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Complex Care

Physician assistant Brett Feldman

When medical, behavioral, and social services coordinate their care, the needs of the patient are better met.

A small subset of individuals with complex medical, behavioral, and social needs accounts for a disproportionate share of health care spending. The lack of coordination among these services means that patients with complex care needs are often not effectively managed and experience fragmented care and unnecessary hospitalizations.

Our aim is to increase coordination across the areas of acute care, long-term support services, home care, and behavioral health. Community services can and should function in harmony, attuned to the needs of the patient. We back the development of state and federal policies that can improve this coordination. We are also working to integrate housing, nutrition, and transportation with medical services, and we seek to identify, evaluate, and promote effective models of care.

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Image: Physician assistant Brett Feldman checks a vacant homeless camp under a bridge in Allentown, Pennsylvania, in February 2016. Far from the confines of a doctor’s office or hospital, Feldman looks for homeless people and treats them for ailments ranging from diabetes to trench foot, mental illness to substance abuse. (Matt Slocum/The Associated Press)

Rate of average annual health care expenditures for people with disabilities or complex health compared with all U.S. adults
Proportion of U.S. adults who have three or more chronic conditions
Proportion of health care spenders who account for 51 percent of national health expenditures
Rate of mental illness among the homeless as compared to the general population