Common traits of successful high-need patient care models

Nurse with patient
Dealing successfully with high-need patient populations can benefit a hospital's bottom line, but it's not easy.

High-need patients account for a disproportionate share of costs in the healthcare system, making their care an area of focus for budget-conscious providers.

Nearly half of healthcare costs in the United States go toward care for a mere 5% of the patient population, according to a special publication from the National Academy of Medicine. These “high-need” patient populations require more time and resources, which drives providers’ and policymakers’ interest in managing the care of this population more efficiently.

A recent study also found that hospitals caring for a high proportion of high-needs patients provided better care overall. The biggest barrier to addressing this population, according to the report, is that it’s not a homogeneous patient population at all. High-need patients require high total costs and intense treatment over time, but other than that, they are a diverse population with diverse needs.

Keeping the complicated nature of high-need patient populations in mind, the report finds a number of overarching elements common to successful care models:

  • Segment high-need patient populations and match care to patient need. The diverse nature of high-need patients means providers have to segment the population based upon the general needs of patients in each group. The report stresses the need to follow up with additional assessments of behavioral health and social risk to fine-tune additional resources or services required to treat high-need patients.
  • Coordinate care to make life easier for patients. Different settings tackle coordination in different ways, but they generally rely upon patient-centered interdisciplinary collaboration and smooth transitions among providers. The report suggests models typically fall into one of three broad categories:
    • Integrated care, relying on interdisciplinary teams that cover medical care as well as behavioral health services.
    • Transitional care, in which a single caregiver, usually a nurse, guides the patient among caregivers and care settings.
    • Enhanced primary care, defined in the report as primary care settings that make use of supplemental services and collaborations among caregivers.
  • Get patients and families involved. Researchers noted benefits when programs promoted greater patient engagement.