Healthcare practitioners must apply a multifaceted approach when looking to improve care for high-need patients, including prescribing appropriate interventions; addressing patients’ medical, social, and behavioral needs; and participating in appropriate payment models that reward care of at-risk patients. A review of these strategies was published in JAMA Internal Medicine.1

Approximately 5% of patients in the United States contribute to half of total healthcare spending. The shift toward value-based care in national policy has made the optimization of therapy in these high-need patients of prime importance. The National Academy of Medicine has issued a report titled, “Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health,”2 which shares key decision-making strategies for addressing care in these patients, care that consequently results in improved outcomes and reduced costs.

Following a review of recent literature and expert panel discussions, a total of 6 high-need patient populations were identified by the National Academy of Medicine: children with complex needs, nonelderly disabled adults, frail elderly individuals, people with major complex chronic conditions, people with less severe but multiple chronic conditions, and people with advancing illness. In each of these groups, costs related to care are allocated to different resources, including drugs, inpatient care, and post-acute care services. In addition to targeting these therapies, the authors of this review suggest addressing socioeconomic factors and behavioral risk factors in each group in an effort to reduce disparities and standardize care costs.

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Care models should be tailored to each specific high-need patient group — for example, a model geared toward low-income elderly patients. Patient attributes should also be identified by practice models, which may help physicians identify patients with specific attributes that can matched to the most appropriate intervention. Timely data access for patient monitoring, outreach programs to the patient’s community, and integration of social services in clinical care are additional features that are characteristic of successful care models. Finally, optimizing the organizational culture in a practice by emphasizing leadership, customizing patient care based on changing needs, and providing specialized training of workplace professionals are all key components of successful care models treating high-need patients.

Overall, the investigators suggest a multifaceted approach is needed for the “care of vulnerable patients whose health and well-being depend on integrated, high-quality care.”


  1. Figueroa JF, Jha AK. Approach for achieving effective care for high-need patients. JAMA Intern Med. 2018;178:845-846.
  2. Long PV, Abrams MK, Anderson GF, et al. Effective care for high-need patients: opportunities for improving outcomes, value, and health. July 6, 2017. Accessed June 6, 2018.