Just 10% of patients account for 65% of the nation's healthcare spending. These patients often have multiple chronic conditions and frequently use healthcare services as a result. Yet, many of these patients aren't getting the care they need, according to a new survey.
The findings, published by the Commonwealth Fund, found that patients who frequently use healthcare services have greater unmet behavioral health and social needs compared to other adults. In addition, these patients face more barriers to access.
The report surveyed 3,009 U.S. adults, 1,805 of whom had two or more major chronic conditions.
The survey found that high-need patients reported higher levels of social isolation compared to others. About 37% of them lack companionship or feel lonely compared to 15% of other adults. Moreover, almost 62% of high-need respondents said they were stressed about essentials like paying for housing, utilities and food. Only about 32% of other adults expressed the same stress.
Oftentimes when social needs aren't met for people with chronic illnesses their health worsens, said Melinda Abrams, vice president of delivery system reform at the Commonwealth Fund and co-author of the report.
The survey also found that high-need patients were more likely to delay their care as opposed to other adults. About 44% of high-need patients reported delaying care because they faced issues accessing their physician compared to 21% of other patients. Twenty-two percent of high-need patients also said they lack transportation compared to 4% of others. High-need patients were also more likely to say they couldn't get an appointment compared to other adults.
Most high-need patients also reported they didn't have the support of others to help them deal with their illnesses. Of the 57% surveyed who said they had trouble with daily activities, only 38% said they usually have someone to help them. Of those who did receive help, three-quarters of it was from family members.
Abrams said in order for high-need patients to get the care they need, health systems must change how they delivery care. “It means doing business differently, not just thinking exclusively about the medical needs but the importance of addressing a broader set of needs,” she said. Abrams acknowledged that systems have already begun to make care delivery changes in the push to value-based reimbursement.
In an effort to more aggressively push physicians toward value-based care, the Commonwealth Fund and four other healthcare foundations developed best practices that provide a list of resources for health system leaders, payers and policy makers.
The John A. Hartford Foundation, the Peterson Center, the Robert Wood Johnson Foundation and the Scan Foundation contributed to the report.
The report provides care models to treat an array of patients including adults under 65, people with multiple chronic conditions, people with advanced illness and frail older adults.