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.

Another is “vulnerable populations,” which refers to those who have poor access to health care, receive poor-quality care, and experience poor care outcomes — often resulting from societal injustices related to race, ethnicity, poverty, gender, sexual orientation, age, first language, or physical or mental health condition. In particular, people who are low-income have historically experienced our health system’s shortcomings more acutely, which is an indicator of a poorly performing health system. Real improvement requires comprehensive approaches that address physical health, behavioral health, and social needs, as well as reforms in how health care is organized, structured, and paid for.