Overview of Segmentation of High-Need, High-Cost Patient Population
There are many promising strategies to segment individuals with complex needs. Here is one conceptual framework.
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Displaying 221 - 238 of 238
Proactively Identifying the High-Cost Population
Segmenting the high-cost population is the first step in matching appropriate care management strategies.
Brief/Report
Developing Care Management Programs to Serve High-Need, High-Cost Populations
Care management programs should include processes for evaluating patient-reported outcomes.
Brief/Report
Utilization of Hot Spotting to Identify Community Needs and Coordinate Care for Patients in Memphis, TN
The approach identifies patients through chart review and data analytics coupled with the intelligence of community health workers.
Peer-Reviewed Article
Delivery System Reform: Improving Care for Individuals Dually Eligible for Medicare and Medicaid
Dual-eligible beneficiaries are often more sick, have greater functional and cognitive impairments, and require more care coordination.
Brief/Report
Payment to Promote Sustainability of Care Management Models for High-Need, High-Cost Patients
Provider incentives must be based on Triple Aim outcomes.
Brief/Report
What Matters Most: Essential Attributes of a High-Quality System of Care for Adults with Complex Care Needs
Experts describe how delivery systems can effectively serve adults with complex needs.
Brief/Report
High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care?
There is considerable variation in use and spending among high-need adults, suggesting this population should be segmented into subgroups.
Brief/Report
How High-Need Patients Experience the Health Care System in Nine Countries
The U.S. had the highest rate of cost-related access problems.
Brief/Report
Generating Hypotheses about Care Needs of High Utilizers: Lessons from Patient Interviews
This resource presents promising ideas for more effective modes of care for persons with complex needs.
Peer-Reviewed Article
Adding a Measure of Self-Management Capability to Risk Assessment Can Improve Prediction of High Costs
Less “activated” patients are more likely to benefit from care coordination.
Peer-Reviewed Article
Using Data to Better Serve the Most Complex Patients: Highlights from NGA’s Intensive Work with Seven States
The National Governors Association worked for two years to improve care and lower costs for Medicaid “super-utilizers.”
Brief/Report
Key Components for Successful LTSS Integration: Lessons from Five Exemplar Plans
Successful long-term services and supports programs have a single point of accountability, such as a care manager.
Brief/Report
Emergency Department Super-Utilizer Programs: Rural Health Systems Analysis and Technical Assistance Project
This guide describes how to design, implement, and assess a program to reduce preventable ED use.
Implementation Tool
The Core of Care Management: The Role of Authentic Relationships in Caring for Patients with Frequent Hospitalizations
This study links “authentic healing relationships” with patient motivation and active health management.
Peer-Reviewed Article
Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis
Much of the evidence comes from small studies, so further testing is needed.
Brief/Report
The Return on Investment (ROI) Calculator: The Business Case and Person-Centered Care
A calculator that can help build and present business case for serving adults with complex needs.
Implementation Tool
Supporting a Culture of Health: Opportunities to Improve Models of Care for People with Complex Needs
Key opportunities include strengthening information technology connections across service providers.
Brief/Report