The Robert Wood Johnson Foundation has released a summary report from its February 2013 Super-Utilizer Summit, a meeting of super-utilizer program leaders, CMS, RWJF's Aligning Forces for Quality and other stakeholders, detailing underlying themes and key recommendations for structuring programs to eliminate super-utilization.
Of emergency department super-users in Washington State:
• A super-user typically visited an ED between 78 and 134 times in 15 months.
• A super-user was admitted as an inpatient an average of seven times, but as few as zero and as many as 22 times over 15 months.
• 90 percent have an indication of a current substance abuse problem.
• 100 percent have an indication of mental illness.
• 20 percent are currently homeless.
• 30 percent are currently or have been recently living in a group-care setting.
• 10 percent are receiving personal in-home care.
Given that these characteristics are representative of super-users across the nation, the Super-Utilizer Summit identified steps for the healthcare system to take to begin to address the problems behind super-utilization.
1. Identify populations and sub-populations through data analysis. To deal with super-utilization, it is necessary for the healthcare system to identify the locations and characteristics of super-utilizers. This has been achieved in some instances, such as with the Camden (N.J.) Coalition, by the use of Medicare claims data for predictive modeling. Other potential data sources may include admissions data, demographic files, patient assessments, electronic health record data, conversations with patients and families and information gathered by care teams.
2. Invest in care teams and care management interventions. Care teams take information from data analytics and deploy it in real time. Features in common among successful care times include nursing staff, social workers and experience with community outreach. Teams should engage individual patients within their communities to better gauge, understand and respond to the needs patients may have when it comes to their health. Care team engagement, when effective, is persistent and extensive and features an in-person component.
3. Integrate replicable, sustainable utilization reduction programs into healthcare. Such a move will require re-framing traditional medicine in the context of expanded primary care and population health. This step may be the most difficult of the three noted in the report, as it requires a change of mindset in the healthcare delivery system from making sick patients well to keeping healthy patients well. The report also suggests this step will require overcoming the bias that more expensive, technical medical care is superior in quality to simpler, community-based care approaches.
More Articles on Capacity Management:
Study: Triage Tool Doubles the Number of Safely Discharged Chest Pain Patients
PPACA Medicare Expansion Strains Capacity
5 Areas to Address to Improve Patient Flow