HCI3 Update from the Field: Super-Utilizers

Submitted by francois.debrantes@hci3.org on Friday, April 12, 2013 - 12:15

Newtown, CT – April 12, 2013

Super-utilizers. It seems like a marketer's dream target audience, and, for some, it is. For most of us, it should be a target audience of a different sort – When Jeff Brenner first realized who these folks were, the solution seemed simple: deploy good care management close to where they live, and save Medicaid millions. As the story continued to unfold, as well counted in Gawande's Hot Spotters, the savings for Medicaid came from significant reductions in hospital revenues. Super-utilizers are the hospital marketer's dream target audience in a fee-for-service world, and their conversion to normal utilizers is a loss of revenue…a bad thing. At the same time, super-utilizers are the payer's nightmare members and should be the target audience for care management. If anyone ever needed a medical home, these patients do. So Jeff, through the Camden Coalition, worked tirelessly to create some simple algorithms that identify these patients using hospital records, and tie the patients back to community physicians. And it works. Since then, many health care foundations have supported this effort and spread it out to other communities. We've joined the ranks of supporters and have developed a self-contained analytic package that mines claims data to identify super-utilizers, tie them back to treating clinicians, and generate reports that should help communities better manager these patients.

What this means to you – We've been astonished at how many super-utilizers we find in any claims dataset, including commercial payers'. There are thousands upon thousands of these patients, across the country, going in and out of hospitals continuously. Our analytic package provides more than just a mechanism to identify these patients, it also provides insights on the reasons why they're admitted and the total costs of care spent on them every year. You can preview some of the reports and views that can be gleaned from the analysis, and we encourage all employers, all health systems, and all health plans to take the time to run the numbers and do something about these patients. The package is free, so we're pretty sure the ROI is there. Of course, finding and managing the super-utilizers is only a stopgap, because until we flip the core incentives that prevent clinicians and hospitals from doing good, it's going to be tough to stop a new batch of these patients from appearing in the next analysis. Consider this quote from the CEO of Advocate: "When we look at our utilization numbers, for instance, we feel schizophrenic – this number is good…no, it's bad…no, it's good!" No, it's definitely bad, but that's what we're encouraging, and that's why the super-utilizers are the marketer's dream instead of the nightmare they should be. As I've said plenty of times before, it's tough to be good when you're encouraged to be bad. It doesn't have to be this way.


Francois de Brantes
Executive Director
Health Care Incentives Improvement Institute, Inc.
w: www.hci3.org