Affordable, quality health care. For everyone.

High-Need, High-Cost Patient Personas

To improve the experiences of those who rely on our health system the most, the Commonwealth Fund partnered with Healthwise, a health care nonprofit, to focus on patients’ needs in their own voices as a way of identifying gaps in care. The team interviewed dozens of patients with high needs — that is, those with multiple chronic conditions or possibly severe physical or mental limitations —to explore their experiences and how their struggles to find support has affected their lives and those of family and paid caregivers.

As part of this research, we developed “personas” for different segments of the high-need patient population. A persona helps depict the experiences, motivations, and goals of a group of patients, as well as the barriers they face. Personas offer what aggregate data cannot: firsthand insights into how the health care system not only fails to meet the needs of patients but may even contribute to subpar health outcomes. Ultimately, the personas can offer practical guidance on how consumer‐driven changes could lower costs and improve care.

This information can help health system leaders, payers, and policymakers address flaws in care and processes. Building on the segmentation approach developed previously, the personas in this project describe older adults living with multiple conditions, frailty, and advancing illness as well as those under 65 living with disabilities. There is also a persona to illustrate paid, as well as unpaid (i.e., family or friend), caregivers for high-need patients.

In this section, we offer an in-depth overview of different personas in each patient or caregiver segment, along with video narratives from a real patient or caregiver who has lived the experience.