The High Price of Failing America’s Costliest Patients
Even patients with whom I have the best rapport would probably rather not see me so often. Sometimes I readmit a patient I cared for just weeks before in the hospital. “Nice to see you again,” I offer with a smile. The usual response, loosely paraphrased: I’d rather be anywhere else.

Even patients with whom I have the best rapport would probably rather not see me so often.

Sometimes I readmit a patient I cared for just weeks before in the hospital. “Nice to see you again,” I offer with a smile. The usual response, loosely paraphrased: I’d rather be anywhere else.

This reflects not some deep deficiency in my bedside manner (I think), but rather an essential truth about medicine: People want health, not health care. And those who require the most health care and get the least health — high-need, high-cost patients with multiple or severe medical conditions — feel this most acutely.

Leaving aside the moral compulsion to improve the quality and efficiency of their care, there is an overwhelming financial imperative to do so. It’s well known that the country’s staggering health care costs are not evenly distributed. Just 1 percent of patients account for 20 percent of costs, and 5 percent of the population accounts for nearly half the nation’s health care spending.

But exactly who these patients are — and how we can better meet their needs — is less clear.

Misaligned Financial Incentives

One emerging definition, based on research, focuses on people with three or more chronic conditions who have a functional limitation, such as difficulty dressing, bathing, feeding themselves, walking, taking medications or using transportation.