
Managing Your 'Top 5%': What Capitated Wound Care Actually Costs for High-Risk Diabetic and Immobile Members
Five percent of your members drive 50% of your costs. You already know this. Your analytics team has shown you the pyramid. It's your highest-cost members—usually the ones with multiple chronic conditions, severe functional limitations, and social instability—who are pulling the entire cost structure. Within that 5%, there's a subgroup that's wrecking your margin predictability: diabetics with active wounds, immobilized patients with pressure injuries, and patients with both. These aren't complicated cases. They're expensive cases. And you can't manage them with traditional case management.











