“What’s a high-risk patient?” asked our newly hired care coordinator.

Interesting question, and, as you would expect, one without an easy answer.

One of our patient-centered medical home certifying agencies was performing an audit for recertification, and requested information on our high-risk patient registry, including how patients were identified and assigned to the registry.

When you ask doctors or any other providers, we all know one when we see one. Complex medical problems that require us to pour enormous amounts of time into trying to get patients healthy. “Frequent fliers.” “Noncompliant” patients. Endless comorbidities. Polypharmacy. Low health literacy. The list goes on and on.

But having any or all of these things does not automatically make someone high risk. There is so much more to it than that.

When it comes down to it, defining a patient as “high risk” becomes very tricky, gets us into foreign territory, even into dangerously politically incorrect territory.

Think of all the potential definitions, all the multiple variables, all of the different ways of looking at each individual patient, and what might end up getting us to think of them as being “high risk.”

Age. Length of problem list. Number of medications. Number of specialists and subspecialists they see. Number of appointments, no-show rate. Somatic complaints, underlying psychiatric disease, excessive imaging and testing.

Under the current patient-centered medical home paradigm, being labeled a high-risk patient is an advantage. Lots of resources will be poured into your care. People will be calling you at home all the time, helping make sure you take your medicines, get your tests done, see your specialists, come back for follow-up.

But who would want to be labeled high risk?

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