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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
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2

KEY CHARACTERISTICS OF HIGH-NEED PATIENTS

Fictional Patient vignette: Mark is a 54-year-old man with rheumatoid arthritis and chronic heart disease. Many days he was reliant on a wheelchair to get around because of chronic pain. His job didn’t allow him to telework, yet it was difficult to get to the handicap entrance in the back of the building and his schedule was firmly fixed at 9 to 5. As a result, Mark spent more than an hour a day commuting in his car (public transportation wasn’t readily available). Everyday tasks like running errands and getting groceries were difficult. Between his pain and his heavy work schedule, he was left with little time to visit with other people, both friends and family, and it had left him feeling incredibly isolated and alone. He really missed having a pet, but he’d had to give his cat, Felix, away because Mark could no longer take care of him properly. Mark felt he wouldn’t mind his disease so much if it didn’t impact his life and relationships so heavily.

Who are high-need patients? A simple definition describes them as individuals with complex conditions and circumstances requiring multiple services that, for the most part, are not currently delivered easily or effectively by the health care system. This definition is impractical, however, for the task of identifying a population. In general, high-need individuals are the most costly patients, but not all high-cost individuals are also of high-need (Zodet, 2016). Many high-need patients are seniors, but younger adults with disabilities, chronic mental illness, and/or substance abuse disorders also require extensive care (Blumenthal et al., 2016b). Some individuals are of high-need for an extended time because they have multiple chronic conditions that may be stable with treatment but persist for years while other individuals, such as those treated for certain cancers or complex orthopedic surgeries, may be high-need only temporarily

Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×

(Johnson et al., 2015b). In addition to their formal diagnoses, many high-need patients have functional limitations that affect their ability to get care or engage in activities of daily living. Others may have severe, persistent behavioral health issues, or their conditions may be exacerbated by such nonmedical factors as a lack of housing, food, and supportive personal relationships (Johnson et al., 2015a; Kansagara et al., 2011).

This chapter explores candidate criteria used to identify high-need patients along with key demographic and experiential characteristics. The next chapter will consider taxonomic approaches to categorizing this heterogeneous population into subgroups with shared management characteristics as a means of developing strategies to inform planning and delivery of targeted and more effective care for specific subgroups.

IDENTIFYING HIGH-NEED PATIENT POPULATIONS

In her presentation at the first workshop, Melinda Abrams from The Commonwealth Fund noted that, to date, little has been written about the characteristics of high-need individuals using empirical data, and, as a result, there is not yet a consistent definition of need. Most studies have examined people who have a specific disease, have multiple chronic conditions, frequently use emergency department services, annually have high individual health care costs, have a disability, or have a mental illness. At some point, noted Abrams, the field will need to settle on a definition.

Health care systems and researchers have used several approaches to identifying high-need populations. One common and direct approach—which focuses on those patients who accrue the largest annual expenditures on health care—is based on the well-established observation that a small percentage of patients account for a large percentage of the nation’s health care expenditures (Cohen, 2015; Cohen and Uberoi, 2013; Stanton and Rutherford, 2006; Zodet, 2016). In 2014, for example, the top 1 percent of spenders accounted for more than 20 percent of total health care expenditures, and the top 5 percent accounted for about 50 percent of the nation’s health care costs (Mitchell, 2016) (see Figure 2–1).

On the other hand, focusing exclusively on cost provides an incomplete picture of high-need patients. A substantial percent of high-cost individuals incurs those costs for only a limited time (Cohen and Yu, 2012). Medical Expenditure Panel Survey (MEPS) data show, for example, that only 42 percent of individuals who accounted for the top 10 percent of medical expenditures had persistently high spending over a 2-year period. Approximately 30 percent had some reduction

Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×

in spending in the second year, while 28 percent had episodic high spending, with lower spending in the second year.

Image
FIGURE 2–1 | Distribution of personal health care spending in the US civilian noninstitutionalized population, 2014.
SOURCE: Dzau et al., 2017.

