States make headway in keeping super-users out of ERs

Super-users, the patients who make a revolving door of hospital emergency rooms (ERs) and often lack insurance or even the vaguest social safety net, have been one of the biggest cost burdens in healthcare delivery.

However, the Affordable Care Act has been addressing that phenomenon to some extent, according to Stateline. At least 15 states have established medical homes for patients considered to be super-users, ensuring they receive the kind of preventive care that would keep them from landing in the hospital on a regular basis. Under the ACA, the federal government has been providing 90 percent of the funding for the medical home programs.

Federal data has shown these programs can systematically cut the number of super-users and reduce costs.

Although many medical home programs have just gotten underway, Missouri has been operating its program since 2012. "Initially, when we started, 24 percent of our enrollees had hypertension under control," Dorn Schufmann, former coordinator of the health home model in the Missouri Department of Mental Health, told Stateline. "At the end of two years, 65 percent had hypertension under control." Partly as a result, the state has saved $3 million by keeping patients away from ERs due to their improved conditions.

Mental health issues are among the biggest drivers of ER super-users. Forty-four percent of ER super-users (four hospital stays or six inpatient visits in a year) had been diagnosed with a serious mental illness, compared to fewer than 10 percent of the general population, Stateline noted. Oftentimes, a person's mental health can lead to physical health issues, such as not being able to take medication for diabetes or other chronic conditions.

"One thing this clearly underscores is that the treatment for physical problems and behavioral problems should go hand and hand," Sujoy Chakravarty, lead author of a Rutgers report on super-users, told Stateline.

To learn more:
- read the Stateline article