The following is the summary of “Characteristics of High-Need, High-Cost Patients” published in the December 2022 issue of Internal medicine by Berkman, et al.
It is a priority and a problem for U.S. policymakers, healthcare delivery systems, and payers to accurately identify high-need, high-cost (HNHC) individuals to reduce their healthcare usage for chronic illnesses that are preventable or controllable. The goal here is to establish parameters by which HNHC patients can be distinguished from the general population. Data was gathered by searching various online databases and reviewing unpublished research papers published between January 1, 2000, and January 22, 2022. HNHC adult patients are those who have high utilization (emergency department, inpatient, or total services) or high expense; hence the research selected must be written in English. Independent, double-reviewed data extraction and quality check.
In total, 64 papers were included in the meta-analysis for analysis, with 47 being multivariate exposure studies, 11 being cluster analyses, and 6 being qualitative research. The results were initially organized using a “best-fit” framework provided by the National Academy of Medicine (NAM) taxonomy. Chronic clinical conditions, especially cardiovascular disease, chronic renal disease, chronic lung disease, diabetes, cancer, and hypertension, were also strongly correlated with HNHC status, as were the number and severity of a patient’s comorbid conditions. The likelihood that a patient will be HNHC. The reviewers made some changes to the NAM taxonomy before settling on a final framework, including the inclusion of chronic pain and high healthcare utilization in past patterns as risk factors for HNHC.
To date, there has been insufficient information to separate out instances of healthcare utilization that could have been avoided or altered from the total volume of such utilization. Identifying patients with HNHC can be identified using a combination of characteristics. Improving the quality of care will also necessitate an individual assessment of care needs and the availability of support resources due to the complexity of their ailments and situations.