Taking charge of high-risk and high-cost patients in the public healthcare system.

Many healthcare systems are struggling with the issue of providing high-quality care to high-needs patients at lower costs. Our comments in this paper draw on insights that we have gained from the development and implementation of integrated models of care in Québec. This experience highlights the importance of developing a clear clinical approach to the delivery and coordination of care and to support providers in new roles. Our second insight is that system-level policy guidelines may help to focus the attention of organizations and providers on key priorities, but they need to take into account differing needs in various contexts. Third, a crucial factor for success over the longer term is the ability of local networks to reshape the allocation and use of resources to bring about change in day-to-day operations. We conclude by highlighting key characteristics of high-performing health systems and with the final observation that politicians and policymakers need to allow enough time to harness the full benefit of change initiatives.