High-Need, High-Cost Segmentation Framework

Jose F. Figueroa
Implementation Tool
October 2021
View the resource


Segmentation framework with publicly available code files identifies specific and actionable patient cohorts with complex needs.


Because people with complex health and social needs require diverse supports, health care stakeholders need ways to segment patient subgroups and tailor strategies to engage patients who are most at risk for experiencing potentially avoidable care or poor health outcomes. Recent work supported by The Commonwealth Fund and led by Jose Figueroa, MD, MPH at the Harvard T.H. Chan School of Public Health, in collaboration with the Institute for Accountable Care, suggests that segmenting patients with complex needs into smaller, meaningful subgroups can help guide which interventions may be more effective for specific people.

About this Tool

This tool includes three statistical analysis software files of code as well as program documentation with data sources and instructions for use. Examples of subpopulations identified include older adults with functional and cognitive impairment and major comorbidity burden, people with serious mental illness and major comorbidity burden, and adults with multiple major chronic conditions.


Health care organizations can use these simple algorithms to incorporate a segmentation framework into population health management initiatives, and to analyze the impact of their interventions and investments.

Posted to The Playbook on