A small number of patients consume a large proportion of the total national health care budget.1 

These medically and socially complex patients have been the target of efforts by health systems and insurers to bend the cost curve of increasing health care expenditures.

To date, care management programs designed to address needs and reduce hospitalizations or disease progression in medically complex patients have shown only modest success.

This cohort study was conducted within Kaiser Permanente Northern California (KPNC), an integrated care delivery system with 4.2 million members. KPNC provides care to a population insured through employer-based plans, Medicare, Medicaid, and the California health insurance exchange.

Members are highly representative of the local populations.14 KPNC uses a single electronic health record for all inpatient and outpatient care, including all pharmacy orders and prescriptions dispensed. 

The findings of the study suggest that a single care model may not meet the needs of adults with high comorbidity and care utilization.

Highly medically complex patient populations may be categorized into distinct patient profiles that are amenable to varying strategies for resource allocation and coordinated care interventions.


JAMA Netw Open. 2020;3(12):e2029068. doi:10.1001/jamanetworkopen.2020.29068

Richard W. Grant, MD, et al.