We all recognize that a relatively small proportion of patients account for a great deal of health care spending. The Commonwealth Fund convened a number of experts to make recommendations on how to create a system that effectively and efficiently meets these patients health needs. (Comm. Fund Report) This set of patients typically has multiple chronic conditions periodically exacerbated by acute flareups. Unfortunately the “experts” basically did nothing but rehash the obvious. Ten recommendations were given; including identify the patients that need greater attention (really, you need to find the patients before you manage them better, never would have thought of that); make care coordination a high priority; train more primary care physicians and geriatricians (that is a good short-run solution!); facilitate communication between providers and integrate health records; engage patients in decision-making; support caregivers, redesign funding mechanisms to reward intensive care management; integrate physical, mental and social needs; engage clinicians in change and learn from experience. That’s it, hope Commonwealth didn’t pay these guys much. What would have been really useful is detailed description of tactics that actually work to improve outcomes for these patients. The report does include three case studies from around the world of programs that have been successful in tackling these patients. Those summaries are more useful because they do give some sense of the specific activities the programs have used to address the needs of this population. A key feature appears to be the use of one-on-one engagement between a clinician or other team member and the patient.