The Elephant in the Waiting Room: Behind a New Healthcare Collaborative

Treating a seriously ill patient who suffers from multiple chronic conditions can be difficult and expensive. These so-called high-need, high-cost (HNHC), or "complex care" patients make up about 5 percent of the U.S. population, but by some estimates, account for 50 percent of healthcare spending.

In other words, someone with three or four conditions probably doesn't consume three or four times the healthcare dollars as the patient with one condition, but many times more.

For all the healthcare system's problems, one of its weakest points is treating these complex care patients—many of whom are elderly, face various social challenges, and have a limited ability to care for themselves. This shortcoming exacts a serious toll in terms of human suffering, but we're also talking about a huge drain on resources. 

"Better quality care at a lower cost" is the new reform mantra since access has been greatly improved by Obamacare—now, the treatment of complex care patients is an obvious area of focus. 

Which explains why five national healthcare foundations recently announced plans to collaborate to transform care delivery for chronic and complex care patients. The groups—the Commonwealth Fund, the John A. Hartford Foundation, Robert Wood Johnson Foundation, the Peterson Center on Healthcare and the SCAN Foundation—said they would start work later this year.

Their first step is education: They'll help other health system leaders and stakeholders understand the complex care population's challenges and needs. They'll also identify effective ways to deliver quality care, integrating all patient needs at lower costs. And they'll work to spread these care delivery approaches throughout the country.

This isn't new terrain for healthcare funders, as we've reported before. But this new collaboration is significant. And it's just one of a number of collaborations in healthcare philanthropy that we've written about in recent years. Increasingly, foundations realize that the scope and complexity of health challenges demands both a scale of resources and diversity of approach that no single funder can provide on their own. 

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The partners in this collaborative outlined the problem and their goals in an article published in the New England Journal of Medicine. "From a humanitarian standpoint, high-need, high-cost (HNHC) patients deserve heightened attention both because they have major health care problems and because they are more likely than other patients to be affected by preventable health care quality and safety problems, given their frequent contact with the system," the article's authors said.

Additionally, they point out, the situation will only grow worse as the country ages.

Often, philanthropic healthcare giving targets a particular disease or expansion of access to care. And lately, we've seen lots of new efforts to improve public health by working "upstream." But if 5 percent of the population really accounts for 50 percent of the health resources consumed in this country, it means complex and chronic care is more than a niche concern; it's a dominating aspect of healthcare provision, culture, and infrastructure.

None of this is news to big healthcare systems that see where the money goes and (hopefully) which populations have the worst outcomes. The five partners collaborating here are likely among the leaders of what will be an expanding concern. Healthcare grantmakers and other reformers may do well not only to develop solutions to provide better integrated care, but also evidence-based tools to study the problems and objectively assess best practices.

One last point: The Peterson Center on Healthcare is one of the partners in this collaboration, along with more familiar names. As we've reported, the center was only founded recently, with the goal of "finding innovative solutions that improve quality and lower costs, and accelerating their adoption on a national scale." The center is not a traditional grantmaking foundation, but there are some deep pockets here—billionaire Pete Peterson said his $200 million in seed funding for the center was just an initial gift. So it's worth watch closely as this new player gets fully up and running.

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