Focusing on High-Need, High-Cost Patients
Meaningful improvement in the health system will require improvement in care for those patients using it the most: people with multiple chronic conditions. Within this clinically diverse group are patients who remain stable for years with appropriate treatment, others who live with extreme functional limitations, and still others with persistent behavioral health challenges or related social needs, like housing or food, that exacerbate their conditions. Care for these high-need, high-cost patients is expensive: despite comprising just 5 percent of the U.S. population, they account for 50 percent of the nation’s annual health care spending.
How Will We Get There?
In a “Perspective” for the New England Journal of Medicine, the heads of five leading health care foundations—the Commonwealth Fund, John A. Hartford Foundation, Peterson Center on Healthcare, SCAN Foundation, and Robert Wood Johnson Foundation—propose three steps to meet the needs of this population:
- understanding this diverse population
- identifying evidence-based programs that offer high-quality integrated care at a lower cost
- accelerating the adoption of these programs nationally.
Critical to the design of effective interventions, these leaders say, is segmenting the high-need, high-cost population into subgroups with similar health care requirements. Already several promising care models have demonstrated success. These include programs that focus on transitions in care and extending primary care teams by integrating nonmedical services.
The adoption of new models of care is challenging, more so than the dissemination of new drugs or devices, the authors say. It requires changes in behavior and clinical workflow, as well as cultural adjustments as professionals take on new roles. Financial incentives in the prevailing fee-for-service reimbursement system present additional challenges, but new models such as value-based payment and accountable care organizations may reduce these obstacles.
Better-quality, more-affordable care for high-need patients will require collaboration among health care providers, communities, social service organizations, and researchers, among others. “We welcome the involvement and support of all stakeholders seeking to improve the performance of our health system by ensuring better care for this vital and growing population,” the authors conclude.