In the United States, two groups experience problems with their health care more intensely and more frequently than any other.

One group is people with intense health care needs who use a lot of services — the 5 percent of the population that accounts for 50 percent of all health spending. These “high-need, high-cost” patients have multiple, serious chronic conditions, such as diabetes or heart failure, and functional limitations that make it difficult to perform daily living activities (such as eating, bathing, toileting). Many have behavioral health concerns and social needs that further complicate their health, their outcomes, and their care.

The other group is “vulnerable populations,” which refers to people who have limited access to health care, receive low-quality care, and experience poor care outcomes. This is often the result of societal injustices related to race, ethnicity, poverty, gender, sexual orientation, age, language barriers, or physical or mental health conditions. In particular, people with low incomes have historically experienced the shortcomings of our health system more acutely.

The Commonwealth Fund’s Health Care Delivery System Reform program believes meaningful change is possible for both groups. Moreover, we believe improvements in care for these patients can spur better performance across the entire health system.

The program supports efforts to:

  • build an evidence base to better understand the needs of these two populations and the gaps in the health system;
  • identify and assess promising models, interventions, and practices to improve care; and
  • promote payment reform and policy improvements to facilitate delivery system reform.

Program Contact:

Corinne Lewis, Program Officer, Delivery System Reform