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Study Shows How to Meet the Needs of Complex High-Need Patients

January 4, 2017


Hospitals and health systems can make a more meaningful dent in the costs of care and improve the value of the care they deliver by zeroing in on the social and behavioral health needs of their most complex high-need patients, according to a new report published by The Commonwealth Fund.


The problem isn’t that these individuals lack access to medical services; rather, it’s that they often lack such social supports as transportation, care coordination, social connection and companionship, and assistance with daily activities, according to the report.  These social and behavioral concerns lead many patients to delay services and visit emergency rooms for care, adding considerably to the healthcare burden.


“Our research shows that when people with complex needs require medical help, they encounter a healthcare system that’s expensive, inefficient and poorly coordinated,” David Blumenthal, president of The Commonwealth Fund, said in a statement.  “We want to better understand what works for effectively treating these patients, so we can identify gaps, reduce duplication and accelerate what works.”


The report presents the findings of a survey based on phone interviews with 3,009 adults age 18 and older living in the United States.  Of those interviewed, 1,805 were identified as “high-need” based on major chronic conditions, behavioral health problems and physical limitations or disabilities.


“While nearly all of the high-need patients surveyed have consistent access to healthcare (95 percent), they nevertheless struggle to get the coordinated medical, behavioral and social services they need to stay well and avoid costly hospital visits,” The Commonwealth Fund said in a statement.


By focusing on patient-centered communication and supporting easier access to care and information, hospitals, health systems and medical practices can reduce the unnecessary care that drives up the nation’s healthcare costs, the report concludes.


“With better access to care and good patient-provider communication, high-need patients are less likely to delay essential care and less likely to go to the emergency department for nonurgent care, and thus less likely to accrue avoidable costs,” the report states.  “For health systems to improve outcomes and lower costs, they must assess patients’ comprehensive needs, increase access to care, and improve how they communicate with patients.”


The report cites research revealing that 10 percent of patients consume 65 percent of healthcare services and supports previous research showing the significant unmet social and behavioral health needs of many high-need patients.


Among the survey’s findings:

  • The high-need population is older, has lower levels of education and income, and includes more women and African-Americans.  Sixty six percent of high-need adults reported annual incomes of less than $30,000, more than twice that (32 percent) of not high-need adults.  Almost two-thirds (62 percent) of high-need patients experience stress about their ability to afford housing, utilities and nutritious meals, compared with 32 percent of other adults.
  • Many high-need patients are socially isolated.  Thirty-seven percent of high-need participants reported loneliness and lack of companionship compared with only 15 percent of other adults.  Almost two-thirds (62 percent) reported concern about material hardships such as housing and food, compared with only 32 percent of other adults. 
  • Nearly half of high-need patients delay care and report access problems.  While the vast majority (95 percent) of high-need respondents said they have a physician or place of regular care, 44 percent said they have delayed receiving care because of an access problem such as transportation or limited office hours.
  • Less than half of high-need adults receive assistance with functional limitations.  Fifty three percent of high need patients reported seeing multiple doctors or using multiple healthcare services.  Of these, only 43 percent reported having an up-to-date and informed care coordinator.  In addition, only 39 percent of high-need respondents said they could obtain psychological counseling to deal with emotional stress in a timely manner and fewer than four in 10 of the 57 percent of respondents who experience difficulty with activities of daily living receive support with those activities.  Most of the assistance comes from family members or relatives.
  • Good patient-provider communication is critical for the high-need population.  Although 60 percent of high-need patients have providers who engage in patient-centered communication (compared with 52 percent of other adults), they are less likely to have providers who involve them in treatment decisions (82 percent of high-need adults compared with 90 percent of others) or listen carefully to them (85 versus 91 percent, respectively).
  • High-need adults are less likely to delay care and visit the ER if they have good access and communication.  The survey results point to strategies that health systems and physicians can use to address these problems, including providing after-hour visits and same-day answers to medical questions; and using patient-centered communication to cultivate good relationships with patients.  High-need adults were less likely to report emotional stress when they had timely access to care and information.  Nearly half (47 percent) of high-need adults visited the ED multiple times in the past two years.


“To help people who most need resources, the interventions must be more comprehensive and creative than just a standard set of doctor visits,” the report states.  “Healthcare providers should build relationships and collaborate with social service agencies, community-based organizations, and behavioral health providers to deliver better outcomes and avoid high-cost care for this population.”  Specific needs include transportation services, emotional counseling, assistance with functional limitations and care coordination.


The Commonwealth Fund report was released in tandem with a new online resource to help healthcare leaders, policy makers and insurers improve care for high-need patients.  The Playbook:  Better Care for People with Complex Needs, is a curated compendium of best practices, resources and promising approaches, such as an intensive outpatient care tool kit and a paper on tailoring complex care management for high-need, high-cost patients.  The resource was developed by the Institute for Healthcare Improvement with support from The John A. Hartford Foundation, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation, the SCAN Foundation and The Commonwealth Fund.

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