This resource harvests the lessons learned from eight health care organizations that successfully developed programs for individuals with multiple chronic conditions and functional limitations.
- Ten key questions can help you find out if you’re ready to redesign care for individuals with complex needs.
- The resource lists key steps in redesigning care: identifying target patients, designing a complex care management model, assigning roles to the care team, engaging physicians and office staff, enrolling and engaging patients, and developing a measurement plan.
- For each step, the guide recommends changes to try and identifies resources for further reading.
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