Expanding Assertive Community Treatment to Transform Care for Complex Patients
A new study shows that health systems can rely on assertive community treatment (ACT), which has strong evidence supporting its effectiveness for treating the most complex, least engaged patients.
“In this commentary, we explore the ACT model, review the evidence for its efficacy, and demonstrate its clear applicability as an established intervention for improving the lives of highly complex individuals,” explained Trygve Dolber, MD, and coauthors.
For decades, ACT has been the gold standard for engaging individuals with schizophrenia who avoid clinic-based services yet have high risks for hospitalization. Its multidisciplinary teams deliver coordinated medical, behavioral, and social support, often around the clock. While originally designed for severe mental illness, ACT’s structure and principles align closely with the needs of other high-utilizing, socially complex patients whose challenges extend beyond any single diagnosis.
These individuals often cycle through emergency departments and inpatient units, burdened by unmet social needs such as unstable housing or food insecurity. Traditional interventions targeting those needs in isolation rarely reduce costs or improve outcomes unless patients are ready to engage, which is something ACT addresses through persistent outreach, relationship-building, and integrated care delivery.
Evidence consistently shows that ACT reduces hospitalizations. Seventeen of 23 program studies found significant decreases, with high-fidelity ACT cutting psychiatric hospital use by 58% compared with standard case management and by 78% compared with no intervention in just one year. While cost savings are slower, ACT delivers rapid gains in stability, housing, and quality of life.
Financially, ACT is resource-intensive. Mid-1990s US analyses found annual per-patient costs of $15 000 to $16 000 (inflation-adjusted to 2024), roughly double standard case management. However, longer-term evaluations show eventual cost-efficiency when factoring in reduced unplanned care and improved patient stability.
ACT programs increasingly incorporate primary care to address chronic diseases such as heart disease, diabetes, and emphysema that drive the 20-year shorter lifespan seen in schizophrenia. Partnerships with federally qualified health centers have boosted primary care attendance in most studies, though early cost reductions remain modest. Effective integration hinges less on organizational structure than on strong communication between ACT and medical teams.
Importantly, ACT fidelity standards do not require a behavioral health diagnosis, opening the door to its use for other high-need populations. By applying clear admission criteria focused on avoidable, recurrent hospital or emergency use, ACT could target patients with multiple chronic conditions who, like those with schizophrenia, fail to benefit from traditional, time-limited interventions.
“Because close coordination and deep integration of services are necessary, hospital systems must be able to organize, not only to support this kind of program in isolation but to integrate it with existing services,” concluded the study authors.
Reference
Dolber T, Runnels P, Pronovost PJ. Assertive community treatment for complex and costly patients. Am J Manag Care. 2025;31(7):e173-e175. doi:10.37765/ajmc.2025.89768
