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February 24, 2015

Optimizing High-Risk Care Management

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Partners HealthCare, Boston, Massachusetts
  • 3Massachusetts General Hospital, Boston, Massachusetts
JAMA. 2015;313(8):795-796. doi:10.1001/jama.2014.18171

The most costly 1% of patients account for one-fifth of national health expenditures—accruing average annual expenses of nearly $90 000 per person.1 These individuals typically have several complex, co-occurring conditions for which they often receive poorly coordinated care, driving unnecessary utilization and poor outcomes. Given these characteristics, high-risk care management programs have potential to improve care and reduce costs for this population.2,3 The structure of these programs varies, but most involve care managers who work with panels of high-risk patients to coordinate care across clinicians, engage patients in setting and achieving health-related goals, and monitor and track health outcomes. Although these programs have traditionally been managed by payers or third-party vendors, clinicians and health care organizations are increasingly adopting programs of their own.2,4