CERC's Model for High-Need, High-Cost Care

The distribution of health care spending is strongly skewed in the US, with the top 5% of health care spenders accounting for more than half of the total $3.2 trillion in health care spending in 2014. This high-need, high-cost (HNHC) population is often faced with multiple chronic medical and behavioral health conditions, functional limitations, and social risk factors.

Patients with complex social and medical needs experience substantial difficulties when trying to navigate our highly fragmented health care system. As a result, many of their medical and emotional needs remain unaddressed and contribute to poor health and increased health care utilization.

CERC's HNHC care redesign team identified three challenges in current care delivery methods aimed at HNHC patients and proposed these solutions:

·      Promote alternate care settings that provide safe and lower cost alternatives to EDs and hospital admissions. This strategy includes empowering paramedics to assess and treat patients at home and using alternative care sites for acute intoxications with no other medical needs or injuries (Sobering Centers).

·      Integrate behavioral health and primary care. The best evidence of clinical efficacy and cost savings points to the Collaborative Care Model of behavioral health integration. In this model, the PCP oversees the BH care and provides prescriptions. A BH care manager provides systematic follow up of patients, communication among providers, and psychotherapy interventions. A psychiatrist provides consultation and supervision to the PCP and the care manager.

·      Identify and invest in health-related social issues that have a sustainable return on investment for healthcare alone. In particular, CERC's care redesign team advocates for providing targeted non-emergency medical transportation and housing the high-cost homeless.

A conservative estimate of national savings from the full implementation of the CERC model is$1.5 billion dollars in direct healthcare spending per year, or 2% of annual spending for the HNHC population. Additional savings are likely if the model is extended to wider populations, such as primary care populations, or the adult Medicaid population.

Team: Chuan-Mei Lee, MA, MD; Danielle Rochlin, MD; Claudia Scheuter, MD; Arnold Milstein, MD, MPH