Identifying High-Cost, High-Need Patients in a Network of Community Hospitals

Area of Science:

• Health Economics
• Healthcare Management
• Patient Outcomes

Background:

• Community-based academic health centers manage diverse patient populations.
• Understanding healthcare cost drivers is crucial for resource allocation.
• High Cost and High Needs (HCHN) patients represent a significant expenditure group.

Purpose of the Study:

• To analyze and compare healthcare costs between HCHN patients and other patient groups at HonorHealth.
• To identify demographic and clinical characteristics associated with higher healthcare utilization in HCHN patients.
• To inform the development of targeted interventions for cost reduction and outcome improvement.

Main Methods:

• Retrospective analysis of patient encounters resulting in admission in 2019 at HonorHealth.
• Comparison of mean healthcare costs, length of stay, and demographic factors between HCHN and non-HCHN patients.
• Utilized a framework developed by the National Academy of Medicine for cost analysis.

Main Results:

• HCHN patients were older (71 vs. 52 years), had longer lengths of stay (6.5 vs. 3.0 days), and higher mean charges ($134,743 vs. $16,414).
• HCHN patients exhibited different demographic profiles, including a higher prevalence of White patients and public insurance.
• Mean cost per HCHN patient decreased with increasing age groups.

Conclusions:

• HCHN patients represent a substantial financial burden on the healthcare system.
• Demographic and clinical factors significantly differentiate HCHN patients.
• Implementing targeted interventions for HCHN patients holds potential for reducing healthcare costs and improving health outcomes.