Is a Strategy Focused on Super-Utilizers Equal to the Task of Health Care System Transformation? No.

Abstract

To read or post commentaries in response to this article, see it online at http://www.annfammed.org/content/13/1/8.

Health seeking behavior as a predictor of healthcare utilization in a population of patients with spinal pain

“…This is dramatically different than other studies that have investigated super users. [ 27 , 42 – 44 ] One explanation for the differences between emergency department utilization rates between our study and previous studies is that we used the top 25 percent as the cut point for high healthcare utilization. If we had used the top five or one percent AHRQ values, we would have likely obtained more information about super utilizers versus high utilizers of healthcare.…”

“…More importantly was the way we defined high healthcare utilization. It has been termed healthcare super utilization;[ 27 ] however, this term has not been consistently defined across studies. Depending on the study, super utilization rates range from the top one to top ten percent (or more) of healthcare costs.…”

“…Depending on the study, super utilization rates range from the top one to top ten percent (or more) of healthcare costs. [ 27 ] Complicating the issue, the AHRQ Medical Expenditure Panel Survey report has varying classifications of high utilization rates ranging from the top one to top 25 percent of healthcare consumers. [ 3 ] We elected to use the top 25 percent (which is reported to account for 86% of total healthcare costs) primarily because we were more interested in high utilization versus super utilization.…”

“Pay for Success” Financing and Home‐Based Multicomponent Childhood Asthma Interventions: Modeling Results From the Detroit Medicaid Population

“…In reality, the target population might experience future utilization rates that differ from those observed before the year of the intervention. Prior research has observed the regression‐to‐the‐mean phenomenon, in which many of the highest users of health care in a population in a given year typically do not have a similar high rate of use the following year . To investigate the impact of the assumption of unchanged utilization rates over time, we conducted sensitivity analysis by varying the annual number of hospitalizations that would occur without the intervention in Group 3 from 100% of the hospitalizations observed in the year before the intervention (likely an overestimation of the intervention effect) down to 5% of that hospitalization rate.…”

Implementation Science Workshop: a Novel Multidisciplinary Primary Care Program to Improve Care and Outcomes for Super-Utilizers

“…Patients with very high levels of hospitalizations and emergency room visits, sometimes identified as “super-utilizers,” 1 often represent a population with unmet healthcare needs. Though patients in this group are heterogeneous and difficult to define across settings, 2 they frequently have poor access to care, complex medical and social problems, and high healthcare costs. Programmatic interventions that target this group share the goal of improving care quality, and often employ care management to address the myriad psychosocial factors that complicate care, such as poor housing conditions, poverty, substance abuse, and mental illness.…”