Study: US health system not meeting the needs of its sickest patients

The sickest adult patients pay the most for healthcare, but do not get some of the care they truly need, a new study found.

The research, published by The Commonwealth Fund, found that high-need adults may spend on average twice as much as the entire adult population spends. The study defines such patients as people with three or more chronic conditions plus some type of other limitation that may prevent them from performing basic daily activities, and counts some 12 million U.S. adults in that category.

Despite their complicated medical needs, these patients are more likely to skip or delay treatment, according to the study. About 20 percent of high-need adults chose to delay or pass on a treatment, compared with 8 percent of the total adult population. David Blumenthal, M.D., president of the Commonwealth Fund, said in an announcement of the findings that the research shows how the healthcare industry is “failing” these patients.

According to the study, these vulnerable patients are likely to be over-65, white, female and uninsured. They’re likely to have low-incomes, which makes the high medical costs they face even more concerning, according to the study.

“We have known for a long time that there are very sick patients facing challenges in daily living and that our healthcare system has to do a better job of caring for them,” Melinda Abrams, vice president for delivery system reform at The Commonwealth Fund and a co-author of the reports, said in the announcement. “This research shows us who they are, what their needs are, and how the system is, or isn’t, working for them right now.”

The report offers three key ways that care for high-needs adults can be improved, including:

  • Payers should find ways to improve their provider networks and benefits to help these patients
  • State lawmakers should try to ensure that high-needs adults who use Medicare have access to needed specialists
  • Tailor programs for high-needs to adults to those who will benefit the most and target those patients