Who are the 5%?

The Foundation for Complex Healthcare Solutions (FCHS) focuses its resources on the 5% of the population which generates 57% of healthcare costs. But who exactly are the 5%? What health and medical issues cause their costs to be so extraordinary?

Who make up the 5%? Young, old, male or female, insured or uninsured? They are, not surprisingly, mostly older patients with multiple chronic conditions. Their conditions include diabetes, heart disease, obstructive lung disease, high blood pressure, kidney disease, arthritis, and H.I.V., among others. The majority is white and female (60%), and most have private insurance. The most expensive 1% accounted for 22% of health care costs in 2009 or about $90,000 per person according to the Agency for Healthcare Research and Quality. “An individual in this costliest bracket receives much of his or her care in hospitals – sometimes in multiple hospitals in the same city” according to the American Medical News. Lack of care coordination is, therefore, a significant cost driver. According to Ira Klein, MD, chief of staff to the chief medical officer at Aetna, these missed connections between multiple care providers are “probably the primary reason why we cannot manage costs of people who have multiple morbidities.”

To learn more about the programs we support or if you have an innovative program for a complex healthcare condition and are looking for support, contact us at www.foundation-chs.org.