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PA Hospitals Address Super-Utilizers Through Innovative Programs to Improve Care Quality and Reduce Costs

February 19, 2015

New research from the Pennsylvania Health Care Cost Containment Council (PHC4) shows that super-utilizers—hospital patients with five or more hospital inpatient admissions—accounted for a disproportionate amount of health care resources during 2014.

Representing just 3 percent of all patients hospitalized in 2014, super-utilizers accounted for 11 percent of admissions, 14 percent of patient days, $545 million (14 percent) of Medicare fee-for-service payments, and $216 million (17 percent) of Medicaid payments.

These findings support Pennsylvania hospitals' increased focus on meeting the complex needs of super-utilizers and the many important, innovative efforts already underway.

“Pennsylvania hospitals are working to address the care coordination and health and social factors that can lead to repeated emergency room visits, hospital admissions, and readmissions,” said HAP President and CEO Andy Carter.

“Hospitals are committed to patient-centered medical homes, accountable care models, and other innovations designed to keep patients healthier and to reduce, when possible, the need for intensive and expensive medical care.”

Pennsylvania hospitals and health systems are engaged in efforts to work with super-utilizers and other patients to better coordinate care, increase accountability, and reduce costs.

The following is a sampling of hospital and health system initiatives that address super-utilizers and improve care coordination in the commonwealth:

  • Allegheny Valley Hospital makes follow-up house calls to people at high risk of readmission

  • Cole Memorial’s communication initiative, which received a 2014 HAP Achievement Award, uses its new coordinated care protocol to avoid repeat visits

  • Geisinger Health System’sProvenHealth Navigator” initiative is a patient-centric medical home

  • Pennsylvania Psychiatric Institute’s “Ready Program” is a mental health model used to reduce readmissions

  • Pocono Health System’sCommunity Care Network” is a patient-centered medical home

  • Reading Health System’s “Project Connect” is for emergency department super-utilizers and complex patients; and its mobile “boots on the ground” community care management initiative creates better health outside of the hospital

  • The South Central Pennsylvania High Utilizer Collaborative includes four Pennsylvania health systems: Crozer-Keystone Health System, Lancaster General Health, PinnacleHealth System, and Wellspan Health, as well as Neighborhood Health Centers of the Lehigh Valley and Widener University. Programs within the collaborative include:

          – Crozer-Keystone Health System, Camden Coalition of Healthcare Providers, and Cooper University Hospital’s super-utilizer fellowship program

          – Lancaster General Health’sCare Connections,” a transitional primary care home that serves complex patients

          – PinnacleHealth System’sCommunity Health Navigation Network,” which offers services to the Harrisburg community through improved access, education, and communication

          – Neighborhood Health Centers of the Lehigh Valley’sThe Lehigh Valley Super Utilizer Partnership,” an initiative that provides intensive outreach and care coordination for patients with complex illnesses

          – WellSpan Health’sBridges to Health,” a program that makes the patient a partner with a dedicated health care team

  • The University of Pennsylvania’sIMPaCT program” focuses on high-poverty neighborhoods

  • Thomas Jefferson University and Hospital and Camden Coalition of Healthcare Providers’ “hot-spotting initiative” offers an advanced data analysis technique

  • Thomas Jefferson University’s educational program pairs health professional students with super-utilizers to enhance students’ understanding of the social determinants that contribute to patients’ health status and use of health care

In addition, HAP’s Pennsylvania Hospital Engagement Network, as part of the Centers for Medicare & Medicaid Services Partnership for Patients initiative, has worked with hospitals and health systems during the past three years to reduce readmissions and preventable harm in the commonwealth.

PHC4 notes that patients’ social determinants of health, age, and ethnicity can put them at higher risk of becoming super-utilizers. Individuals with health insurance are more likely to have a primary care physician and seek preventive services, such as screenings and vaccinations.

With health insurance coverage, individuals also may be less likely to develop chronic conditions. This is why increased, gapless coverage through Medicaid expansion in Pennsylvania is important for the reduction of super-utilization.

“With Medicaid expansion and the federal health insurance marketplace, Pennsylvanians, regardless of income, have access to affordable insurance,” said Carter.

“Now we must help the newly insured use this access wisely—to seek routine, preventive, and primary care. Hospitals also need support and resources to address the growing mental health crisis in our state and nation, and increase the availability and coordination of behavioral health care.”

CONTACT

Katie Byrnes
(717) 561-5342
kbyrnes@haponline.org
Twitter: @HAP_Media

Priscilla Koutsouradis (southeast)
(215) 575-3743
priscillak@dvhc.org

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