DEFINING THE PHRASE: Super Utilizer

super utilizer

What is a Super Utilizer?

Super utilizer (SU) is a phrase used in the healthcare industry to describe high-need, high-cost consumers with complex, often co-existing, physical and behavioral conditions. Super utilizers are characterized by their overuse of hospital inpatient services and emergency departments (ED). Often considered a burden on the medical system, these patients are noteworthy because the healthcare landscape is not presently equipped to care for them. Recent data published by the Robert Wood Johnson foundation notes that 5% of the population receiving healthcare makes up 60% of all healthcare costs, without a doubt, SUs have a significant impact on this number. These individuals are considered super utilizers of healthcare resources because they typically have more than one untreated or improperly treated chronic condition (and often suffer from a combination of physical and behavioral issues). As a result, they tend to have a high volume of emergency room visits and inpatient hospital stays, that amount to costly and ineffective management of conditions. SUs don’t receive comprehensive care and, therefore, fail to show significant, long-term improvement making them a continuing concern for the healthcare system.

Balancing care

Another factor characteristic of SUs is that they do not have a healthcare home base, meaning that they are often not associated with a primary care physician. According to the U.S. National Library of Medicine, a primary care provider (PCP) is “a health care practitioner who sees people that have common medical problems.” SUs tend to miss out on consistent and coordinated care such as routine check-ups and standard screenings because they lack this vital relationship with a PCP. The PCP is arguably the most important member of the healthcare team, handling routine vaccinations and performing all standard tests and screenings. Regular visits to a PCP can benefit a super utilizer in myriad ways; a PCP functions as a care coordinator, managing care and referring patients to appropriate specialists when necessary. PCPs also serve as the first line of defense in maintaining good health through preventive treatments, treatment of common ailments, and identifying health problems as they arise, preventing major illness. But most important for SUs is that a PCP knows the patient’s history, medications, and overall health picture, which enables them to help patients manage their own health more effectively. Evidence has demonstrated that individuals who have a PCP live longer lives than those who do not. Super utilizers are a segment of the population that could most benefit from these relationships, yet, are the least likely to have them.

Solutions for the future

Patients with relationships to PCPs have less reason to visit EDs, in fact, studies suggest that frequency of inpatient stays and ED visits decrease when a PCP is providing consistent care. With rising healthcare costs demanding that we come up with new ways of managing the super utilizers of healthcare resources, it’s time for new strategies. The result of having a healthcare home base can range from simple interventions that dramatically improve the lives and health of SUs to more complex, coordinated treatments, in either case, there is potential for decreased drain on EDs and improved patient health.

BHPI sees the value in connecting consumers with PCPs. As part of our new Health:SHARE Solutions initiative, one of the key strategies is Making Primary Care Work, a series of tools that enable the providers in our behavioral health networks to help consumers connect with their PCPs for regular visits. We understand that helping people connect with a physician who can support them on their healthcare journey will support overall wellness. Additionally, we know that improving behavioral health is more successful when chronic physical conditions, such as high blood pressure and diabetes, are effectively managed. Our goal is the integration of primary and behavioral health. When successful, this type of care can dramatically affect the super utilizers in our population, so that healthcare resources can be better allocated and patients have better outcomes.

References:

https://www.openminds.com/market-intelligence/executive-briefings/is-specialty-care-coordination-an-opportunity-for-your-organization.htm/

http://www.rwjf.org/en/library/collections/super-utilizers.html

https://www.washingtonpost.com/blogs/the-checkup/post/super-utilizers-place-huge-burden-on-health-care-system/2012/10/19/c62781ba-1a32-11e2-ad4a-e5a958b60a1e_blog.html

https://www.camdenhealth.org/super-utilizers-place-huge-burden-on-health-care-system/

http://www.commonwealthfund.org/publications/health-reform-and-you/primary-care-our-first-line-of-defense

https://www.nlm.nih.gov/medlineplus/ency/article/001939.htm

About Behavioral Health Professionals, Inc.:

Established in 2002 and headquartered in Detroit, Michigan, BHPI is a Managed Behavioral Health Organization offering behavioral health services through a fully integrated network of world class healthcare providers.  Our emphasis is on adding value for our customers by offering expert behavioral care management, medical coordination, and behavioral disease and chronic behavioral condition management.  BHPI offers collaborative solutions by building strong partnerships with HMOs, Health Systems, Insurance Companies, and Employer groups.  For more information visit: BHPI.org