Develop and cost your care model

A care model is a specific set of interventions, activities, and tasks that is carried out consistently and targeted to a given population, designed to interact with targeted individuals in a predictable way and improve their care. A key step in improving the care of complex subgroups is to have both a deep understanding of the unmet need(s) driving the poor outcomes of an identified subgroup as well as a specific proposal with a high likelihood of addressing those needs. In the beginning the intervention is likely based on an hypothesis: “We think this is what is driving our unacceptable outcomes for this group; based on that understanding, and evidence from other programs, we think this intervention will address that problem; but we will undoubtedly learn as we go.” While the evidence base is evolving, many existing models have been shown to meaningfully improve individuals’ quality of life. Designing a model for your patient segment, testing it, refining it, and bringing it to scale are key to improving care for people with complex needs. This can present a challenge in terms of projecting savings and costing your model. Engaging your clinical and organizational stakeholders early in your goal-setting and design process, continuing to engage through implementation, and sharing “lessons learned” will be key to success.