New Report Discusses Effective Care for High-Need Patients

A new report by the National Academy of Medicine (NAM) explores how the healthcare system can improve care and manage costs for the 5% of high-need patients who account for almost half of the healthcare spending in the United States.

The report, Effective Care for High-Need Patients Opportunities for Improving Outcomes, Value, and Health, summarized the discussions at 3 NAM workshops between July 2015 and October 2016. The workshops brought stakeholders together to reflect on 4 main issues:

1. Key characteristics of high-need patients
2. The use of a patient categorization scheme, or taxonomy, for informing and targeting care
3. Promising care models of common attributes to improve service for the patient populations
4. Areas of opportunity for policy-level action to support evidence-based programs

By investigating the key characteristics, the report strives to define the measures that can be used to categorize high-need patients. The criteria would include total healthcare costs, the intensity of care used for a given period of time, and the functional limitations of a patient’s daily life. The patient demographics would also need to be considered, as high-need patients are often older, female, white, less educated, and publicly insured.

“The needs of this patient population often extend beyond care for their physical ailments to social and behavioral services, which are often of central importance to their overall well-being,” notes the report. “Therefore, to improve outcomes for this population, it will be necessary to address functional, social, and behavioral needs, largely through the provision of social and community services.”

Patient taxonomy is needed to help target a specific population and serve them more effectively, according to the report. This will include functional, social, and behavioral factors which will allow patients to be assigned to a clinical segment, followed by an assessment of behavioral health issues and social service needs to identify which services are necessary.

The report emphasized the importance of care models that will organize common attributes into different dimensions in an analytic framework. This will be cross-referenced to the proposed taxonomy that will assist heath system leaders to match the needs of their patients.

According to the report, in order to improve care, federal and state governments must be involved through policy action and payment reforms. A strategy needs to be developed to incentivize the provision of evidence-based social services along with the delivery of medical services.

“While each stakeholder sector individually may impact a patient’s life, a community, or even a regional health delivery system, one of the most expensive and challenging populations for the current health care system will remain underserved until there is a unified effort—rather than small, incremental steps—to improve care for the nation’s high-need patients and to reduce the cost of delivering that care,” concludes the report.