Optimizing High-Risk Care Management

• Published in: JAMA : the journal of the American Medical Association 2015-02, Vol.313 (8), p.795-796
• Main Authors: Powers, Brian W, Chaguturu, Sreekanth K, Ferris, Timothy G
• Format: Article
• Language: English
• Subjects: Clinical medicine; Disease management; Health care expenditures; Health care industry; Humans; Medicare; Patient Care Management - economics; Patient Care Management - organization & administration; Quality of care; Risk; United States
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2014.18171

The most costly 1% of patients account for one-fifth of national health expenditures--accruing average annual expenses of nearly $90,000 per person. These individuals typically have several complex, co-occurring conditions for which they often receive poorly coordinated care, driving unnecessary utilization and poor outcomes. Given these characteristics, high-risk care management programs have potential to improve care and reduce costs for this population. The structure of these programs varies, but most involve care managers who work with panels of high-risk patients to coordinate care across clinicians, engage patients in setting and achieving health-related goals, and monitor and track health outcomes. Although these programs have traditionally been managed by payers or third-party vendors, clinicians and health care organizations are increasingly adopting programs of their own. Here, Powers et al discuss the potential of high-risk care management programs that are practice-based, payer-catalyzed, and purchaser-supported to deliver better care at lower cost.