Recently the National Academy of Medicine (NAM) (formerly the Institute of Medicine) released it's "Effective Care for High-Need Patients, Opportunities for Improving Outcomes, Value and Health." The report attempts to address a long-standing problem in health care delivery, e.g., five percent of patients ("high-need" patients) account for, or consume, 50 percent of health care resources. That is if these patients were identified in a more timely manner and better managed overall health care spending could be substantially reduced. Beyond the complexities involved in managing care for these highly co-morbid patients, the US does a comparatively poor job of coordinating or blending clinical care with non-clinical social service supports these patients need to mitigate their functional status limitations.
During this 28 minute conversation Ms. Abrams discusses among other things the NAM work group's efforts to calculate methods for identifying high-need or super utilizers, or more generally developing patient categorization schemes, the importance of accompanying clinical care with social service supports for those patients with functional status limitations, how/why the 14 profiled providers in the report are able to provide comprehensive quality care for these patients, and the need for improved reimbursement models to allow for or support such care.
Ms. Melinda Abrams is currently Vice President at The Commonwealth Fund. Since 1997 she has worked on, among other projects, the Fund's Task Force on Academic Health Centers, the Child Development and Prevention Care Program and most recently has led the Patient-Centered Coordinated Care Program. Ms. Abrams has served on numerous national boards and committees for federal agencies and private organizations and as a peer-reviewer for several health care journals. She is the recipient of the Champion Award from the Primary Care Development Corporation and a Primary Care Community Research Leadership Award from the Patient Centered Primary Care Collaborative. Ms. Abrams earned her undergraduate degree from Cornell and her M.S. in health policy and management from the Harvard School of Public Health.
The NAM report is at: https://nam.edu/effective-care-for-high-need-patients/
For more on the Commonwealth Fund's work go to: http://www.commonwealthfund.org/