Patients with multiple chronic conditions and cognitive or physical limitations have the greatest healthcare needs and account for a disproportionately large share of healthcare spending. Subsequently, curbing national healthcare expenditures requires improving outcomes and lowering costs for these high-needs patients. However, a report recently published by The Commonwealth Fund found that although they pay the most for healthcare services, high-need patients have the worst care experiences.
The Commonwealth Fund's latest brief examined high-needs patients' experiences with care using self-reported measures on unmet medical need, access to specialists, level of patient-provider communication and having a medical home — a source of care that provides comprehensive and accessible care. Researchers conducted a retrospective cohort analysis of the 2009 to 2011 Medical Expenditure Panel Survey-Household Component to draw its findings.
Here are five things to know from the report.
1. Although high-needs patients pay more for healthcare services each year than all other adults ($21,000 and $4,845, respectively), this higher level of spending does not always lead to better access and care experiences. Adults with high needs were most likely to report having an unmet medical need (20 percent), compared with those who have multiple chronic conditions but no cognitive or physical limitations (12 percent) and all other adults (8 percent).
2. About half of the people in each group said they didn't have trouble getting a referral to a specialist when they believed they needed to see one, but there was variation across insurance types. Among high-needs adults, those enrolled in Medicare (either alone or in combination with Medicaid) were most likely to say they could easily access a specialist. Those covered by Medicaid only were the least likely to report having easy access to a specialist. However, the report notes the data used in the study came from before the implementation of the Affordable Care Act, and may reflect the challenges Medicaid patients felt prior to Medicaid expansion.
3. Prior research shows that strong communication between patients and providers leads to better medication adherence, improved health outcomes and increased patient satisfaction. However, less than half (40 percent) of high-needs adults who received care at a physician's office or clinic reported having "good" communication with their provider. According to the report, "good" patient-provider communication is defined as having a provider who always:
- Spends enough time with the patient
- Shows respect
- Listens carefully
- Explains things in a way that is easy for the patient to understand
4. Nearly all high-needs patients (93 percent) reported that they have a usual source of care, compared to 75 percent of all adults. However, fewer than half (46 percent) of high-needs adults said they had a usual source of care that satisfies the definition of a medical home, which provide comprehensive, coordinated, patient-centered care.
5. "These findings suggest the health care system is not optimally configured to serve adults with high needs," the researchers concluded. "Our findings reinforce other research that shows that having a functional limitation in combination with multiple chronic diseases imposes a greater burden on patients than multiple chronic diseases alone. This additive burden must be taken into account when designing care systems for high-need patients."