Managing High-Need, High-Cost Patients: An International Perspective


Policymakers in the United States have much to gain by learning how health systems in other countries seek to manage care and control costs for their high‐need, high‐cost patient populations. This project will provide data and insights about different national approaches to caring for these patients. Under a phase 1 feasibility study small grant approved in October 2017, the research team is establishing the country collaborations needed for the study and confirming the availability and comparability of cross-national cost and utilization data. Building on previous Commonwealth Fund-supported segments of the high-need, high-cost population developed through analysis of Medicare data, Dr. Ashish Jha will lead a Harvard team developing five standardized patient profiles representing a combination of clinical conditions, frailty indicators, behavioral and mental health conditions, and socioeconomic characteristics to compare services and costs across countries. Country partners will collect and analyze patient‐level data for each of these patient profiles, using a predefined, standard set of data categories including inpatient, outpatient, and postacute care; long‐term care; tests and procedures; physician services; drug utilization; and costs. The project team will also seek utilization and spending data related to social services. The team will develop a methodology for standardizing prices across countries for the basket of health care services. This project will engage U.S. health care delivery system leaders, payers, and policymakers in needed debate over best practices for caring for high‐need, high‐cost patients and provide opportunities to learn from abroad. Findings will be presented at the Fund's 2018 international symposium, which will focus on frontline delivery system models for patients with complex health and social care needs.

Grant Details

Grantee Organization:
President and Fellows of Harvard College
Principal Investigator:
Ashish Jha, M.D., M.P.H.
Award Amount:
Approval Date:
November 14, 2017

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