Analysis: Health Care System Must Better Address High Need, High Cost Individuals
High-need adults, who are defined as having three or more chronic diseases and limitation in ability to care for themselves, account for a high proportion of health care spending and most are age 75 and older, according to new data analysis from the Commonwealth Fund.
The findings, which come from an analysis of the 2009-2011 Medical Expenditure Panel Survey, shows that these adults had annual health care expenses that were nearly three times higher and out of pocket expenses that were more than one-third higher than adults with multiple chronic diseases.
Average annual spending on health care services and prescription medicines was more than $21,000 annually for high needs adults, which is more than four times the average for all U.S. adults. Their annual median household income was less than half that of the overall adult population, $25,668 versus $52,685. “In contrast, average out of pocket spending for patients with multiple chronic diseases and no functional limitations was about a third less than that of high need adults and their annual median income was about the same as adults in the overall population.
Women made up nearly two-thirds of adults with high needs;
Nearly 75 percent of adults with high needs were white non-Hispanic.
More than half were age 65 and older while most were 75 and older.
Only 4 percent of high needs adults surveyed were uninsured. More than four of five adults with high needs were covered by public insurance.
“As health system reform shifts payment away from fee-for-service to value-based care models, the incentives to focus on and improve care for high-cost patients will grow,” concludes the report. “The share of adults who have multiple chronic diseases as well as a limitation that hinders their ability to carry out necessary daily activities such as bathing, eating, using the telephone, or taking medication is much smaller than the share with multiple chronic diseases alone. But the former group have substantially higher average annual health care expenditures and out of pocket costs.”
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