Report Overview
A high percentage of health care expenditures are associated with a small proportion of the popu lation—people with complex health care needs. Most patients in this high-cost group are Medicare beneficiaries with multiple chronic conditions, frequent hospitalizations, and limitations on their ability to perform basic daily functions due to physical, mental and psychosocial challenges.
The growth in Medicare expenditures for beneficiaries with five or more chronic conditions is striking, jumping from 52 percent of total Medicare spending in 1987 to 76 percent in 2002 (Figure 1). Health care spending for people with five or more chronic conditions is 17 times higher than for people with no chronic conditions (Figure 2). Given the 73 percent projected growth in the next 10 years of the over-65 population and the far higher prevalence of complex health care needs among this group, the costs of providing care for this population sector threatens Medicare’s future viability.
Conclusion
A number of lessons can be drawn from the literature on care management. Care management provided by RNs, who are in close communication with physicians and are supported by an interdisciplinary team, can improve the quality of life and other clinical outcomes for complex patients in primary care, home, and hospital-to-home settings. In addition, care management within the hospital-to-home care transition, and possibly within primary care, can significantly reduce hospitalizations and health care costs for complex patients.