Providers increasingly are focusing on the social determinants of health to rein in health care spending associated with so-called "super-utilizers," Sarah Varney reports for Kaiser Health News.
Background on 'super-utilizers'
Super-utilizers are patients with serious illnesses who visit the hospital and ED frequently. They tend to be uninsured or enrolled in Medicare or Medicaid.
According to KHN, super-utilizers account for just 5 percent of the U.S. population but 50 percent of health care spending.
N.J. initiative cuts ED visits among participants by 40 percent
Providers are working to identify super-utilizers and address the root causes of their health problems in an effort to curb health care spending, KHN reports. One longstanding effort in New Jersey, for instance, has demonstrated benefits, and similar models are being expanded across the country.
Inspired by how police departments use crime data to track how individuals move between corrections facilities, Jeffrey Brenner—a family physician in Camden, New Jersey—more than 10 years ago began examining ambulance and ED records to map how high-cost patients were moving between local hospitals.
Brenner, along with a team of social workers at the Camden Coalition, use the data to seek out super-utilizers and help them with tasks like finding housing. According to KHN, the model has resulted in significant savings: ED visits fell by 40 percent and monthly hospital bills decreased from $1.2 million to $500,000 among the model's first group of patients.
The Patient Care Intervention Center in Houston also adopted the model and worked with local hospitals, as well as not-for-profits and city and county agencies, to pool data on super-utilizers.
Once the super-utilizers are identified, teams, including firefighters and paramedics, are sent out to places like parks to find these patients and encourage them to enroll in programs offered by the center. After two years, costs for affected patients decreased by 83 percent while hospital visits declined by 70 percent.
Despite their success, programs geared toward patients' social health can face implementation challenges. According to KHN, while federal and private insurers typically see financial benefits to curtailing super-utilizers' spending, hospitals can see it as lost revenue.
For example, workers with the Patient Care Intervention Center once were barred from a Houston hospital because hospital officials were concerned the facility would lose money if super-utilizers stopped visiting. However, such barriers could give way in the future as the U.S. health care system continues to push health systems to change their business models to better reward providers for providing quality care, KHN reports.
"I think we're in a 20-year arc of recalibrating and rethinking what is health and what's health care? What's the purpose of our health care system? What are we trying to accomplish?" Brenner said (Varney/Kane, Kaiser Health News, 1/23).
Three steps to identify your own super-utilizers (and make your community healthier)
Explore three steps you can take to establish each patient’s current and future risk level, the root causes of the patient’s health risks, and which interventions would make the biggest impact.