Programs Targeting Complex Patients — An Inventory

Key Questions Answered
  • What programs are improving care for patients with complex needs across the United States?
Key Themes and Takeaways

This resource contains profiles of nearly a hundred programs that target complex patients across 36 states and territories, including Puerto Rico and Washington, DC.


  • To qualify for inclusion, the programs must either offer social services integration or address socioeconomic disparities.
  • Each profile includes information such as partner organizations, target population, care team, and funding sources.
Population Addressed
Adults Under 65 with Disabilities
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
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