High-Need, High-Cost Patients

State of Play:  Improving primary care for patients with chronic illness is critical to improving healthcare quality, value and patient experience. Primary care providers are participating in several new payment models as part of the Comprehensive Primary Care Initiative that emphasizes quality and value.  No data are yet available on how they affect care delivery. 

HLC Position: HLC supports chronic disease prevention and management, which affects the Medicare population at disproportionate levels, as essential components of healthcare delivery through better public and private sector development of evidence-based wellness practices.  As part of various value assessments intended to determine whether new and innovative treatments warrant coverage, HLC advocates that any new structure should include population health and the long-term benefits of health innovations as criteria over short-term financial concerns to ensure that these new evaluations do not serve as unwarranted barriers to patient access. Lessons learned from new approaches within Medicare and Medicaid can help lead to more effective ways of preventing chronic disease.   

HLC Recent Activity:

  • HLC has finalized the high-need beneficiary playbook for improving care for high-need, high-cost patients and has begun distribution to congressional offices and other health policy thought leaders and staff.
  • On October 31, HLC wrote the U.S. surgeon general in response to the request for comment on “Community Health and Prosperity,” on which HLC recommended ways to improve care of high-need, high-cost populations.
  • On October 15, HLC held a briefing, “Addressing Needs for Complex Patient Populations,” discussing ways to optimize care for high-need patients.
  • In October, HLC met with Senate Aging Committee staff to focus on the hearing “Patient Focused Care: A Prescription to Reduce Healthcare Costs” and to share the high-need beneficiary playbook.
  • On July 11, HLC wrote House Ways and Means Committee Chairman Kevin Brady (R-TX) and Ranking Member Richard Neal (D-MA) in support of the “Personal Health Investment Today (PHIT) Act” (H.R. 6312). R. 6312 would make certain fitness expenses tax deductible.
  • On May 25, HLC signed onto a letter from the Obesity Care Advocacy Network to the Health and Human Services Office of Disease Prevention and Health Promotion voicing support for nominees to the National Clinical Care Commission, whose efforts include treatment and prevention of obesity.
  • During the week of April 16-22, HLC participated in “National Healthcare Decisions Day”and shared information on social media about this initiative that educates the public and providers about advance care planning, which is especially critical for high-need Medicare beneficiaries.
  • On March 27, HLC joined its partners in the Diabetes Advocacy Alliance (DAA)in asking the Centers for Medicare and Medicaid Services (CMS) to address barriers to the utilization of diabetes self-management training.
  • On March 19, HLC joined its partners in the Obesity Care Advocacy Network (OCAN)in providing comments to the United States Preventive Services Task Force (USPSTF) on the task force’s draft recommendations on obesity. OCAN thanked the USPSTF for recognizing the importance of behavioral counseling for patients with obesity but asked that the task force also include pharmacotherapy and surgery in its recommendations.
  • HLC continues to participate in organizations that support Medicare wellness programs, including the Diabetes Advocacy Alliance (DAA), the Obesity Care Advocacy Network (OCAN), the Partnership to Fight Chronic Disease, the Campaign to End Obesity, the Strategies to Overcome and Prevent Obesity Alliance, the National Coalition for Promoting Physical Activity, and Prescriptions for a Healthy America.
  • HLC works with the DAA technology workgroup to advocate for Medicare coverage of innovative technologies, including the use of smartphone applications with continuous glucose monitors (CGMs).