High-Need, High-Cost Segmentation Framework Segmentation framework with publicly available code files identifies specific and actionable patient cohorts with complex needs. Implementation Tool October 2021
Identifying Patients with Persistent Preventable Utilization Offers an Opportunity to Reduce Unnecessary Spending Medicare patients with the top five percent in preventable utilization account for almost half of all avoidable Medicare costs. Peer-Reviewed Article July 2020
Serious Illness Approaches by ACOs: Facey Medical Group This case study analyzes a successful example of a medical group partnering with a home health agency to provide community-based palliative care for high-risk members of their accountable care organization. Case Example May 2019
Identification and Assessment Toolkit for Patients with Serious Illness Includes case studies, clinical assessment tools, and other resources for identifying and assessing the needs of patients with serious illness. Implementation Tool March 2019
How Accountable Care Organizations Use Population Segmentation to Care for High-Need, High-Cost Patients Accountable Care Organization leaders explore approaches to segmenting high-need, high-cost populations. Brief/Report January 2019
Effective Care for High-Need Patients: Opportunities for Improving Value, Outcomes and Health The National Academy of Medicine offers a synthesis of the evidence for improving care for high-needs patients. Brief/Report June 2017
Effective Management of High-Risk Medicare Populations A three-pronged strategy can help manage care for Medicare beneficiaries. Brief/Report September 2014