The term “super-utilizer” describes individuals whose complex physical, behavioral, and social needs are not well met through the current fragmented health care system. As a result, these individuals typically bounce between emergency departments, inpatient admissions/readmissions and institutionalizations in a costly and often chaotic process—an ineffective way to provide care and improve patient outcomes.
In this report, three main areas of innovative strategies used by super-utilizer programs are discussed: (1) data collection and analysis strategies; (2) care teams and interventions; and (3) integration/replication/sustainability of the programs.
Each patient is unique and successful super-utilizer programs realize that it is important “to figure out which patients need which interventions in which setting by which provider.” Complex care management programs delve into the physical, behavioral, and social needs of patients to help break the cycle of costly, repetitive emergency room visits or inpatient admissions.
Super-utilizer programs offer a complex and unique care management practice that help make an impact in a patient’s physical, social, and behavioral well-being. However, the challenge is taking this level complexity and uniqueness to scale within our current health care system. Creating healthy communities through housing, jobs, education, food and parks is one place to begin—thus creating more people who are healthy and less who are sick.
About the Study:
This report presents common themes and key recommendations for building better systems of care for high utilizers. The appendices also include materials related to existing complex care management programs that can be educational resources for states and policy-makers considering ways to implement, spread, and sustain such programs.
The recommendations presented in the report emerged from a summit held on February 12-13, 2013 and hosted by the Center for Health Care Strategies, in partnership with the National Governors Association and sponsored by the Robert Wood Johnson Foundation and The Atlantic Philanthropies.