Tailoring Complex Care Management for High-Need, High-Cost Patients

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    Fee-for-service is a major obstacle for improving care for high-need, high-cost patients
    Covering nonmedical services like housing can improve care and lower costs for high-need, high-cost patients

Background

High-need, high-cost (HNHC) patients account for a disproportionate share of health care spending, and the complex care they need can be fraught with quality and safety issues. Any effort to address quality and cost challenges must focus on improving care for this population. The Commonwealth Fund’s David Blumenthal, M.D., and Melinda Abrams highlighted six key opportunities in this JAMA “Viewpoint.”

Policy Options for Improving HNHC Patient Care

Promote value-based payment. The prevailing fee-for-service payment system—which incentivizes the delivery of more services, even when fewer may be needed—represents a major obstacle to improving HNHC patient care. Value-based payment strategies will give providers a stake in optimizing, rather than maximizing, the delivery of health services.

Improve value-based payment design and implementation. Authorities need to ensure that clinicians working under value-based payment arrangements do not continue to be reimbursed on a fee-for-service basis, which sends mixed messages. Equally critical will be developing risk-adjustment formulas that account for social and economic factors that complicate care for HNHC patients. Failure to do so may discourage physicians from treating these individuals.

Allow payments for nonmedical services. Meeting the housing, nutritional, and personal care needs of HNHC individuals is important to improving their care and reduce their health-related expenses.

Assist clinicians in adopting best practices. Practices should be directed and assisted in adopting proven strategies for addressing the needs of HNHC patients, including: grouping patients with similar needs into cohorts, using multidisciplinary care teams, leveraging health information technology, and promoting patient engagement.

Prioritize health information exchange. Removing the political and economic obstacles to health information exchange—that is, the exchange of electronic health records between providers—would pay particular dividends for HNHC patients, whose complex care must typically be coordinated among multiple physicians.

Support ongoing experimentation. The efforts of the Center for Medicare and Medicaid Innovation and the Patient-Centered Outcomes Research Institute to develop, monitor, and evaluate efforts to care for HNHC patients should be supported and extended.

Conclusion

Physicians, health care organizations, public officials, and other health care stakeholders cannot achieve their quality or cost goals unless they manage high-need, high-cost patients better.

Publication Details

Publication Date: September 26, 2016
Authors: David Blumenthal, M.D., Melinda K. Abrams
Contact: Mary Mahon, Vice President, Public Information, The Commonwealth Fund
E-mail: mm@cmwf.org
Summary Writer: Brian Schilling
Citation:
D. Blumenthal and M. K. Abrams, "Tailoring Complex Care Management for High-Need, High-Cost Patients," Journal of the American Medical Association, published online Sept. 26, 2016.
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