Summary: Who are the super-users, people who go to the emergency room more than anyone else and consume a lot of services and a lot of health-care dollars? It’s not who you think, according to an analysis by California Healthline of a pilot program studying this question. Who are they? People who have things in common: Substance use, behavioral issues, early-life trauma and a lack of care coordination, according to this piece, “Surprising Results From Pilot Program Aimed at Medi-Cal ‘Super-Utilizers,'” by David Gorn, California Healthline Sacramento Bureau writer.
“A small segment of Medi-Cal beneficiaries run up huge health care bills — but they’re not necessarily the people you’d expect them to be. The so-called ‘super-utilizers’ are one of the biggest drivers of escalating spending in California’s health care system,” Gorn writes.
“A two-year pilot project in rural Humboldt County dealing with that population produced some surprising results. Generally, the assumption about super-utilizers has been that they have complex health issues, multiple chronic conditions and multiple medications and they overuse the emergency department because they have no primary care provider. The pilot project found that other issues might play a bigger role.
” ‘When we started to home in on the top 100 utilizers from the hospital system and we built a profile of who those people were, it was really surprising to us,’ said Sharon Hunter, a nurse in Humboldt County who helped coordinate the Care Transitions project, a subset of a larger pilot reform effort in the county called Aligning Forces. ‘We thought these people were coming into the ED during off-hours, nights and weekends, but we found the highest utilization was Wednesday in the middle of the day,’ Hunter said. ‘We thought they did not have primary care providers, but in fact they did.’
The biggest reveal, though, came from the super-utilizers’ health conditions. ‘They were not necessarily seniors — most were 41 to 65,’ Hunter said, ‘and complex, chronic disease did not seem to be part of their makeup.’
“For the most part, she said, people with behavioral problems or substance use issues were the ones who used the ED more than anyone else.” David Gorn, Surprising Results From Pilot Program Aimed at Medi-Cal ‘Super-Utilizers,’ California Healthline.