By many estimates, only 5% of U.S. patients are high-need, high-cost (HNHC), yet they account for about 50% of health care spending. It has become a national priority to understand the needs of this patient cohort, identify drivers of their utilization, and implement solutions to improve their clinical outcomes while reducing their costs.
High-need, high-cost patients often have multiple chronic conditions, complex psychosocial needs, and limited ability to perform activities of daily living. Care delivery solutions, including care management, telemedicine, and home health visits, have had mixed levels of success for various outcome measures, including system-centric ones such as total cost of services and utilization of secondary care (emergency department [ED] use and inpatient hospitalization) as well as patient-centered ones such as self-assessed health status.
A possible explanation for the variable success could be that many solutions are designed primarily by health system administrators, not the patient “customers” who best understand their own needs. Little has been published about patients’ views on the care models that target their complex health care needs, which aspects of current care delivery high-need, high-cost patients find beneficial, nor how health systems can partner with patients to design and implement solutions. Better serving high-need, high-cost patients must begin with improving our understanding of their needs and perspectives.