State HIE helps providers pinpoint ER 'super-users'

Like many other areas across the country, Kentucky grapples with emergency room "frequent fliers"--and until last year, the commonwealth had never successfully addressed the problem.

GCN reports that technology--ranging from data analytics tools to geomapping software--is helping officials from the Kentucky Department for Medicaid Services connect "super-users" to the right kind of medical care.

John Lagerfeld, M.D., chief medical officer of Kentucky DMS, told GCN, "... [W]e do think that's what will create the difference moving forward from what we historically have experienced in a much more fragmented system."

Kentucky found, in analyzing its patient population data to identify the "super-users," that in one year, about 350,000 Medicaid recipients used ERs at a cost of $341 million. And of those, a little more than half visited just one time; almost 45,000 patients went four or more times. The state identified 4,400 Medicaid recipients as "super-users," who used the ER 10 or more times at a cost of about $34 million.

Sixteen hospitals participated in this program, all connected to the Kentucky Health Information Exchange (KHIE). One example of diverting super-users from the ER--a patient may be transported by ambulance, but the ER tips off the hospital about the user, so coordinated care teams care work on how he or she will be treated once reaching the hospital.

"The objective here is to steer this patient, this super-utilizer, away from the emergency department to a better place to receive primary care, which would be a patient-centered medical home, primary care provider or it might be the local health department," Polly Mullins-Bentley, executive director of KHIE, told GCN.

As reported in February, through similar efforts, data analytics tools are enabling hospitals nationwide to cut costs by pinpointing which patients are utilizing the most resources.

For instance, to propel hot spotting efforts in California, Alta Bates Summit Medical Center in Berkeley and Oakland, recently paid $400,000 for new software that helps it to easily identify usage patterns. From there, resources have been strategically deployed to the surrounding community with an eye on preventing patient readmissions.

To learn more:
- read the article in GCN

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