Reporting on how, why hospital superusers account for bulk of health-care spending

About Joanne Kenen

Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.

Tim Darragh

Tim Darragh

Tim Darragh has written a “How I did It“ essay on his yearlong project looking at a community-wide effort to reduce hospitalization and ER use among a group of “superusers,” people who have complex medical conditions and use a whole lot of very expensive health care. Many have multiple medical problems, often including mental illness or other behavioral issues. We also wrote about his work a few weeks ago.

Darragh looked at a specific program financed under the Affordable Care Act in the Allentown, Pa., area. (He was at The Morning Call at the time. He recently moved to New Jersey Advance Media, which publishes The Star-Ledger and NJ.com.) But hospitals and health care systems across the country are looking at ways to reduce avoidable hospitalizations and rehospitalizations; the incentives are part of the ACA, and insurers are also demanding this to reduce costs. Addressing these patients’ needs before they become a crisis that lands them in the ER isn’t just a money-saver. It’s also better health.

Emergency department

Photo by KOMUnews via Flickr

The specific ACA-related penalties on readmissions are Medicare-focused. But Medicaid also is looking at the superusers. (Many are dual-eligibles, meaning they are getting both Medicare and Medicaid.) A year-end update from the Medicaid Innovation Accelerator Program noted that addressing “superutilizers” is going to be one of the top four priorities of the coming year. (Note that Medicaid hyphenates super-user, so when you search online for programs, better try both ways.)

In addition, the Center for Medicare and Medicaid Innovation has a number of projects that come at this challenge from different directions – Comprehensive Primary Care (CPC) initiative, Partnership for Patients, and the related Hospital Engagement Network, and the Health Care Innovation awards, to name a few. You can also search the CMMI website for programs in your state, and call your local hospitals or the state hospital association for innovation hot spots. Whether or not hospitals are formally affiliated with any of these programs or pilot projects, they are almost certainly taking steps to address the superusers.

Darragh’s work and our earlier post will give you some ideas on how to approach it in your community – and you can do it in smaller bites if you don’t have a year to work on a series. Read what Darragh learned in his reporting.

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