Tailoring Complex Care Management for High-Need, High-Cost Patients

David Blumenthal
Melinda Abrams
Journal Article
October 2016

This viewpoint article provides promising policy recommendations to improve care for high-need, high-cost patients. Some recommendations can be accomplished through executive action, while others require legislative change, but all will require active collaboration among private health care organizations and clinicians, insurers, patients, and caregivers. Recommendations include:

  • Expand the prevalence and improve the effectiveness of value-based payment (VBP) strategies.
  • Continue intensive evaluation and refinement of value-based payment arrangements. Public authorities need to work with private health care organizations and clinicians to ensure that the incentives to improve value reach frontline clinicians and that VBP adequately account for patients’ medical and social risk.
  • Allow flexibility to use evidence-based non-medical services within VBP arrangements, in which clinicians and health care organizations are accountable for the total costs of care.
  • Support implementation of digital infrastructure for care continuity.
  • Increase support for care delivery model refinement, including continual experimentation, evaluation, and improvement as well as associated research support.
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Population Addressed
Adults Under 65 with Disabilities
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • What are promising policy recommendations to improve care for high-need, high-cost patients?
Level of Evidence
Expert Opinion
What does this mean?