Effective care for high-need patients: opportunities for improving outcomes, outcomes, value, and health

ABSTRACT

Today, 1 percent of patients account for more than 20 percent of health care expenditures, and 5 percent account for nearly half of the nation's spending on health care (Figure S-1) (Mitchell, 2016). Improving care management for this population while balancing quality and associated costs is at the forefront of national health care goals, and reaching this particular goal will require active involvement of a broad range of stakeholders at multiple levels. To advance insights and perspectives on how to better manage the care of this population and to stimulate actions on opportunities for improving outcomes and reducing the costs of health care, the National Academy of Medicine (NAM), through its Leadership Consortium for a Value & Science-Driven Health System (the Leadership Consortium), in partnership with the Harvard T.H. Chan School of Public Health (HSPH), the Bipartisan Policy Center (BPC), The Commonwealth Fund, and the Peterson Center on Healthcare­which funded this initiative­has undertaken a collaborative assessment on strategies for better serving high-need patients. The NAM was tasked with bringing together experts and stakeholders over the course of three workshops held between July 2015 and October 2016 to consider and reflect upon the key issues for improving care for high-need patients and summarizing the presentations, discussions, and literature for publication. This publication reports and reflects on the following issues (1) key characteristics of high-need patients; (2) the use of a patient categorization scheme­or a taxonomy­as a tool to inform and target care; (3) promising care models and attributes to better serve this patient population, as well as insights on "matching" these models to specific patient groups; and (4) areas of opportunity for policy-level action to support the spread and scale of evidence-based programs. The publication concludes by exploring common themes and opportunities for action in the field.