3 steps to make high-need, high-cost patients a priority


Meaningful improvement in the nation’s healthcare system means organizations must make high-need, high-cost (HNHC) patients a bigger priority, argues an essay published in the New England Journal of Medicine.

HNHC patients are a humanitarian priority as well as a demographic and economic one, write the five authors who work for the Commonwealth Fund, the John A. Hartford Foundation, the Peterson Center on Healthcare, the SCAN Foundation and the Robert Wood Johnson Foundation.

A common statistic puts care for HNHC patients as comprising a full 50 percent of care costs even though they are only 5 percent of patients, and as the population ages, they become an even more immediate priority.

Going forward, healthcare leaders must take three steps, according to the piece:

Better understand the patient population: The HNHC population, contrary to some stereotypes, contains multitudes, according to the piece, from those nearing the end of their lives to patients with multiple chronic but stable conditions and those whose risk is exacerbated by lack of social resources. That’s why leaders must conduct further research into their patient populations. “This process is critical to designing effective interventions, because programmatic effectiveness and efficiency increase dramatically when we can target the people most likely to benefit from specific interventions,” the authors write.

Identify programs that improve care and cut costs: Successful programs target those most likely to benefit, provide effective in-person communication and coordination throughout the care team, and have high levels of patient and caregiver engagement.

Implement solutions that work on a national scale: This has proven a challenge, due in large part to the need for upfront capital, as well as the programs often being very specifically suited to one patient population. However, recent developments such as the Centers for Medicare & Medicaid Services speeding the transition to value-based payments are lessening these obstacles, the authors write.

- read the essay