Evaluating complex care programs: Is it a zero-sum game?

Complex populations in health care are often defined as groups of individuals with co-occurring medical and behavioral health diagnoses as well as significant social challenges. Large sums of money have been devoted to developing interventions focused on “bending the cost curve” by attenuating the rapidly rising costs of caring for these populations. Whether such programs actually save health care dollars remains an open question because rigorous evaluation data are limited. In this NEJM Catalyst commentary, the authors highlight the challenges of comprehensively evaluating complex care interventions. They make three recommendations: allow adequate time to evaluate impact (at least 24 months), look beyond dollars to improvements in quality of life, and capture program effects outside of the health care sector.