How Accountable Care Organizations Use Population Segmentation to Care for High-Need, High-Cost Patients

Publisher: New York, NY: The Commonwealth Fund
Jan 03, 2019
Ann S. O’Malley, Eugene C. Rich, Rumin Sarwar, Eli Schultz, W. Cannon Warren, Tanya Shah, and Melinda K. Abrams

Key Findings:

  • New payment and care delivery models such as accountable care organizations (ACOs) have prompted health care delivery systems to better meet the requirements of their high-need, high-cost (HNHC) patients.
  • We explored how a group of mature ACOs are seeking to match patients with appropriate interventions by segmenting HNHC populations with similar needs into smaller subgroups.
  • 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.
This issue brief explores how a group of mature Accountable Care Organizations subdivide or “segment” their HNHC patients so that they can better plan for care management for those patient subgroups needs.