Super-utilizers are the frequent fliers of the health care system, whose serious illnesses send them to the hospital multiple times every year and cost the system hundreds of thousands of dollars annually. Figuring out how best to address these patients’ needs and reduce their financial impact on the health care system is a subject of intense interest among policymakers. Now a new study has found that, in contrast to the notion that “once a super-utilizer, always a super-utilizer,” many patients who use health care services intensely do so for a relatively brief period of time.
Research and news reports often point out that super-utilizers are often uninsured or on Medicare and Medicaid and account for a large percentage of health care spending. Federal officials have suggested that their “large numbers of emergency department [ED] visits and hospital admissions … might have been prevented by relatively inexpensive early interventions and primary care.” Many of the programs that have been developed to reduce super-utilizer health care use have focused on the needs of people with multiple chronic conditions, ensuring they have a medical home through which their care is coordinated, for example, or addressing their social services needs.
The study by researchers at Denver Health, a medical center that serves many uninsured and underinsured patients, examined the characteristics and costs of patients who were hospitalized more than three times during a 12-month period in the two years from May 1, 2011, to April 30, 2013, or were hospitalized at least twice in 12 months and had a serious mental illness.
The results surprised researchers, says Tracy Johnson, director of health care reform initiatives at Denver Health and the study’s lead author, which was published this week in Health Affairs. At the end of the first year, only 28 percent of 1,682 patients who were originally identified as super-utilizers still met the criteria. At the end of two years, the figure had shrunk to 14 percent. Per person spending decreased in line with their decreased use of health care services, from a baseline $113,522 per capita to $47,017 in year two.
Moreover, on an individual level, super-utilizers didn’t necessarily have characteristics of patients frequently assumed to fall into that group, Johnson says. “You’d think they’d all be people with multiple chronic conditions,” she says.
While a substantial 42 percent of high-cost patients with frequent hospital stays did have multiple chronic conditions, others did not. (Researchers grouped patients based on the category that best represented the reason for their hospitalizations. Some patients could have been placed in multiple categories.) Forty-one percent of super-utilizers’ hospitalizations were primarily related to serious mental health diagnoses. Smaller numbers of high-use patients were hospitalized because of orthopedic surgery, trauma, terminal cancer or for emergency inpatient dialysis.
“Other literature we saw said that there’s this homogenous group of people, and [suggest that] we can just do this one program and save millions of dollars,” Johnson says, “but what we saw is that it’s more nuanced.” Therefore, different types of super-utilizers may benefit from different program interventions to reduce their health care use and costs.