Idea in Brief
The Problem
Half of U.S. spending on health care goes to treating the sickest 5% of the population. While disease-management programs have improved the quality of these patients’ care, they’re expensive and have not, as hoped, reduced costs.
The Cause
The top 5% is more diverse than has been appreciated, and the people in some of its segments change constantly. Disease-management programs can’t address this heterogeneity and unpredictability.
The Solution
Kaiser Permanente has developed a cost-effective model that uses relatively inexpensive medical assistants and technology to help primary-care physicians directly manage people with multiple but improvable chronic conditions—both patients who are already in the top 5% and those who are at risk of moving up into it.
When corporate executives, health care leaders, and policy makers discuss the challenge of curbing U.S. health care costs, the conversation invariably turns to the sickest 5% of the population, who consume 50% of health care spending. For a long time the hope has been that improving the efficiency and quality of their treatment would significantly reduce the $3.5 trillion that the United States lays out annually for health care. Over the past two decades this thinking has led employers, insurers, and health systems to embrace expensive disease-management programs that, operating in parallel with patients’ primary-care physicians, use registered nurses and social workers to monitor, coach, and provide services to many people in the top 5%. While these programs do increase the quality of their care, our health system, Kaiser Permanente (KP), and nearly all others have found that they do not reduce net costs.