Play by Play

Playbook postings and exclusive perspectives from leaders in the field


The complex care field is emerging. The Better Care Playbook is your go-to source for the latest and best information, curated to help you find what you need fast.

In an effort to get new ideas to the field as quickly as possible, the Better Care Playbook is now accepting content submissions from the complex care community. You can share a resource, a Play, or a case example using this form, which will soon be featured on the Playbook home page.

It should be great news. The US knows what kind of care to provide for older adults. We have PACE (Programs of All-Inclusive Care for the Elderly) programs in hospitals and communities, ACE (Acute Care of the Elderly) units in hospitals, and GRACE (Geriatric Resources for Assessment and Care of Elders) in hospitals, for example.

Research has shown that many people with complex health needs are  assisted by family members, who often operate as de facto care coordinators.

Yet most care delivery systems don’t proactively identify and meaningfully engage or support family caregivers in visits or care plans.

Patients with complex needs are often described as the 5 percent of patients who account for 50 percent of health care spending. Behind that oft-cited statistic are the individuals who make up that population – all of whom have their own stories and needs.

In a new Playbook video, David Blumenthal, MD, MPP, president of the Commonwealth Fund, offers insight into the individuals within the group with the story of “Mrs. D,” a patient he cared for.

Marit Tanke, MD, PhD, a Commonwealth Fund Harkness Fellow, led a research project to analyze high-need, high-cost patients across four countries — the United States, the Netherlands, Canada, and Germany.

What did she learn? The US is not the only country with a high proportion of health care spending concentrated in a small number of patients.