2010 — Managing High Cost, Multimorbid Patients

Wagner TH, VA Palo Alto; Chee CP, VA Palo Alto; Chang E, Greater Los Angeles VA; Zulman D, VA Palo Alto; Maciejewski M, Durham VA; Asch S, Palo Alto VA;

Workshop Objectives:
The top 5% most expensive patients are typically responsible for > 50% of all costs in a given year. Across health care facilities and over time, this statistic consistently remerges. Unfortunately it has also proven to be challenging to change. This workshop will highlight operational and research efforts designed to improve the identification and management of high cost, multimorbid patients.

Activities:
I. Introduction of topic and of workshop participants (Todd Wagner) II. Managing high cost patients assumes that these patients would remain high cost in the future. Christine Chee will present results from observational research examining the natural history of high cost VA patients over seven years. III. Results from programs designed to manage high cost patients are mixed, in part because many programs have been evaluated using pre-post designs. Donna Zulman will describe a single site randomized clinical trial of a new patient care team designed to manage high cost patients. Evelyn Chang will then update the audience with the design of an ongoing evaluation of a VA multisite intensive care management demonstration project. IV. Engaging multi-morbid high cost patients in health promotion activities has been particularly challenging, but managing obesity is a priority in VA's effort to containing costs. Matt Maciejewski will present findings from a retrospective cohort study that examines VA health expenditures before, during and after MOVE! participation. V. Finally, Steve Asch will summarize the presentations, with connections to the emerging literature, and lead a discussion of new, emerging ways to manage this population especially in light of the increasing prevalence of shared management with non VA providers under the Veterans Choice Act.

Target Audience:
Target Audience: This workshop is focused on clinicians, researchers and operational leaders interested in developing innovative, high value programs for managing complex, multimorbid patients who consume over half of the health care costs in a given year.

Assumed Audience Familiarity with Topic:
None. This workshop will review key papers over the past decade and highlight new programs developed to help high cost, multimorbid patients.