Last month, the Pacific Business Group on Health (PBGH) and the Health Care Transformation Task Force (HCTTF) released a report and contracting tool to help organizations effectively manage care programs that improve the health outcomes of high-need, high-cost (HNHC) patients.
HNHC patients are a small percentage of individuals with complex medical, social, and behavioral needs. By their nature, the individuals represent a disproportionate part of the medical spend for employers and are some of the most complex patients to identify and support. The report and accompanying tool explore different types of contracting and offer specific, practical guidance for payers and providers as they develop contracting relationships.
Research highlights include:
- Identifying individuals with persistently high needs and costs through risk stratification, then further segmenting by specific need type, is critical to improved outcomes and financial sustainability.
- Guaranteed access to data is critical for successful care management, as is ensuring contractual specifications on both the type of data and the frequency with which it is shared.
- For an HNHC care management program to be truly sustainable, the program should provide an ROI over the course of multiple years and meet specified contractual targets.
Information about the report and contracting tool can be found here: https://hcttf.org/care-management-contracting-for-high-need-high-cost-populations-best-practices-and-tools/