Healthcare System Not Meeting Needs of Sickest Patients, Report Finds

Efforts to improve health care should focus on the needs of those with multiple chronic illnesses and limited ability to care for themselves, a report from the Commonwealth Fund argues.

According to the report, High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care?, twelve million people in the United States have at least three chronic illnesses as well as a functional limitation that makes it hard for them to perform basic daily tasks. The study also found that these adults are older and less educated than U.S. adults overall and more likely to be white, low-income, and publicly insured, with more than half over the age of 65 and nearly two-thirds of them women.

According to the new research — which was released along with a companion study, Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences — the sickest adults struggle to get the health care they need but spend more out-of-pocket and have higher medical costs than other adults. Indeed, 20 percent of the sickest adults reported that they went without or delayed needed medical care or prescription medication in the past year, compared to 8 percent of all U.S. adults. The research also found that out-of-pocket expenses for adults with high needs ($1,669) were more than twice those of the average adult ($702). At the same time, the annual median household income for high-need adults was less than half that for the overall adult population.

To address these inequities, the reports recommend that private insurers consider how benefits and provider networks can be improved to help high-need enrollees; that state policy makers consider how to ensure that high-need adults enrolled in Medicaid are able to access needed specialty care; and that initiatives to improve care for high-need patients target those patients most likely to benefit from them.

"We have known for a long time that there are very sick patients facing challenges in daily living and that our healthcare system has to do a better job of caring for them," said Melinda Abrams, vice president for delivery system reform at the Commonwealth Fund and a co-author of both reports. "This research shows us who they are, what their needs are, and how the system is, or isn’t, working for them right now. This gives us a clearer picture of how to help them get and afford the care they need, so they’re able to live their lives to the fullest extent possible."

"New Commonwealth Fund Report Profiles the 12 Million Sickest Patients; Finds Health Care System Not Meeting Their Needs" Commonwealth Fund Press Release 08/29/2016.