In a special publication, the National Academy of Medicine (NAM) suggests methods for improving care for the top 5 percent of high-need patients, who account for half of the nation’s health care spending.

In partnership with other stakeholders, NAM conducted three workshops over two years to survey stakeholders about strategies to improve care for this population. In the subsequent report, NAM recommends establishing defining characteristics of a high-need patient based on:

  • total accrued health care costs;
  • intensity of care for a given time; and
  • functional limitations.

NAM also has developed a conceptual taxonomy for characterizing high-need patients by behavioral health and social risk factors, in addition to clinical and functional groups. NAM recommends care models that correspond with these factors, identify barriers to successful care models, and offer opportunities for reform, including:

  • transitioning to value-based payment systems;
  • streamlining proven quality measures; and
  • creating tools to help organizations implement care models for their patient populations.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.