Community programs help cut healthcare "super-users"

Programs focused on healthcare "super-users"--the small percentage of Medicaid patients who make up most of the program's spending--help reduce spending and hospitalizations, according to USA Today.

For example, Johns Hopkins Community Health Partnership helps these patients, many of whom have chronic conditions, maintain their health after discharge from the emergency room (ER). This involves taking precautions like calling them at least once a week between doctors' appointments to make sure they're taking their medications or to find out whether they need food or housing assistance.

The program works with other community resources, such as care coordinators, social workers, nurse practitioners and primary care physicians, according to the article. Any patient with a predicted risk of readmission within the next year higher than 50 percent is put in touch first with a community worker, then with a case manager. A program at some Florida hospitals uses a similar targeting strategy, FierceHealthcare previously reported.

Integra, a company that helps insurers identify and target Medicare and Medicaid patients who visit the ER more often than the doctor, has cut hospitalizations by half, CEO Michael Yuhas told USA Today. "With the expansion of Medicaid and the ACA [Affordable Care Act]--and the fact that insurers have to take all comers---it's very much in their interest to make sure these people stay healthy and use healthcare wisely," he said.

Johns Hopkins' program has had similar success, according to Michael Fingerhood, M.D., who serves as the primary doctor for one of the patient's within the program. "I can tell you personally that I think it's helped decrease emergency room visits," he said. "We're below our goal for hospitalizations."

The Centers for Medicare & Medicaid Services is heavily investing in such programs, giving New Jersey's Cooper University Hospital $2.8 million to expand its programs and giving Hopkins $10 million, according to the article.

To learn more:
- read the article

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