What Is Key to Interventions With High-Need, High-Cost Patients?
Patients identified as high-need, high-cost (HNHC) constitute a very small percentage of the population but account for a disproportionally high level of healthcare use and cost. A systematic review of research studies on interventions found that individualized and tailored patient engagement and resources to support care providers are critical to the success of interventions.
Payers and providers have implemented programs seeking to improve health outcomes for HNHC patients and reduce their costly use of potentially preventable healthcare services, including emergency department and hospital visits.
The RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center conducted a survey of research under a contract from the Agency for Healthcare Research and Quality (AHRQ). Their survey included 110 studies, and found that characteristics associated with HNHC include patient chronic clinical conditions, behavioral health factors including depression and substance use disorder, and social risk factors including homelessness and poverty. “We also identified prior healthcare use and race as important predictors,” the authors said.
The authors noted that they found limited evidence of approaches for distinguishing potentially preventable or modifiable high use from all high use.
In seeking to understand how and why interventions work, they looked at efforts engaging HNHC patients directly and engaging care providers in these interventions. They categorized evidence based on primary setting and in general found that ED-, primary care–, and home-based care models result in reduced use of healthcare serves. ED, ambulatory intensive caring unit, and primary care-based models result in reduced costs; and system-level transformation and telephonic/mail models did not result in changes in use or costs.
The researchers concluded that patient characteristics can be used to identify patients who are potentially HNHC, but that evidence focusing specifically on potentially preventable or modifiable high use was limited. “Based on our program theories, we conclude that individualized and tailored patient engagement and resources to support care providers are critical to the success of interventions,” the authors said. “Although we found evidence of intervention effectiveness in relation to cost and use, the studies identified in this review reported little information for determining why individual programs work, for whom, and when.”
