Replicating effective models of complex care management for older adults

Improving our system of care for older adults with complex, chronic illnesses requires wrestling with a vexing dilemma. Models of care that are readily scalable have limited effectiveness, and effective models are difficult to scale. As an example of the former, the patient-centered medical home (PCMH) has become widespread, but its impact on population health and health care costs varies and has been modest overall. As a stand-alone solution, the PCMH appears insufficient to deliver the diverse set of interventions required by chronically ill, older adults with complex needs—a growing segment of the US population that drives health care costs. Two complementary approaches provide opportunities to address this challenge: 1) strengthen the design and implementation of scalable models to make them more effective, and 2) innovate methods to improve the replication and spread of models already proven to be effective. Recent research and interest among funders and model builders working in the emerging field of complex care suggests that option two, innovating new methods of replicating effective models of care, deserves more attention.