Healthcare payers have traditionally focused on payments to providers within specific sectors such as acute, physician, pharmacy and other providers. Recently, there are renewed efforts to draw attention away from sector specific costs and focus on the characteristics of individuals who are the drivers of healthcare spending, such as profiling by patient, physician, and health care market characteristics. Targeting improvement interventions to modifiable factors among high-cost populations is an obvious approach but necessitates characterizing high-cost populations and matching interventions to applicable populations. Expanding cost methodology and tracking care through episodes across the continuum of care supports such intervention implementation and policy planning, particularly for persons in the top 5% of health care expenditures.