'Intensive care coordination' saves $14M in superuser costs

So-called emergency room “superusers” are one of the top drivers of hospital spending. So in an effort to improve care--and their bottom lines--California hospitals are taking steps to better coordinate patient care after discharge and connect patients with the services they really need, according to Kaiser Health News.

The Illumination Foundation, a homeless health services program based in Irvine, California, runs the Chronic Care Plus initiative, which tracks superusers through the healthcare system and works to find lasting solutions for their ailments and health problems. The key to the program’s success is the recognition that these patients aren't necessarily the sickest, but typically have multiple socioeconomic and health-related problems that exacerbate their conditions, such as homelessness, mental illness or addiction issues. Before entering the program, patients relied on the emergency department for practically every health problem, John Simmons, the program’s lead nurse, told the publication.

Simmons works to end this cycle through a process called intensive care coordination, helping patients with housing options, addiction treatment and access to social services and primary care. Once patients got access to these services, they often did the rest of the work themselves, Simmons said. “The beauty of the program was, we took those people and got them self-sufficient,” he told KHN, “and you notice their health [go] on an upward trend.” Over a two-year period, the program saved at least $14 million for fewer than 40 people, and the real figure is almost certainly more when reduction in police and emergency transportation services are factored in, according to Simmons.

The speed with which the program has improved outcomes and finances should spur leaders to expand the program to other cities and states, said Pat Brydges, an administrator at St. Joseph Hospital of Orange, one of the program’s sponsors, noting that the improvements would likely be even more dramatic on a national scale. Indeed, other hospitals and entities have had success with similar approaches, such as Kaiser Permanente Northwest, which stationed “navigators” in its ERs to redirect superusers to more appropriate care settings, and the Highmark Foundation, which partnered with three western Pennsylvania providers and reduced non-emergency ER use nearly 43 percent via navigators.

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