Value-Based Care for the High-Need Patient


Improving care for high-need, high-cost patients is an imperative for patients and the healthcare system. Programs are in development, NEJM perspective reports.

Improving care for high-need, high-cost patients - a population said to comprise 5 percent of the population, but account for 50 percent of health care spending each year in the U.S. - is an urgent priority, according to a perspective published July 27 in the New England Journal of Medicine.

This group of patients typically consists of patients with multiple chronic conditions. The care of these patients is often made more challenging because of complex social needs and their limited ability to care for themselves. And, the number of high-need, high-cost patients is likely to climb with the aging population.

Developing a better understanding of this population and identifying and adopting integrated approaches to improving care, will improve outcomes for these patients, the authors wrote.

High-need, high-cost patients are a diverse population. Some patients are near end of life, but more often than not, more are living average lifespans with chronic conditions that were once deemed fatal, but can now be managed with medications. Other high-need, high-cost patients have extreme functional limitations. Others have persistent behavioral health challenges and others are stymied by social issues, such as the lack of housing, food and supportive personal relationships. 

The authors suggest the adoption of evidence-based, integrated approaches that can improve outcomes at lower costs.

While there are promising research-based health care models for this group of patients, including programs focused on managing transitions of care and others that integrate nonmedical services or focus on interdisciplinary person-centered primary care, few have been implemented, largely due to the complexity of getting the programs off the ground and funding the programs.

Five foundations - the Commonwealth Fund, John A. Harford Foundation, Peterson Center on Healthcare, SCAN Foundation and Robert Wood Johnson Foundation - are developing programs to improve care and outcomes for these patients.

“Higher-quality, more affordable care for high-need, high-cost patients will require new levels of collaboration among health care providers, payers, communities, social service organizations, academics, researchers and others,” the authors wrote. “We welcome the involvement and support of all stakeholders seeking to improve the performance of our health system by ensuring better care for this vital and growing population.”



Blumenthal D, Chernof B, et al. “Caring for High-Need, High-Cost Patients -a Urgent Priority,” New England Journal of Medicine. July 27, 2016. DOI: 10.1056/NEJMp1608511


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