High-Need, High-Cost Patients David Blumenthal, MD, MPP President, - - PowerPoint PPT Presentation

Patient-Centered Care For High-Need, High-Cost Patients

OECD Policy Forum on the Future of Health Care Paris, France January 16, 2017

David Blumenthal, MD, MPP

President, The Commonwealth Fund

Agenda

a) Who is the high-need, high-cost patient? b) A patient-centered approach to the high-need, high-cost individual? c) The implementation challenge. d) Commonwealth Fund agenda.

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Who is the high-need, high-cost patient?

17% 16% 30% 28% 55% 28% 52% 83% Age 65+ No high school degree Income below 200% FPL Public insurance

All adults High-need adults (3+ chronic conditions & functional limitation)

Data: 2009–2011 Medical Expenditure Panel Survey (MEPS). Source: S. L. Hayes, et al., High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? The Commonwealth Fund, August 2016.

U.S. High-Need Adults Tend to be Older, Have Low Socioeconomic Status, and Have Public Insurance

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Behavioral Health Issues are a Key Predictor of High Costs

$0 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000

Asthma/COPD Congestive heart failure Coronary heart disease Diabetes Hypertension

No mental illness or drug/alcohol problem Mental illness but no drug/alcohol problem Mental illness and drug/alcohol problem

Source: C. Boyd et al. Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services for Medicaid Populations. Center for Healthcare Strategies Data Brief, December 2010.

Average Annual Health Expenditures Among a U.S. Medicaid Population

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Distribution of health expenditures for the U.S. population, by magnitude of expenditure, 2013 1% 5% 10% 49% 65% 22% 50% 97%

Population Share of Health Spending

In the U.S., Health Care Costs Concentrated in Sick Few—Sickest 5% Account for 49% of Expenses

Source: Agency for Healthcare Research and Quality analysis of 2013 Medical Expenditure Panel Survey; MEPS Statistical Brief 480.

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Distribution of hospital and home care expenditures for the Ontario population, by magnitude of expenditure, 2009/10

5% 61% Population Share of Health Spending

In Ontario, Sickest 5% Account for 61% of Hospital and Home Care Services Expenses

Source: Saad R, et al., “High-Cost Users of Ontario’s Healthcare Services,” Healthcare Policy, 2013.

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Share of expenditures (%)

In Scotland, Sickest 2% Account for 50% of Hospital and Pharmacy Expenses

Note: Costs are for hospital and community pharmacy services only. Source: Correspondence with Health and Social Care Analytical Services.

Share of service users (%)

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Getting to Patient-Centeredness

Segmentation Strategies

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Source: Ashish Jha, analysis of Medicare data.

39.5% 25.6% 20.1% 10.2% 3.6% 1.1%

Frail Elderly Under 65 Disabled Major Complex Chronic Minor Complex Chronic Simple Chronic Relatively Healthy

Segments of High-Cost Patients in U.S. Medicare

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Getting to Patient-Centeredness

Source: http://www.sagehealthadvisor.com/

User-Centered Design

EMOTIONAL NEEDS PERSONAL NEEDS FUNCTIONAL NEEDS MEDICAL NEEDS

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Esther Project (Sweden)

Improving Performance

Health System Performance

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Macrosystems Microsystems

Implementation Challenges

Culture

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Macrosystems

Integrating social and medical services Workforce Payment policy

Implementation Challenges

Share decision- making with patients

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Microsystems

Support informal caregivers Identify at-risk patients Engage clinical leaders

• Five Foundation Collaborative.
• Cross-national working group.
• IT-enabled consumer engagement.

The Commonwealth Fund

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Vision of the Digital Health Advisor

Tracking Communication Coordination Advice

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Commonwealth Fund International Experts Working Group on Patients with Complex Needs

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• Established in 2014 (with LSE).
• Aims:
• Learn from international experts.
• Develop recommendations for policymakers .
• Identify promising frontline delivery system

innovations.

• Product: Ten recommendations for policymakers.