You don’t hear much about them in the health care debate, but people known as “super-utilizers” place a huge and costly burden on the medical system.
The New Jersey-based Robert Wood Johnson Foundation (RWJF) recently announced that it’s awarded grants totaling $2.1 million to groups in six communities (Boston, Cincinnati, Cleveland, Humboldt County, California, Maine and Western Michigan) to address their super-utilizer situations.
But what exactly is a super-utilizer?
Simply put, super-utilizers are people who overuse emergency departments and hospital inpatient services, making more visits to those facilities in a month than some people make in a lifetime. Susan Mende, senior program officer at RWJF, explains that these patients suffer from “multiple chronic complex diseases, including mental health issues” along with “really difficult social situations” such as inadequate – or nonexistent – housing.
They also lack a primary care physician or other medical home, so their health care is haphazard and uncoordinated, Mende explains. The first task facing the grant recipients is to identify the local super-utilizers by “looking at emergency room data across multiple hospitals.”
According to the RWJF press release announcing the grants, “Health care spending in the United States is unevenly distributed, with the sickest 5 percent of patients causing more than 60 percent of health care costs.” Mende says the lack of coordination of super-utilizers’ treatment often leads to “repeating really expensive diagnostic tests such as CAT scans,” which dramatically drives up the cost of their care.
The grant-funded program builds on the work of Jeffrey Brenner, a Camden, New Jersey doctor who a decade ago determined that in Camden and elsewhere, a small group of super-utilizers accounted for the bulk of health-care costs.
Brenner, whose work you can read more about in this 2011 article in The New Yorker, found that taking a different approach to helping these people manage their health could benefit both the patients and the health-care delivery system. He formed the Camden Coalition of Healthcare Providers, which takes a collaborative and preventive approach to helping super-utilizers better manage their physical and mental health.
The coalition’s “outreach team” includes a nurse practitioner, a social worker, and a health outreach worker and is backed up by a family medicine doctor. These folks visit patients at their homes, in the hospital, or wherever they happen to be, and coordinate not just their health care but arrange for their housing and make sure they have access to food, among other matters that contribute to their being super-utilizers. (As Mende told me, “Sadly, some people come to the emergency room because they know they’re going to get fed.”)
Sometimes, Mendes says, “interventions are so simple, you think ‘Why didn’t we do this before?’” Small things such as providing eyeglasses to a diabetic patient who otherwise couldn’t see well enough to check her blood sugar or noticing whether an older person doesn’t have family to look after him can make a big difference, she says.
According to the RJWF, which has supported Brenner’s work since 2005, the Camden coalition “has cut in half the average per month hospital charge ... for its earliest group of super-users and nearly halved their number of monthly ED visits.” Further, the release says, monthly medical costs per super-utilizer dropped 56 percent, from $33,333 to $14,597.
The new grants are aimed at helping these six communities, which are among a larger set of communities the RWJF has been working with for several years through its Aligning Forces for Quality initiative, replicate Brenner’s successes.
This approach seems to make lots of sense. What do you think?