Serving People With Complex Health Needs: Emerging Models, With a Focus on People Experiencing Homelessness or Living in Permanent Supportive Housing

The Affordable Care Act of 2009 (P.L. 111-148) codified into law a strong emphasis on care coordination as an important strategy for improving the performance of the U.S. health care system. This article examines new structures for coordinating care for people with complex, co-occurring health conditions. Within that large group, the article focuses on people who are now or recently were homeless and the importance of including housing as part of coordinating their care. “Care coordination” is used as shorthand for a continuum of strategies and structures being developed to reach the three goals of better health care experience, better health outcomes, and cost savings. Six models are described, ranging from simple in structure—a partnership of one permanent supportive housing program and one community health center—to complex, including a limited liability, for-profit care coordination entity serving Cook County and two county-run programs (in Hennepin County, Minnesota, and Los Angeles County, California). All are works in progress, but show promise of improving care for difficult-to-serve populations.