful for your teams in: selecting and engaging patients, identifying and prioritizing care gaps, and delivering interventions to address patient needs across the biopsychosocial spectrum? What factors are most critical to success in these areas?
• Care management programs must develop strong relationships with patients, primary care providers, and hospital and community-based providers (e.g. behavioral health, in-home support services, and social services agencies). Who are your critical partners, and what approaches have you used to best engage them?
• What are the keys to successful implementation of CCM? What challenges have you encountered with implementation? What “do’s” or “don’ts” have you learned?
• How do you plan to ensure that your work in complex care management is sustainable? What challenges the sustainability of your approach? How are you building the case for sustainability or growth of the model in your context?
This panel is part of our US Communities Initiative, which is supported by the Agency for Healthcare Research and Quality (AHRQ), and aims to foster discussions between health care professionals on evidence-based practices, and translating these practices across disparate settings, to improve health care delivery in underserved populations in the US.
In an effort to understand the impact of our Expert Panels, please take our short (4 question) survey before the discussion begins: https://www.surveymonkey.com/s/VQWGCZQ
If you work in a complex care management program, or are beginning to implement one, and would be interested in speaking with us about the impact this Expert Panel has on your work, please contact us at:
We’re looking forward to a rich discussion next week – please join the conversation and share your questions or comments for our panelists!