Managing Care for ‘Super Utilizers’
Of the multiple initiatives in which the Millennium team is engaged to reduce avoidable emergency department visits and hospitalizations by 25 percent, a current project focused on “Super Utilizers” is particularly illustrative of our primary mission.
According to the Health Care Incentives Improvement Institute (HCI3), “Super Utilizers” are any patient who has three or more In-Patient (IP) Admissions and/or six or more Emergency Department Visits within a one-year time frame.
While this “definition” alone indicates the merits of focusing on this group, further data related to “Super Utilizers” shows:
- New York State’s Super Utilizer population includes only a minority of all Medicaid patients yet accounts for a large number of ED visits and IP Admissions that, in turn, drive a high rate of spending.
- Specifically, the average health care cost per Super Utilizer statewide is 4.1 times greater than the average Medicaid patient.
With these facts in hand, the NYS Department of Health contracted with the business consultant and auditor KPMG to develop and implement a program to “Manage Care for Super Utilizers” that Performing Providers Systems such as Millennium could take advantage of on a voluntary basis.
Overall, the concept is to:
- Work with KPMG experts to identify cohorts of patients who are Super Utilizers, and understand the impact of their care choices. (For example, the average cost per Super Utilizer in Millennium’s network is 3.2 times greater than cost for non-Super Utilizer, which is slightly better than the statewide data above.)
- Work with partner organizations to develop sub-projects that address the unique issues presented by these Super Utilizers.
Our approach will be to develop a four-way partnership between Millennium, ECMC’s Primary Care Clinics, ECMC’s Emergency Department and Evergreen Health Home to further investigate and address these challenges.
To date, we have identified 112 Medicaid patients who meet the criteria of being ECMC Super Utilizers. With this data in hand, we are developing a flagging mechanism to identify these patients in the ECMC electronic medical record; and, if they are eligible and willing, to enroll them in the Evergreen Health Home.
We are also — most importantly – conducting bi-weekly case conferences including all four partners during which we’re rolling up our sleeves and working to develop longer term solutions that address the diverse needs presented by these Super Utilizers.
At the end of the day, Managing Care for ‘Super Utilizers’ goes right to the heart of the matter of achieving our primary goal – realizing a 25 percent reduction in avoidable emergency department visits