The White Papers

A significant proportion of health expenditures are concentrated within a small population of medically complex individuals. Identifying and managing care for this group of patients is an important step towards improving health outcomes and reducing total costs for the entire population.

The Health Care Transformation Task Force, a consortium of patients, payers, providers and purchasers working to transform the U.S. health care system, works to address this issue through its Improving Care for High-Cost Patients Work Group.

The Work Group recently released the third and final in a series of white papers, entitled “Payment to Promote Sustainability of Care Management Models for High-Need, High-Cost Patients.” It outlines emerging payer and provider partnerships that incentivize sustainable delivery system re-engineering to improve care through innovative value-based payment models. It finds that the fee-for-service payment system has and continues to impede broad adoption of effective interventions for high-need, high-cost patients. Further, it notes that conflicting requirements and methodologies from multiple payers threaten to hinder progress in the future, even in supportive environments.

The paper assists patients, payers, provider and purchasers by:

Outlining the continuum of payment models in use for high-need, high-cost patient interventions among Task Force members and throughout the broader U.S. health system;

Providing key considerations and recommendations regarding the design of payment models for complex care management, disease management, and palliative care initiatives; and,

Recommending strategies to ensure all high-need, high-cost patients are offered needed services, regardless of insurer.

The first paper in this series addressed the identification of high-cost patients and reviewed quantitative and qualitative methods for stratifying these patients into care management programs.

The second paper in this series assessed care management programs for high-cost patients, identified several lessons learned and opportunities for improvement, and presented six case studies from Task Force members.

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