Profiling chronic or complex conditions, including behavioral health issues, offers another approach that, on the surface, seems sensible. Ashish Jha from the Harvard T.H. Chan School of Public Health and Jose Figueroa from Harvard Medical School and Brigham and Women’s Hospital, together with colleagues, conducted an analysis of Medicare data to segment the high-cost patient population into clinically meaningful subgroups (Joynt et al., 2017).4 As part of this analysis, they developed a list of complex and noncomplex chronic conditions that could be used to help determine level of patient need (see Table 2–1) from key chronic disease groups included by the Centers for Medicare & Medicaid Services in its measure for unplanned admission for patients with multiple chronic diseases (RTI International, 2015). The nine complex chronic diseases in Table 2–1 were differentiated by Jha, Figueroa, and colleagues because they account for the majority of spending and morbidity.

In fact, an analysis of MEPS data conducted by The Commonwealth Fund (Hayes et al., 2016c) identified approximately 79 million people age 18 or older

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4 More details about the segmentation work are discussed in Chapter 3.

Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×

(i.e., 30 percent of the population) with three or more chronic conditions,5 indicating—as was mentioned in the article—that simply counting conditions is an oversimplified approach, and additional factors must be taken into account.

TABLE 2–1 | Complex and Noncomplex Chronic Conditions

COMPLEX CHRONIC CONDITIONS NONCOMPLEX CHRONIC CONDITIONS
Acute myocardial infarction
Ischemic heart disease
Chronic kidney disease
Congestive heart failure
Dementia
Diabetes
Chronic lung disease
Psychiatric disease
Specified heart arrhythmias
Stroke
Amputation status
Arthritis and other inflammatory tissue disease
Artificial openings Benign prostatic hyperplasia
Cancer
Cystic fibrosis
Endocrine and metabolic disorders
Eye disease Hematological disease
Hyperlipidemia
Hypertension
Immune disorders
Inflammatory bowel disease
Liver and biliary disease
Neuromuscular disease
Osteoporosis
Paralytic diseases/conditions
Skin ulcer
Substance abuse
Thyroid disease
NOTE: Complexity designation is based on spending and morbidity.
SOURCE: Reproduced from Joynt et al., 2017

The most basic identifiers of high need are functional limitations. These include limitations in activities of daily living—self-care tasks that include dressing, bathing or showering, ambulating, self-feeding, grooming, and toileting—or instrumental activities of daily living that support an independent lifestyle, such as housework, shopping, managing money, taking medications, using the telephone, or being able to use transportation (Hayes et al., 2016c). If high-need populations are defined as individuals who have three or more chronic conditions plus functional limitations, roughly 11.8 million individuals age 18 or older (i.e., approximately 5 percent of the US adult population) would be classified as high-need individuals (Hayes, 2016).

Also relevant to the consideration of functional limitations and the way they are best managed is the interplay of physical capacity and mental or emotional status.

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5 For this study, chronic diseases were identified using an approach that assigns ICD-9 diagnosis codes (first three digits) to the Agency for Healthcare Research and Quality’s Clinical Classification System (Hwang et al., 2001; Paez et al., 2009).

Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×

For example, the following six circumstances represent compelling limitations and needs:

  • Recovery from acute injury or surgery
  • Intensive therapeutic interventions
  • Chronic addiction-related impairment
  • Long-term mobility impairment
  • Long-term cognitive impairment
  • Needs at the end-of-life

Any of these may represent a very high degree of functional impairment or limitation at any given time, but the nature, intensity, and combination of interventions required may vary considerably.

Determining an ideal definition for a high-need patient requires a delicate balance. A highly constrained definition will risk missing people, potentially depriving them of needed resources. On the other hand, casting an overly broad definition might include people who are not high-need and do not need additional resources. Abrams noted that basing identification of high-need patients exclusively on cost will miss many people, and if the focus is exclusively on chronic conditions, a large number of people may be identified whose chronic conditions are under control.

