Targeting enhanced services toward high-cost, high-need medicare patients

High-cost, high-need patients account for disproportionate health-care costs. In the Medicare population, 5 % of fee-for-service beneficiaries account for 39 % of total Medicare spending. There are many inpatient, outpatient, and community-based services that can meet the complex needs of high-cost, high-need Medicare patients. Twenty-first-century health-care reform offers new opportunities to translate evidence-based models of care for complex patients into practice. New care delivery mechanisms such as Accountable Care Organizations and Home-Based Primary Care can improve quality of care and reduce costs. New incentives, such as hospital readmission penalties and outpatient reimbursement for care coordination, can also help traditional health-care delivery systems to enhance services for high-cost, high-need Medicare patients.