Better Care for High Cost, High Need Beneficiaries

JUNE 8, 2016 BY NISHA BHAT

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Today we released a fact sheet, Care Coordination for High-Cost, High-Need Beneficiaries, the third in our fact sheet series spotlighting challenges facing the U.S. health system and offering our recommendations for improving the quality and affordability of health care. The fact sheet can be found here.

Care Coordination for High-Cost, High-Need Beneficiaries describes the difficulties confronting those Medicare and Medicaid beneficiaries who have the highest needs and generate the highest costs.  It also identifies key policy opportunities to improve care for these patients.  These include integrating behavioral health and primary care services, promoting patient-centered care planning, and improving chronic care and care coordination in Medicare Advantage plans and Medicare Accountable Care Organizations.

What does this have to do with affordability?  Medicare beneficiaries with multiple chronic conditions accounted for 93 percent of total Medicare spending, and 98 percent of Medicare hospital readmissions in 2010. In addition, the average per capita Medicare spending for beneficiaries with one or more chronic conditions and one or more functional limitations (limitations that require help with activities of daily living, such as eating, bathing and dressing) was nearly twice that as average per capita spending for beneficiaries with three or more chronic conditions.

For Medicare beneficiaries with behavioral health conditions, spending is even higher.  In 2010, Medicare spent an average of $43,792 per beneficiary aged 65+ with both severe mental illnesses and substance use disorders compared to an average of $8,649 per beneficiary for all beneficiaries aged 65+.

As we look for ways to improve our health care system, a focus on better and more affordable care for high-cost, high need beneficiaries is a good place to start.