Choose Your Population and Identify Individuals

Individuals with complex needs are not homogeneous. They represent a diverse population with a wide range of health, behavioral, and social needs. Too often, when their needs are unmet by traditional health care models, they experience sub-optimal health outcomes despite high levels of acute care utilization and cost. But just as there are many different ways individuals can be complex, there are many different ways the health care system can fail these patients. A key step in designing a program for complex individuals is to have a clear idea of what problem(s) you are trying to solve for which complex subgroups. If the problem is “high costs,” which subgroup of high-cost patients seem to struggle with the same issues that could be addressed by a new intervention? Once this group is identified, it’s wise to focus on individuals who are the strongest fit for the program. This means identifying individuals within a select segment who are most likely to see health benefits and whose health care costs are likely to be decreased by a new intervention.