Managing High-Risk, High-Cost Patients: The Southern California Kaiser Permanente Experience in the Medicare ESRD Demonstration Project

Peter Crooks, MD

Spring 2005 - Volume 9 Number 2

In the recent book, Epidemic of Care,1 Kaiser Permanente (KP) CEO George Halvorson and coauthor George Isham show how the use of health care resources is distributed among a health plan's members. They present an illustration (adapted here as Figure 1) from which can be estimated that in a given year,

  • the least expensive 70% of patients account for 10% of the expenditures; and
  • the most expensive 1% of patients account for 30% of expenditures.

Clearly, two different approaches are needed for managing the care of these two groups of patients.

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