Improving the performance of America’s health system will require improving care for the patients who use it most: people with multiple chronic conditions that are often complicated by patients’ limited ability to care for themselves independently and by their complex social needs. Focusing on this population makes sense for humanitarian, demographic, and financial reasons.
From a humanitarian standpoint, high-need, high-cost (HNHC) patients deserve heightened attention both because they have major health care problems and because they are more likely than other patients to be affected by preventable health care quality and safety problems, given their frequent contact with the system. Demographically, the aging of our population ensures that HNHC patients, many of whom are older adults, will account for an increasing proportion of users of our health care system. And financially, the care of HNHC patients is costly. One frequently cited statistic is that they compose the 5% of our population that accounts for 50% of the country’s annual health care spending.
At least three steps are essential to meeting the needs of these patients: developing a deep understanding of this diverse population; identifying evidence-based programs that offer them higher-quality, integrated care at lower cost; and accelerating the adoption of these programs on a national level. Although we are making progress in each of these areas, much work remains.
HENRY KOTULA 