THE OVERLAP OF HIGH-NEED AND HIGH-COST DEFINITIONS

Regardless of which definition is used to identify a high-need patient population, many of the characteristics of other definitions emerge from the analysis. For example, Jha, Figueroa, and colleagues analyzed Massachusetts claims data, looking broadly at high-cost patients in three categories: the non-Medicare population under age 65, the Medicare population, and the dual-eligible population (Joynt et al., 2017). The analyses of these data reveal that high-cost individuals have more chronic conditions than non-high-cost individuals (see Figure 2–2).

Moreover, the number of chronic conditions increases when moving from the non-Medicare under 65 to the Medicare and dual-eligible populations. High-cost patients are also more likely to have a higher number of frailty indicators (see Figure 2–3), which attempt to capture an individual’s ability to engage in activities of daily living or their functional limitation status.

Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×

Likewise, by considering adults who have three or more chronic conditions and also have functional limitations, Hayes and colleagues at The Commonwealth Fund (2016) found that high-need adults averaged more than $21,000 a year in health care and prescription drug expenses, more than fourfold the average for all US adults, and almost three times more than for adults with three or more chronic conditions but no functional limitation. Out-of-pocket expenses for high-need adults averaged $1,669 per person per year, approximately three times higher than for the average US adult ($702) and 44 percent higher than for adults with three or more chronic conditions ($1,157). Annual spending by the top 5 percent of high-need individuals in terms of yearly expenditures exceeded $73,000 compared to nearly $27,600 by the top 5 percent of those with three or more chronic conditions and just under $21,000 by the average adult (see Figure 2–4).

Image
FIGURE 2–4 | High-need adults had higher spending on health care than did those with three or more chronic conditions without functional limitations.
SOURCE: Reproduced from Hayes et al., 2016c

Concordant with their higher expenditures, these high-need individuals also made greater use of the emergency department; had more hospitalizations than did either the average adult or adults with multiple chronic conditions (see Figure 2–5); had more doctor visits; and had more paid home health care days. Finally, the high-need adults were more likely to incur and maintain high health care spending over a 2-year period than were either adults with three or more chronic conditions but no functional limitations or US adults overall.

It is necessary to use major characteristics identified and validated through various studies to develop a consistent and reliable definition of high-need. For example, taken together, total accrued health care costs, intensity of care utilized for a given period of time, and functional limitations could form a basis for defining and identifying a high-need population.

Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×

THE IMPACT OF BEING A HIGH-NEED PATIENT

A rough understanding of the demographics of the high-need patient population does emerge from the research. According to analyses by The Commonwealth Fund and by the Agency for Healthcare Research and Quality (Cohen, 2015), high-need adults are disproportionately older, female, white, and less educated. Jha, Figueroa, and colleagues found the high-cost Medicare population to be disproportionately older, female, and nearly twice as likely to be dual-eligible (Joynt et al., 2017). Hayes and colleagues (2016) reported similar findings (see Figure 2–6). As a group, high-need patients are also more likely to be publicly insured (83 percent were insured under Medicare, Medicaid, or both), have fair to poor self-reported health, and have a behavioral or substance abuse condition. The average median household income for high-need adults ($25,668) was less than half of that of the overall adult population ($52,685), which was only slightly higher than the median household income for adults with three chronic conditions but no functional limitations ($52,499).

Functional limitations are key drivers of need. Adults with functional limitations tend to have higher health care expenses than adults with no such limitations (Olin and Dougherty, 2006; Zhang et al., 2015). Studies have also shown that adults with functional limitations are more likely to require care in a nursing home or assisted living facility (Foley et al., 1992; Gaugler et al., 2007). Functional limitations are also one type of patient-reported outcome that researchers believe represents an accurate assessment of an individual’s health status and need for services (Wolinsky et al., 2011).

