Caring for High-Need, High-Cost Patients: Exemplars from the Field

The first in a series of case studies from The Commonwealth Fund profiling innovative programs designed to address the needs of America's high-need, high-cost patients, a group that accounts for a disproportionate share of health care spending. These programs illustrate for health system leaders, providers, payers, and policymakers that it’s possible to improve care and rein in spending through new approaches to caring for this population. Each program demonstrates ways of tailoring health care services to serve different subgroups of high-need adults, including the frail elderly, those with co-occurring physical and behavioral health conditions, and those with physical disabilities.

The first profile is of MedStar Washington Hospital Center’s Medical House Calls Program, which participates in the Centers for Medicare and Medicaid Services’ Independence at Home Demonstration and relies on geriatricians, nurse practitioners, and social workers to make house calls to frail elders who are unable to make it into the doctor’s office. Early results from the demonstration suggest the approach can reduce Medicare spending for these patients by 20 percent or more—one reason Congress is considering making home-based primary care for frail elders a permanent feature of the program.

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