Posted: May 12, 2015

The Complex Care Clinic: Improving the Health of the Sickest, Most Vulnerable Patients


The greatest gaps in quality of healthcare in the United States are in underserved populations. These individuals face not only the challenges of our complex health care system but also the socioeconomic barriers of poverty. Our clinical innovation bridges these gaps for the neediest individuals. In 2000, Virginia Commonwealth University Health System (VCUHS) established Virginia Coordinated Care for the Uninsured (VCC), a program to provide access to high-quality health care for uninsured, indigent patients in our community. VCC enrolls individuals below 200% of the federal poverty level who are otherwise uninsured. Enrollees are assigned a medical home in their community from a network of primary care providers. They can also receive specialty care, testing, and medication through VCUHS facilities. The VCC program reduces the need for acute medical services and decreases costs. These benefits increase each year an individual is enrolled in the program.

Yet, despite this success, a small percentage of individuals continued to struggle with a high-degree of illness. To help these people, we created the Complex Care Clinic. Through this clinic, the most complex patients receive care through a primary care medical home bolstered by additional mental health, social work, pharmacy, and nursing support. The interprofessional model provides intensive care coordination that engages deeply with individuals and their lives. Over the first year of the program, individuals reported high levels of satisfaction with the clinic, and utilization was decreased by half. This approach is a model for the care of the underserved, particularly as other states expand Medicaid coverage. The Complex Care Clinic of the VCC is an innovative model that demonstrates how the health of the most frail, underserved individuals could be improved through interprofessional, patient-centered care.


Interprofessional, Population Health, Health Equity Research, Patient-Centered Care, Public Health Sciences, Chronic Disease, Poverty, Complex Care Clinic


Barbara Harding, BAN, RN, MPA, CCM, PAHM, Virginia Commonwealth University Health System

Arline Bohannon, MD, Virginia Commonwealth University School of Medicine

Sheryl Garland, MHA, Virginia Commonwealth University

Alan W. Dow, MD, MSHA, Virginia Commonwealth University School of Medicine