Inclusion and exclusion criteria for complex care programs: Survey of approaches

Around the country, innovative health care organizations are developing programs to better coordinate care for people with complex medical, behavioral health, and social needs. As a first step, organizations need to consistently and efficiently identify individuals in their patient population who can benefit from enhanced care coordination and also determine when to “graduate” patients out of their programs. The Center for Health Care Strategies surveyed organizations involved in its Transforming Complex Care and Complex Care Innovation Lab initiatives to find out how they are identifying individuals for their respective complex care programs.

This technical assistance tool shares criteria used by these innovators, which can help inform other programs seeking to develop or refine eligibility criteria for complex care management programs.