A substantial literature shows that, for the population as a whole, medical care influences only a relatively small portion of overall health (McGinnis et al., 2002; Taylor et al., 2015b) and that social services expenditures significantly impact population health outcomes (Bradley et al., 2011). Similarly, the importance of social services to the well-being of high-need patients also has a disproportionate impact relative to medical care. Inadequate availability of social services, such as a lack of stable housing, a reliable food source, or basic transportation, can clearly worsen health outcomes in high-need patients (Taylor et al., 2015b).

A reality for high-need patients is that their needs often go beyond care for their physical ailments. For example, a study of high-need patients in Washington State who are frequent users of the emergency department for their health care needs found that a majority of these individuals had an alcohol or a substance abuse disorder and mental illness (Mancuso et al., 2004). In fact, for some high-need individuals, alcohol and substance abuse disorders can be

Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×

important contributors to chronic physical and behavioral health conditions, including hypertension, congestive heart failure, depression, anxiety, and other mental and physical disorders (Mertens et al., 2003; Mertens et al., 2005). Jha, Figueroa, and colleagues also found that a mental health diagnosis and an alcohol or a substance abuse diagnosis were both predictors of high-cost status (Joynt et al., 2017).

The results of a series of The Commonwealth Fund surveys further illustrate some of the challenges high-need individuals face in receiving adequate care. A 2014 survey, in which high-need individuals were defined as those 65 years or older with three or more chronic conditions or functional limitations, found that high-need individuals are particularly susceptible to a lack of coordination within the health care system (Sarnak and Ryan, 2016). Lack of coordination was determined to be in evidence when test results or records were not available at a medical appointment; there were duplicate tests orders; conflicting information was received from different providers; or a specialist lacked a patient’s medical history or the patient’s primary care provider was not informed about specialist care. Some 44 percent of high-need individuals reported a care coordination problem over the preceding 2 years compared to 27 percent of other older adults (Sarnak and Ryan, 2016). Additionally, more high-need adults reported that they thought a medical mistake was made in their treatment or care (13 percent) compared to the overall population of older adults (6 percent) and, despite the high level of insurance among this population, some 22 percent reported cost-related problems accessing care compared to 16 percent of the overall population of older adults.

A subsequent study by The Commonwealth Fund (Salzberg et al., 2016), based on an analysis of the 2009–2011 MEPS data, also found that being a high-need individual had a substantial impact on the care experience. According to this analysis, high-need adults were more likely to report having an unmet medical need—defined as forgoing or delaying needed medical care or prescription medication in the prior year—and less likely to report having good patient-provider communications compared to all adults or those with multiple chronic illnesses but no functional limitations. Unmet needs were greatest among high-need adults with private insurance and Medicaid. Easy access to specialists did not differ appreciably among the three groups, with approximately 50 percent of the individuals in each group reporting they had no trouble getting referred to a specialist when they believed they needed to see one.

One troubling finding from this analysis was that, although 93 percent of high-need adults have a usual source of care, only 46 percent of high-need adults reported that they had a usual source of care meeting the definition of a medical

Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×

home in providing care that is comprehensive, accessible, and responsive to the patients’ needs. This finding is important, the authors wrote, because medical homes benefit all patients and may especially help high-need patients improve outcomes and reduce spending. They also noted that, while low, the proportion of high-need patients receiving care in a medical home model was greater than the 36 percent of the general adult population who have a usual source of care meeting the definition of a medical home.

The most recent survey by The Commonwealth Fund included adults with two or more major chronic conditions, with or without functional limitations; individuals under 65 with a disability; and elderly individuals with multiple functional limitations (Ryan et al., 2016). The findings reiterated many of the conclusions from previous studies, but they also provided a focus on nonmedical aspects of care. For example, Ryan and colleagues (2016) stressed the social isolation and unmet social needs expressed by high-need patients, with nearly two-thirds articulating concern about such material hardships as housing, meals, or utilities. Additionally, of those high-need patients who reported a need for assistance with activities of daily living, only slightly more than one-third (38 percent) responded that they usually or always had someone available. Emotional counseling services were also cited as difficult to access, with less than half of those who may have needed them in the past 2 years able to set up an appointment in a timely fashion.

