Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

Brief
Key Questions Answered
  • What are the key characteristics and experiences of high-need adults?
  • What difference does insurance type make in their experiences?
  • What are potential policy changes to consider to improve care for high-need patients?
Key Themes and Takeaways

This resource examines the characteristics and health care experiences of adults with high needs, defined as people with three or more chronic diseases and a functional limitation. (The data predate the enactment of the Affordable Care Act.)

  • One in five high-need adults (20 percent) reported having an unmet medical need, compared to one in eight adults with multiple chronic diseases (12 percent) and about one in 13 adults (8 percent) in the total population.
  • Among high-need adults, those with Medicare (alone or in combination with Medicaid) were the most likely to report easy access to specialists. Those covered by Medicaid alone were the least likely to report easy access.
  • About 40 percent of high-need adults reported having “good” patient-provider communication. The rate among adults overall was 49 percent.
  • Nearly all high-need adults (93 percent) reported they had a usual source of care, but fewer than half (46 percent) of them reported that their care met the medical home criteria — that is, comprehensive, accessible, and responsive care.
  • Overall, high-need adults covered by Medicare or dually enrolled in Medicare and Medicaid, who represent the majority (70 percent) of high-need adults, reported better care experiences and relatively low rates of unmet needs.
Authors
Claudia A. Salzberg
Susan L. Hayes
Douglas McCarthy
David C. Radley
Melinda K. Abrams
Tanya Shah
Gerard F. Anderson
Population Addressed
Frail Older Adults
People with Multiple Chronic Conditions
Level of Evidence
Rigorous Observational Study; Moderate Evidence
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