Understanding Who Becomes and Remains a High-Need, High-Cost Patient and the Association with Mental Illness, Phase 2

Building on their understanding of the heterogeneity of this population, the researchers will seek in phase 2 to identify who becomes high-cost, who remains high-cost, and what role mental health conditions play. In phase 2, Jha’s team will create a patient-level database that aggregates Medicare claims with additional data from in-patient, long-term care, home health sources, and patient surveys. This comprehensive dataset will enable the team to:

1. Identify patient-level factors associated with becoming high-cost in each of the six population segments.
2. Examine characteristics of patients who are persistently high-cost to ascertain why some high-cost patients remain so while others, with the same features, revert back to lower levels of spending.
3. Assess the relationship, overall and within each subgroup, between specific mental health conditions and high-cost status, focusing on spending, utilization, persistence of high-cost status, and quality of care. The team will also look at how mental illness compares to other chronic conditions in this regard.

Findings from these analyses will help health system leaders and policymakers target their efforts to improve care and reduce spending for the most expensive patients. In particular, a better understanding of patient subgroup characteristics should enable health systems to match patients to the most appropriate interventions.