As Blumenthal and his colleagues stated in a discussion paper for the National Academy of Medicine’s Vital Directions for Health and Health Care Initiative (Blumenthal et al., 2016a), addressing just the health care needs—or, for that matter, the social and behavioral health needs—of high-need patients in isolation is likely to be inadequate. As the authors of this paper concluded, “Health-system leaders, payers, and providers will need to look beyond the regular slate of medical services to coordinate, integrate, and effectively manage care for behavioral-health conditions and social-service needs for functional impairments to improve outcomes and lower spending.” They also noted that the heterogeneity of the high-need population speaks to the implausibility of finding one delivery model or one program that meets the needs of all high-need patients, stating, “Payers and health systems may need to divide these patients into groups that have common needs so that specific complex care-management interventions can be targeted to the people who are most likely to benefit.” Addressing clinical needs alone will not improve outcomes or reduce costs. Rather, it will also be necessary to address an individual’s functional, social, and behavioral needs, largely through the provision of social and community services that today are not typically the province of health care delivery systems.

Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×

REFERENCES

Blumenthal, D., G. Anderson, S. Burke, T. Fulmer, A. K. Jha, and P. Long. 2016a. Tailoring complex-care management, coordination, and integration for high-need, high-cost patients: A vital direction for health and health care. Discussion Paper, National Academy of Medicine, Washington, DC.

Blumenthal, D., B. Chernof, T. Fulmer, J. Lumpkin, and J. Selberg. 2016b. Caring for high-need, high-cost patients—an urgent priority. New England Journal of Medicine 375(10):909–911.

Bradley, E. H., B. R. Elkins, J. Herrin, and B. Elbel. 2011. Health and social services expenditures: Associations with health outcomes. BMJ Quality & Safety 20(10):826–831.

Cohen, S. B. 2015. The concentration and persistence in the level of health expenditures over time: Estimates for the US Population, 2012–2013. Rockville, MD: Agency for Healthcare Research and Quality.

Cohen, S. B., and N. Uberoi. 2013. Differentials in the concentration in the level of health expenditures across population subgroups in the US, 2010. Statistical Brief #421. Rockville, MD: Agency for Healthcare Research and Quality.

Cohen, S. B., and W. Yu. 2012. The concentration and persistence in the level of health expenditures over time: Estimates for the US Population, 2008–2009. Rockville, MD: Agency for Healthcare Research and Quality.

Dzau, V. J., M. B. McClellan, J. M. McGinnis, and et al. 2017. Vital directions for health and health care: Priorities from a national academy of medicine initiative. JAMA 317(14):1461–1470.

Foley, D. J., A. M. Ostfeld, L. G. Branch, R. B. Wallace, J. McGloin, and J. C. Cornoni-Huntley. 1992. The risk of nursing home admission in three communities. Journal of Aging and Health 4(2):155–173.

Gaugler, J. E., S. Duval, K. A. Anderson, and R. L. Kane. 2007. Predicting nursing home admission in the US: A meta-analysis. BMC Geriatrics 7:13.

Hayes, S. L., C. A. Salzberg, D. McCarthy, D. C. Radley, M. K. Abrams, T. Shah, and G. F. Anderson. 2016. High-need, high-cost patients: Who are they and how do they use health care? New York: The Commonwealth Fund.

Jha, A. 2016. Targeting High Cost Patients and their Needs. Presentation at the January 19th NAM Models of Care for High-Need Patients meeting, Washington, DC.

Johnson, T. L., D. J. Rinehart, J. Durfee, D. Brewer, H. Batal, J. Blum, C. I. Oronce, P. Melinkovich, and P. Gabow. 2015b. For many patients who use large amounts of health care services, the need is intense yet temporary. Health Affairs 34(8):1312–1319.

Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×

Joynt, K. E., J. F. Figueroa, N. Beaulieu, R. C. Wild, E. J. Orav, and A. K. Jha. 2017. Segmenting high-cost medicare patients into potentially actionable cohorts. Healthc (Amst) 5(1-2):62-67.

Mancuso, D., D. J. Nordlund, and B. Felver. 2004. Frequent emergency room visits signal substance abuse and mental illness. Olympia, WA: Washington State Department of Social and Health Services.

McGinnis, J. M., P. Williams-Russo, and J. R. Knickman. 2002. The case for more active policy attention to health promotion. Health Affairs 21(2):78–93.

Mertens, J. R., Y. W. Lu, S. Parthasarathy, C. Moore, and C. M. Weisner. 2003. Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO: Comparison with matched controls. Archives of Internal Medicine 163(20):2511–2517.

Mertens, J. R., C. Weisner, G. T. Ray, B. Fireman, and K. Walsh. 2005. Hazardous drinkers and drug users in HMO primary care: Prevalence, medical conditions, and costs. Alcoholism, Clinical and Experimental Research 29(6):989–998.

Mitchell, E. M. 2016. Statistical Brief #497: Concentration of Health Expenditures in the US Civilian Noninstitutionalized Population, 2014. Agency for Healthcare Research and Quality.

Olin, G., and D. D. Dougherty. 2006. Characteristics and medical expenses of adults 18 to 64-years old with functional limitations, combined years 1997–2002. Rockville, MD: Agency for Healthcare Research and Quality.

RTI International. 2015. Accountable care organization 2015 program analysis quality performance standards narrative measure specifications. Rockville, MD: Centers for Medicare & Medicaid Services.

Ryan, J., M. K. Abrams, M. M. Doty, T. Shah, and E. C. Schneider. 2016. How High-Need Patients Experience Health Care in the United States: Findings of the 2016 Commonwealth Fund Survey of High-Need Patients. New York: The Commonwealth Fund.

Salzberg, C. A., S. L. Hayes, D. McCarthy, D. Radley, M. K. Abrams, T. Shah, and G. Anderson. 2016. Health system performance for the high-need patient: A look at access to care and patient care experiences. New York: The Commonwealth Fund.

Sarnak, D. O., and J. Ryan. 2016. How high-need patients experience the health care system in nine countries. Issue Brief (The Commonwealth Fund) 1:1–14.

Stanton, M. W., and M. K. Rutherford. 2006. The high concentration of US Health care expenditures. Rockville, MD: Agency for Healthcare Research and Quality.

Taylor, L. A., C. E. Coyle, C. Ndumele, E. Rogan, M. Canavan, L. Curry, and E. H. Brandley. 2015. Leveraging the social determinants of health: What works? Boston, MA: Blue Cross Blue Shield of Massachusetts Foundation.

Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×

Wolinsky, F. D., S. E. Bentler, J. Hockenberry, M. P. Jones, M. Obrizan, P. A. Weigel, B. Kaskie, and R. B. Wallace. 2011. Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries. BMC Geriatrics 11(1):43.

Zhang, J. X., J. U. Lee, and D. O. Meltzer. 2015. The effect of functional limitations and hospitalization on out-of-pocket medical payments in older adults. Annals of Community Medicine and Practice 1(1).

Zodet, M. 2016. Characteristics of persons with high health care expenditures in the US civilian noninstitutionalized population, 2014. Agency for Healthcare Research and Quality.

Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
Page 31
Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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Suggested Citation:"2 Key Characteristics of High-Need Patients." National Academy of Medicine. 2017. Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health. Washington, DC: The National Academies Press. doi: 10.17226/27115.
×
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To advance insights and perspectives on how to better manage the care of the high-need patient population, the National Academy of Medicine, with guidance from an expert planning committee, was tasked with convening three workshops held between July 2015 and October 2016. The resulting special publication, Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health, summarizes the presentations, discussions, and relevant literature.

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