Giving Compass' Take:

• The Pacific Business Group on Health Care Transformation Task Force published a report on high-need, high-cost patients who have complex medical conditions and how health care providers can face the unique challenges that come with caring for those types of patients.  

•How will this change the health care system as a whole? 

• Read about how human service organizations need to collaborate more in order to provide the most effective healthcare.

The Pacific Business Group on Health and the Health Care Transformation Task Force have released a report and contracting tool to assist providers and payers with the care management of high-need, high-cost patients. HNHC patients, a small number of individuals with complex medical, social and behavioral needs, makeup 5% of the U.S. population but account for roughly 50% of the country’s annual healthcare spending.

These patients, many of whom live with three or more chronic conditions, use the largest proportion of healthcare resources in the U.S. Improving their care has long been a priority for the industry.

“High-need high-cost contracting is where you have these more advanced provider systems that are contracting primarily or exclusively for medically-complex patients,” Caitlin Sweany-Mendez, director of transformation facilitation and support at the task force, explained. “It tends to be a bit more sophisticated and flexible” with how people are identified and targeted as compared to whole population contracting.

Key suggestions in HNHC-targeted contracting for delivery system executives include factoring in the importance of service area demographic variations in program design, ensuring that contracts last at least three years to allow the organization to develop and being thoroughly ready before moving toward advanced risk or fully capitated contracts.

Although the report found guaranteed access to data is a good tactic in identifying HNHC populations and properly managing their needs (along with real-time data updates, enrollment data sharing and supplemental health information), data sharing is currently underused by care managers.

A barrier to widespread adoption of HNHC programs is return on investment and worry around receiving adequate payment for service, although the move to value-based payment by payers increases provider accountability in quality of care and cost containment.

Read the full article about managing high need high-cost patients by Rebecca Pifer at Healthcare and Health IT News