On July 6, 2017, the National Academy of Medicine released a valuable report entitled, “Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health.” The report describes key characteristics of high-need patient populations, tools that can be adopted to identify evidence-based models of care for them, and strategies to promote successful implementation of such models in collaboration with a broad range of stakeholders at the federal, state, and community level. It stresses the importance of behavioral health issues, social determinants of health, and community-based supports for high-need patients who often struggle at home with functional limitations associated with aging, disabilities, and a wide range of long-term diseases examined in the report.
The report notes that an impediment to the adoption of more successful care models for high-need patients is reimbursement methods in public and private health insurance plans that create perverse financial incentives, such as fee-for-service methods that reward providers for episodic medical interventions rather than a comprehensive approach to high-need patients’ medical, behavioral, and social service needs. Such impediments can be addressed in collaboration with state Medicaid agencies, managed care organizations, and private insurance plans that appreciate the need for innovative reimbursement methods for high-need patients.
The report also stresses the importance of high-quality data and analytics to match clearly defined categories of high-need patients with community-based care models that can improve health care outcomes and improve the overall value of health care expenditures for them. It notes that 50.4 percent of US health care spending is attributable to 5 percent of the US population facing medical conditions that can be managed more effectively and efficiently through comprehensive, evidence-based models of care. About 22.8 percent of US health care spending is attributable to 1 percent of the US population facing such conditions.
The report from the National Academy of Medicine is available here