U.S. Healthcare System Failing High-Need Patients, Survey Finds

The U.S. healthcare system is failing patients with complex medical needs, many of whom struggle to access the coordinated medical, behavioral, and social services they need to manage their conditions and avoid costly hospital visits, an issue brief from the Commonwealth Fund finds.

Based on a survey of more than three thousand adults, the brief, How High-Need Patients Experience Health Care in the Unites States (20 pages, PDF), found that while 95 percent of the more than eighteen hundred high-need respondents had a regular doctor or place of care, 44 percent reported that they had experienced delays in care in the past year — compared with 21 percent of non-high-need respondents — due to limited access to care coordinators, counseling, assistance in managing functional limitations, and/or transportation services. Nearly half the high-need population — which tends to be older, less educated, and poorer and includes a greater share of women and African Americans than the general population — reported being hospitalized overnight (48 percent) or going to the emergency room multiple times (47 percent) in the past two years.

Members of the high-need population also were more likely to struggle with emotional distress (53 percent, compared with 28 percent among non-high-need respondents); feel socially isolated (37 percent vs. 15 percent); experience stress or worry about material hardships (62 percent vs. 32 percent); and be somewhat or very concerned about being a burden to family or friends (59 percent). In addition, the survey found that among those who struggled to cope with emotional distress, only 39 percent could get counseling promptly; that among those who had multiple sources of care, 42 percent had an informed care coordinator; and that among the 57 percent of high-need respondents with functional limitations, 38 percent had adequate help with daily life.

In conjunction with the release of the brief, the Commonwealth Fund and four other healthcare foundations — the John A. Hartford, Robert Wood Johnson, and SCAN foundations and the Peterson Center on Healthcare — have launched an online resource to help health system leaders and insurers improve care for patients with complex medical and social needs. Developed by the Institute for Healthcare Improvement, The Playbook: Better Care for People With Complex Needs shares case studies, issue briefs, and reference guides detailing promising and successful approaches to serving patients with complex needs, the business case for such models, and opportunities for policy and payment reform.

"Redesigning care for patients with complex needs, especially disadvantaged older people who interact frequently with our medical system, will alleviate suffering, decrease costs, and send a message that we are serious about health equity," said John A. Hartford Foundation president Terry Fulmer. "Working together, we can create age-friendly health systems and scale up solutions that improve outcomes for those in greatest need."

"Five National Health Care Foundations Identify Promising Approaches for Treating Patients With Complex Needs" Commonwealth Fund et al Press Release 09/12/2016. "How High-Need Patients Experience Health Care in the Unites States" Commonwealth Fund Report 12/09/2016.