Too expensive to treat???
Recent efforts to increase accountability for health outcomes and costs has put a spotlight on the immense challenge of providing high-quality and efficient care to people with complex needs, many of whom require inputs from both the medical and social care systems to remain at their highest functional capacity.
People with complex needs often have functional limitations, such as the inability to effectively communicate, move about, or take care of themselves without additional help, and they may have behavioral health needs that typically incur high health care costs. Traditionally, these individuals have been a source of revenue for health systems due to the sheer number of covered services they receive. Yet, under new payment and delivery models, such as accountable care organizations and bundled payments, these people could be viewed as a serious financial risk because of their outlier expenditures and potential for poor health outcomes.
Herein lies an opportunity to improve the management of care for this population. The National Academy of Medicine’s (NAM’s) special publication, Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health, serves as a primer for how health care stakeholders can use evidence-based approaches to effectively manage care for this population. How to measure quality and outcomes as models of care and policies are implemented, while also managing costs of care, should be further discussed. Accountability measures for this population are necessary to assess the effectiveness of health financing reform efforts.