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High-need high-cost patients: A Concept Analysis

Ani Bilazarian1

  • 1Columbia University School of Nursing, New York, New York, USA.

Nursing Forum
|August 28, 2020
PubMed

Insights

High-need, high-cost (HNHC) patients, who drive most US healthcare expenses, are challenging to manage due to varied definitions. This study identified three key subgroups and a feedback loop contributing to their complex care needs.

Area of Science:

  • Health Services Research
  • Healthcare Management
  • Public Health

Background:

  • High-need, high-cost (HNHC) patients represent a small population segment responsible for a disproportionate share of US healthcare expenditures.
  • The lack of a unified definition for HNHC patients hinders the development and effectiveness of interventions targeting disease management and cost reduction.

Purpose of the Study:

  • To clarify the defining attributes of high-need, high-cost patients through a comprehensive literature review.
  • To identify distinct subgroups within the HNHC patient population.
  • To elucidate the core characteristics and contributing factors associated with HNHC patients.

Main Methods:

  • A literature review was conducted using the Walker and Avant method of concept analysis.
  • Two major databases, PubMed and CINAHL, were systematically searched to identify relevant studies.
  • Included studies focused on the definition, characteristics, and management of high-need, high-cost patients.

Main Results:

  • Three primary subgroups of HNHC patients were identified: adults with multiple chronic conditions and functional disability, the frail elderly, and individuals under 65 with a disability or behavioral health condition.
  • HNHC patients are characterized by a cycle of acute exacerbations on chronic conditions, frequent utilization of preventable health services, and fragmented care delivery.
  • Antecedent factors contributing to HNHC status include difficulties accessing timely care, low socioeconomic status, insufficient social support, and social isolation.

Conclusions:

  • Establishing clear definitions and identifying subgroups of HNHC patients is crucial for developing targeted and effective healthcare interventions.
  • Understanding the feedback loop of chronic conditions, service utilization, and care fragmentation is key to improving outcomes for HNHC populations.
  • Addressing socioeconomic and social determinants of health is essential for preventing individuals from becoming high-need, high-cost patients.

Keywords:
chronic disease managementhealth promotionpolicy/politicspublic health

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