How to Solve for Medical Superutilizers

How to lower health care costs? Tackle superutilizersMedical frequent flyers, or “superutilizers,” make up 1 percent of the U.S. population but use upward of 25 percent to 30 percent of health care resources in any given year. In the state Medicaid programs, the numbers are similar; about 5 percent of beneficiaries generate more than 50 percent of the total spending.

The vast majority of these heavy users have three or more chronic conditions, and most of them also face a complex array of social challenges, including homelessness, substance abuse, poor nutrition, frayed family networks and joblessness. What can be done for these types of patients?

An interesting dynamic exists with these superutilizers, which is that not enough resources are being put toward less expensive means of addressing their health and well-being. Some organizations working with superutilizers, such as the Camden Coalition of Health Care Providers (CCHCP), have addressed this dynamic, and their costs for care have plummeted dramatically.

The CCHCP is going through an inflection point. It is attempting to go from an organization that has proven that focusing on the social aspect of health can work to one that is making the social aspect of health “scalable,” turning it into a real business. Doing this requires careful thought about its operational infrastructure to eliminate redundancies and duplication among CCHCP professionals working with superutilizers. Accountability is created for the organization to ensure opportunities for improving health are not overlooked. Learning and innovation are captured and disseminated so that processes and care are improved for all.

These are all good business precepts and it will be interesting to see how this metamorphosis turns out. I’m pulling for them.

Organizations such as CCHCP are at the forefront of how health care should be organized in the U.S. There is much we can learn from them. Medical teams caring for groups of people in a coordinated way are going to require such “social functional positions” as part of the care team. Caring for individuals’ well-being could be a lot less expensive to deal with if these social issues were approached before the chronic and expensive medical issues arise. However, reorganizing health care around social issues also requires that the U.S. “right size” health and spend accordingly. In The American Health Care Paradox by Elizabeth Bradley and Lauren Taylor, research found that the U.S. spends approximately $0.50 on social issues for every $1 of health care expenditures. The rest of the world has this proportion exactly reversed and as a result, spends half of the amount of its Gross Primary Production (GPP) on health care compared to the U.S. Health outcomes are better abroad too.

While it is likely going to take time for the U.S. to right size its approach to health care, it is a worthy goal and could be a considerably less expensive one at that.





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