High-Need, High-Cost Care

The distribution of healthcare spending is strongly skewed in the United States, 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.

Projects and Outcomes

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

  1. Promote alternate care settings that provide safe and lower cost alternatives to hospital admissions. This 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).

  2. 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 primary care provider (PCP) oversees the BH care and provides prescriptions. A behavioral health (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.

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

Blue Shield of California plans to incentivize the adoption in California.

Publications and News