Lessons learned: Complex care interventions

C. Todd Staub, MD/FACP, OptumCare®
Thomas Cheek, MD, Clinical Vice President, New Markets, OptumCare
Stephanie Bartz, Senior Director, Office for Provider Advancement, OptumCare


Recently, Dr. Todd Staub and Dr. Tom Cheek, two of OptumCare®’s leading doctors along with Stephanie Bartz, our clinical engagement and operations specialist, wrote a post for bettercareplaybook.org covering lessons learned in developing complex care interventions. 

The post emphasizes two elements of high-risk, complex patient care: First, working with this population should inspire pride in our efforts in aiming to improve the lives and health of some of the sickest, most vulnerable persons in our health care system. 

It is a great responsibility and privilege to serve this population. Second, the opportunity to improve the lives and outcomes of this population is only possible when we create a sustainable business case for clinical interventions.

Please check out the full article at bettercareplaybook.org for in-depth coverage on building the business case of complex care interventions.

A summary of the article’s main ideas: 

Plan for how success is best measured

The goal when investing in interventional programs is to keep people healthier. When we do our best to tailor interventions for complex patients, they have better health outcomes. More healing and fewer invasive procedures reduce suffering and expenses. 

Tracking data ensures that by giving our best quality care, the health of our patients improves. Precise measurements make the necessary business case for continuing growth of a program that meets the special needs of very sick patients.  

Use the appropriate data

For this population, electronic medical record (EMR) and claims data will not suffice. 

Broader and more specific data points that incorporate culture and demographics, as well as the long list of known social determinants of health, are required to create a deeper understanding of the people we serve.

Involve stakeholders in problem solving

Resist the urge to create a “perfect-on-paper” plan. 

The real world of health care delivery is dizzyingly complicated. And for these patients whose acuity creates an exponential jump in complexity, it is important to bring in the people, closest to the bedside, who in many cases will be carrying out interventions. 

Patients, families, and clinicians are great resources. Bringing them under the tent in the development stage will encourage their ownership, which will enhance successful implementation.


Gather the right team

The people who carry out interventions will always be the most expensive part of complex care. That said, it is wise to ensure that the skill mix and modes of care delivery are optimized: the right care given by the right modality at the right time. 

Consider registered nurses, social workers, nurse practitioners and physician assistants working to the top of their licenses. Add technology (virtual visits, phone follow-up) when convenient and appropriate to save time, money and hassle. 

The roles of each team member and needs of each patient should be carefully considered.


Prove value to leadership

Showing cost savings to justify investment in complex care to organizational leaders can be challenging. Much of the savings result from avoiding hospital care. 

Additionally, a new program requires more than one cycle to work out problems and optimize returns. To encourage support from leadership, it is important to give them the best information possible on project planning, expected timing, and measures of success. 

Keeping leadership informed with regular reports engages them in the process, increases confidence around funding, and creates opportunity for course correction.

Plan a methodology for failure and success

In everything we do in medicine, is it important to measure and document our wins and losses: which actions, steps, and components lead to good outcomes and which lead to poor outcomes? 

By tracking progress and analyzing both successes and failures, it is possible to recreate the benefits achieved by our pilot programs.

Confidence in a best strategy means reproducibility and most importantly, bringing savings and better care to patients across the complex care spectrum.




This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of OptumCare. The views and opinions expressed may change without notice.