High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care?

Brief
Key Questions Answered
  • What are the patterns of spending and health care use among high-need adults?
  • What are the characteristics of high-need patients?
Key Themes and Takeaways

This resource examines health care spending and use of services among adults with high needs, defined as people who have three or more chronic diseases and a functional limitation.

  • One in 20 US adults (5 percent), about 12 million people, met this definition of high need.
  • For high-need adults, average annual per-person spending on health care services and prescription medicines topped $21,000, nearly three times the average for adults with multiple chronic diseases only and more than four times the average for all US adults.
  • High-need adults spent more than twice as much on out-of-pocket expenses as adults in the total population, while their median household income was less than half of that of the overall adult population.
  • High-need adults are disproportionately older, female, white, less educated, low-income, and publicly insured.
  • High-need adults used an average of 26 paid home health care days per year compared to roughly one day per year among individuals with multiple chronic conditions only or the average adult population.
  • Nearly all adults who incurred high health care spending for years in a row had multiple chronic diseases, either with or without functional limitations.
  • Among high-need patients, there is considerable variation in use and spending, suggesting the high-need population should be segmented into subgroups.
Authors
Susan L. Hayes
Claudia A. Salzberg
Douglas McCarthy
David C. Radley
Melinda K. Abrams
Tanya Shah
Gerard F. Anderson
Population Addressed
Adults Under 65 with Disabilities
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Level of Evidence
Rigorous Observational Study; Moderate Evidence
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