Led by the Harvard T.H. Chan School of Public Health and the London School of Economics, ICCONIC is a collaborative of researchers from 11 countries performing a series of international comparisons of high-need, high-cost individuals across the trajectory of health care.

Although health systems around the world are diverse, they all have similar goals: maximizing quality of care for their populations, offering services that are responsive to patient needs, and providing value for money.

One key challenge facing many health systems is how to best design services to provide care to a small number of high-need, high-cost individuals.

This is a clinically diverse group of patients ranging from individuals who live with extreme functional limitations, others with persistent behavioral health challenges, and still others with multiple, complex chronic illnesses. These individuals often use high levels of health care services, tend to experience worse patient outcomes, and are often quite expensive to care for.

For these reasons, high-need, high-cost populations are arguably the group that stands to benefit the most from a better understanding of the effectiveness of different delivery systems.

Despite the enormous importance of this population, there is limited comparable data on how common these types of patients are across countries, and how patterns of utilization and cost differ across health systems. This lack of information limits the potential for mutual learning and potential policy transfer across countries.

ICCONIC hopes to address this problem by developing a novel methodology for comparing cost, utilization, and outcomes of high-need, high-cost populations across different healthcare systems.

Our Approach

We used national and regional patient-level datasets to explore variations in the cost, utilization, and quality of health care for two types of high-need, high-cost (HNHC) patients:

1) A frail older patient recovering from a hip fracture, and

2) An older person with complex multimorbidity (e.g., hospitalized with heart failure and a comorbid diagnosis of diabetes).

Using available data, we compared HNHC personas across the care trajectory in 11 high-income countries: the United States, England, Canada, France, Sweden, Australia, New Zealand, the Netherlands, Germany, Switzerland and Spain.

Our study focuses on three main questions:

  1. What proportion of the two specific high-need patient types are identifiable in a large sample of administrative claims data in each country?
  2. Are there meaningful differences in patterns of spending and utilization associated with these two high-need personas across countries?
  3. How do patient outcomes for these high-need personas, including readmissions and mortality, vary by country?