Healthcare must address the population of high-risk patients with complex needs, and policymakers have numerous opportunities to rise to the occasion.
High-need, high-cost (HNHC) patients comprise a disproportionate amount of spending within the industry, according to The Commonwealth Fund report published in JAMA.
“Physicians, healthcare organizations, public officials, and other healthcare stakeholders cannot achieve their quality or cost goals unless they manage high-need, high-cost patients better,” the authors wrote.
Policymakers have several opportunities to promote solutions that address this population, according to The Commonwealth Fund’s David Blumenthal, M.D., and Melinda Abrams. They urge lawmakers to:
Promote value-based payment: Healthcare’s traditional fee-for-service model is one of the foremost barriers to improving HNHC patient outcomes, according to Abrams and Blumenthal. This has led the federal government to provide incentives for healthcare providers to transition to value-based models more quickly.
Work to improve value-based payments in design and practice: Policymakers must develop mechanisms to avoid the mixed message of fee-for-service reimbursements while working under a value-based arrangement. They must also develop risk-adjustment formulas that incorporate socioeconomic factors; existing regulations’ failure to do this has been the subject of frequent criticisms from groups such as the American Hospital Association.
Help clinicians develop and adopt best practices: Policymakers should help providers implement evidence-based best practices to improve care for HNHC patients. These practices include using multidisciplinary care teams to group and treat patients with similar needs, promoting patient engagement and taking advantage of health information technology.
Promote continual experimentation such as efforts by the Center for Medicare and Medicaid Innovation and the Patient-Centered Outcomes Research Institute, by both supporting existing initiatives and expanding them.