News & Commentary

High-Need Adults Fall Through Cracks

Frank Diamond

The insurance industry has some catching up to do when it comes to providing care for “high-need” adults, according to an issue brief by the Commonwealth Fund. High-need adults have three or more chronic conditions and cannot easily care for themselves or perform routine daily tasks, such as shopping or preparing food.

The findings show that having a functional limitation in combination with multiple chronic diseases imposes a greater burden on patients than multiple chronic diseases alone, the researchers stated.

The average annual spending for high-need adults is about $21,000 per person. That’s nearly three times the average for adults with multiple chronic diseases only (about $7,500) and more than four times that for all adults (about $4,800). In addition, 20% of high-need adults went without or delayed receiving needed medical care or prescription medication in the past year, compared with 8% of all Americans.

One of the takeaways from the Commonwealth Fund brief is that the unmet need varied quite a bit with the type of insurance. Unmet needs were greatest among high-need adults with private insurance (32%), followed by those with Medicaid alone (28%). Unmet need was about half as great among high-need adults with Medicare (14%).

The Commonwealth Fund researchers used nationally representative data from the 2009–2011 Medicare Expenditure Panel Survey. They found that 1 in 20 Americans, ages 18 and older, fit the definition of a high-need patient. That works out to about 12 million people. It’s important to note, though, that the survey does not include institutionalized patients. Far more Americans—about 79 million—have three or more chronic illnesses but no functional limitations.

Among the other findings was that high-need patients with a good rapport with their physicians were more likely to follow treatment regimens, have better outcomes, and reported more care satisfaction. That’s not a big surprise. Rapport was defined as providers spending enough time, showing respect, listening carefully, and explaining things in an easily understood way.

“Private insurers will need to consider how they might improve benefit and network design to reduce unmet needs among high-need patients covered by commercial insurance,” the researchers stated. The answer might be found in the patient-centered medical home approach to care. In general, said the researchers, whether looking at comprehensive care, accessible care, or responsive care, high-need patients were more likely than patients in other groups to report their usual provider offered such care.


A blueprint for high-volume, high-quality lung cancer screening that is detecting cancer earlier—and helping to save lives

Clinical Brief

Multiple Sclerosis: New Perspectives on the Patient Journey–2019 Update
Summary of an Actuarial Analysis and Report