The decision to withdraw more than $11 billion in public health funding, including support for substance use disorder and mental health programs, is a stark reminder of how fragile our nation's safety net remains. With Medicaid also likely to face severe cuts, the burden of care for high-need, high-cost individuals will fall even more heavily on already overstretched systems of care.
These patients, who often navigate co-occurring behavioral and physical health conditions along with social risk factors, already account for a disproportionate share of healthcare spending. If we want to serve them effectively and equitably, we can no longer afford fragmented care or data siloes. More than ever, meaningful progress depends on shared accountability, cross-sector collaboration and a connected approach to care that recognizes complexity as the rule, not the exception.
When the safety net unravels
Despite the urgency, our systems remain built around episodic care and siloed data. As the healthcare system continues its shift toward value-based care, stakeholders must take the next step: creating care models that are not only financially but also clinically and operationally aligned. That begins with a broader view of what counts as data and a shared commitment to translating that data into timely, patient-centered action.
Data continues to act as a lubricant in care coordination, but too often, it's narrowly defined. Admission, discharge and transfer (ADT) feeds are useful, but they are only one piece of the picture for high-need, high-cost patients. More comprehensive data inputs, such as discharge data, behavioral health indicators, prescription history, follow-up status, crisis event patterns and social determinants, can offer a richer and more precise understanding of a patient's needs and how best to address them. Without this level of insight, early intervention becomes difficult, and care remains fragmented.
Consider that individuals with underlying behavioral health needs are 350% - 700% more costly to treat than the general population. High-need, high-cost individuals can cost up to 29 times more than the average patient. While 50% of behavioral health diagnoses occur in outpatient settings, many of these individuals cycle through the emergency department (ED) or inpatient care due to a lack of appropriate, coordinated alternatives. Nearly 10-15% of ED and inpatient visits list behavioral health as a primary or secondary diagnosis.
A broader blueprint for complex care
Serving high-cost, high-need populations means identifying risk before it escalates. It means treating real-time data not as a retrospective performance tool, but as a catalyst for proactive engagement. That might include surfacing crisis events across state lines, using prescription monitoring queries to flag medication overlap or deploying care navigators as soon as a patient is discharged or has missed an appointment. These pivotal moments often determine whether a patient recovers or re-enters a healthcare setting at a higher cost.
Best practices for engaging these populations include:
Building this type of connected care model requires a shift from organizational independence to shared responsibility. That means health plans, providers and community organizations must align around the same goals, use the same shared insights and act on behalf of the same patient in a coordinated fashion. This patient advocacy is especially important for harder to reach behavioral health populations who often straddle clinical, social and crisis systems.
Designing care around complexity, not convenience
To make real progress, the system must stop treating behavioral health and complex care needs as outliers and start designing around them.
That means:
Connected care isn't just a model; it's a mindset. This emphasizes the need for swift infrastructure changes now, that don't just respond to crises but help prevent them.
As the safety-net landscape shifts and funding uncertainty grows, the path forward is clear. By investing in highly coordinated, data-informed care and aligning health plans, providers and communities around shared goals, we can build a system that reaches individuals with complex care needs, supports whole-person health initiatives and strengthens care across the board. This moment demands bold action, but it also offers a rare opportunity to design a system that finally works for everyone.
Photo: Nataliia Nesterenko, Getty Images
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