An Initial Assessment Of Initiatives To Improve Care For High-Need, High-Cost Individuals In Accountable Care Organizations

High-need, high-cost (HNHC) individuals are defined as people of all ages living with clinically complex needs and functional limitations who also incur high health care costs or are likely to do so in the near future. Despite frequent contact with the health care system and substantial medical spending, the physical, social, and behavioral health needs of these individuals often remain unmet due to uncoordinated and fragmented care. Studies suggest that HNHC individuals could benefit from a more holistic approach that coordinates the care they receive and addresses their unmet social needs. Doing so could improve quality of care and quality of life while reducing health care service use.

Accountable care organizations (ACOs) are well positioned to serve the HNHC population more effectively and have financial incentives to do so. ACO payment models incorporate annual global budget targets for defined beneficiary populations. ACOs can earn shared savings payments by controlling spending below their target budget. Although the ACO model is relatively new, ACOs already care for more than 32 million covered lives across all payer types. ACOs have a strong interest in improving care for this population and are required by regulation to provide person-centered care.