Programs Targeting Complex Patients — An Inventory


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.
Posted to The Playbook on
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
Key Questions Answered
  • What programs are improving care for patients with complex needs across the United States?