Finding a Match: How Successful Complex Care Programs Indentify Patients

Meet Mr. D, age 40. Over the past year, he saw his primary care physician 23 times and missed 10 other appointments. He phoned his primary care clinic 22 times. He made 21 emergency department visits and was admitted to the hospital three times for issues that could have been treated by his primary care physician. Affected by fetal alcohol syndrome, developmental delay, and obesity, Mr. D has a history of high blood pressure, diabetes, asthma, and chronic low-back pain. He is a victim of childhood abuse, and suffers from post-traumatic stress disorder, anxiety, and bipolar disorder. He lives in a public housing development, is unemployed, and is insured by Medicaid.