Current Approaches to Identifying the Health Care Needs for High-Need, High-Cost Patients

Mathematica Health Experts Look at Population Segmenting in New Research
Jan 16, 2019

Nurse assisting woman in wheelchairHigh-need, high-cost (HNHC) patients often face a tangle of challenges: Repeated hospitalizations and emergency room visits, chronic medical conditions including undiagnosed mental health disorders, inability to perform daily living activities, economic difficulties, and even increased risk of mortality. With these patients making up just 5 percent of the U.S. population, but accounting for 50 percent of health care costs, addressing their challenges could go a long way towards providing better care at lower costs. New research from Mathematica and the Commonwealth Fund highlight how tailored approaches such as identifying and grouping HNHC patients with similar health care, behavioral, and/or social support needs can improve care.

Mathematica’s Dana Jean-Baptiste discusses the difficulties of treating HNHC patients and offers additional insights based on a recent working paper. A related issue brief explores the approach in more detail by looking at how a group of mature Accountable Care Organizations (ACOs) use a range of approaches to segment their HNHC patients. Although there was no consistent set of subgroups for HNHC patients across ACOs, there were some common ones. Respondents noted that when primary care clinicians were engaged in refining segmentation approaches, there was an increase in both the clinical relevance of the results as well as the willingness of frontline providers to use them. Population segmentation results informed ACOs’ understanding of program needs, for example, by helping them better understand what skill sets and staff were needed to deliver enhanced care management. The Commonwealth Fund supported both the paper and issue brief.

“This research helps us understand what works in addressing the complex health care needs of HNHC patients,” says Jean-Baptiste. “Identifying promising strategies through rigorous research can help the healthcare community identify ways to provide better care and more effectively use resources to treat this population.”