title: Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences.
abstract: Issue: Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients--those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs--those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks--to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009--2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient-provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured high-need adults reported the greatest difficulties having their needs met. Conclusion: The health care system needs to work better for the highest-need, most-complex patients. This study's findings highlight the importance of tailoring interventions to address their needs.
authors: Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine
authors: Claudia A
authors: CA
authors: Salzberg
authors: Commonwealth Fund
authors: Susan L
authors: SL
authors: Hayes
authors: Commonwealth Fund
authors: Douglas
authors: D
authors: McCarthy
authors: Commonwealth Fund
authors: David C
authors: DC
authors: Radley
authors: Commonwealth Fund
authors: Melina K
authors: MK
authors: Abrams
authors: Commonwealth Fund
authors: Tanya
authors: T
authors: Shah
authors: Johns Hopkins Bloomberg School Public Health and John Hopkins University School of Medicine
authors: Gerard F
authors: GF
authors: Anderson
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003142:Communication; D015897:Comorbidity; D006233:Persons with Disabilities; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D017149:Private Sector; D014481:United States