Grant: Project Grant

Research has shown that 5% of health care users account for 65% of health care costs. These 'high-needs, high cost' patients are a diverse group with varying medical, social, and behavioural needs. Further, there is no single model of care that can provide all the services required by this patient population and the interventions that have been developed are often complex and require adaptation to the local setting. This has left decision makers struggling to implement effective strategies to improve care while curbing health care spending in this high-risk group. As costs continue to rise, there is a desperate need to move beyond simply describing high cost patients and start highlighting actionable policy options by breaking this problem down into more manageable pieces. To do this, we have partnered with Alberta Health Services - Strategic Clinical Networks to create a roadmap to help decision makers effectively identify the right intervention for the right population at the right time. Using a 3-pronged phased approach we will: (1) Use population-level linked data sources to develop a classification scheme to identify the common sub-types of high cost patients; (2) Complete an environmental scan and scoping review to identify promising care models for one prioritized high cost sub-group (determined by our knowledge users); (3) Provide key stakeholders with this evidence and discuss the full range of factors that influence the policy making process (e.g. financial constraints, values, beliefs, etc.) with the goal of identifying areas for action based on local context. This roadmap will provide decision makers with clearer pathways to program delivery based on available evidence and is a necessary step to improve care and address concerns of system sustainability posed by this high-risk group. It will also drive research forward in this priority area within Canada.