90 Days Too Late: Finding, and Helping, Healthcare’s Highest Utilizers
In healthcare, the highest utilizers— comprised of just the top 1% of patients—represent nearly one-quarter of all healthcare spending, according to a 2012 Agency for Healthcare Research and Quality study. With healthcare spending at an all-time high, everyone can agree that reducing these costs is a must. But, these “frequent fliers” or super-utilizers, often fly under the radar, making it difficult to identify, intervene and coordinate their care, all of which are steps necessary for improvement.
The biggest hurdle in fixing this broken system isn’t what you’d expect. Most people assume the hardest part is treating these complicated patients. And while that isn’t easy, in fact, the greatest challenge is finding them.
Take for example, Patient #10, a 54-year-old Medicaid patient part of a research study in Washington State. Within 15 months, he visited the emergency department 78 times. Yet, in not one of his 78 visits was he flagged or identified as a frequent flier. Unfortunately, Patient #10 isn’t unique.
Patient care for high-utilizers can prove challenging. In many cases, these patients have multiple health conditions that create complex care needs. The Center for Health Care Strategies study found that 83% of the Medicaid’s high-utilizers had three or more chronic conditions. Patient #10 certainly fit the bill—he suffered from chronic urinary tract infections, severe mental illness and substance abuse history.
Like Patient #10, many of healthcare’s frequent fliers also face challenges beyond their physical health that can impact their ability to access care. Spanning his 78 visits, Patient #10 lived on social security, qualified for personal care assistance, and was homeless. Unstable homes, financial challenges, inconsistent health insurance coverage, and lack of transportation often force patients to seek the closest emergency room, which rarely is the best solution.
To shift high-utilizers from emergency care to primary care, early identification and intervention is key. But, with such complex health and social needs, high-utilizers can be hard to keep up with. The convenience factor of the emergency department can cause patients to bounce between several different facilities when seeking treatment, making it tough for providers to even track them down for proper care.
What’s more, most healthcare providers rely on 90-days-old claims data to identify and prioritize their high-need, high-risk patients. By the time providers have identified and flagged their high-utilizers with this three-month old information, in most cases, it’s too late.
This old and incomplete data leads to fragmentation of care and costly procedures. Additionally, as we previously wrote, challenges of full interoperability in the U.S. prevent providers from easily accessing the data they need for efficient care. Providers treating high-utilizers without their complete health history are bound to do unnecessary testing, prescribe conflicting treatment plans or medications, and cause frustration for both themselves and the patients.
In attempts to address issues, many institutions are taking steps to ensure that these patients don’t fall through the cracks. For example, the Hospital of the University of Pennsylvania turned to interdisciplinary care coordination to tackle their high-utilizer problem. For each patient, the hospital assembled a multi-disciplinary continuity team that worked with the patients’ previous providers to create comprehensive care plans and worked with subsequent providers to implement those plans. As a result, the frequent flier hospital admissions dropped by 32% in just one year.
Another way that care teams better coordinate care is through the implementation of technology that identifies high utilizers in real time. The availability of real-time notifications allows providers to intervene and deploy appropriate resources anytime a patient seeks care.
As healthcare continues to evolve and shift toward value-based care, reliance on old data to care for patients will simply not be enough to move the needle on care quality. Moving to a real-time data model will not only make it easier for providers to collaborate quickly and efficiently, but it will ultimately improve care for those most in need.