Increasing the Focus on Complex Care

Patients with unmet behavioral health and social needs are major contributors to high healthcare utilization and poor health outcomes. This small percentage of the population consume a disproportionate share of resources, in part, because their needs are not being addressed. [1]  Organizations that develop a complex care approach are able to better support their patients, create connections within the community, and decrease utilization. This series will explore the current evidence-based interventions, how to get started, validated screening tools, creating community connections, and closing the data loop. 

Please see past recordings and PowerPoint presentations below:


Hospitals, nursing homes, home health agencies, physician practices, and community-based organizations.

DateTitle/PowerPoint Presentation Video Link
11/16/2022Complex Care SWEEP Launch Watch Presentation
12/15/2022Screening, Referral, and the LoopWatch Presentation
01/19/2023Understanding and Addressing Health Equity as a Driver for ReadmissionsWatch Presentation
02/02/2023Highlighting: Frederick Integrated Healthcare Network (FIHN) Watch Presentation
02/09/2023Highlighting: South County Health Hospital Care Transition Initiative Watch Presentation
02/16/2023Highlighting: NYC Health & Hospital/Queens- Improving Care for High Utilizers and Sustaining Watch Presentation
02/23/2023Highlighting: SmartCare Mobile integrated healthcare (MIH) & Complex Care Educational Series wrap-up and discussionWatch Presentation

[1]Humowiecki M, Kuruna T, Sax R, Hawthorne M, Hamblin A, Turner S, Mate K, Sevin C, Cullen K. Blueprint for complex care: advancing the field of care for individuals with complex health and social needs. December 2018.