National health expenditures in the United States exceeded $3.35 trillion in 2016, which equates to $10,345 for each American.Political figures continue to wax lyrical about different ways to cut the health care costs; however, in reality, few of them are aware of the existence of “super-utilizers.” If they are, they aren’t doing much about it.
What Is a Super-Utilizer and What Do They Cost the Health Care System?
A super-utilizer is someone who regularly visits the ER for minor problems that are easily handled by social workers and primary care doctors. These individuals make up five percent of the population but are responsible for a staggering 50 percent of national health care expenditure.
In Camden, New Jersey, one person visited the ER on 324 occasions in just five years. Another individual went to the ER 115 times in a single year while yet another person racked up approximately $3.5 million worth of medical bills from 2002-2007; Medicare and Medicaid paid for everything.
One of the big issues is the failure of patients to comply with medical regimens. Once a doctor sees a patient and writes a prescription, there is little else that can be done. The big problem is the lack of follow-up care once a patient leaves a doctor’s office or ER. Super-utilizers often visit the ER, receive treatment, and ignore instructions, only to arrive back to the same location a few days later.
Reducing health care coverage or access to treatment does not help matters. A major IT company raised employee co-payments in the belief it would reduce expenses, as staff would take better care of themselves and have fewer medical procedures and doctors’ visits as a result. In reality, there was a reduction in lower-cost preventive care and an increase in expensive treatments.
One employee had diabetes and high cholesterol and couldn’t afford the new co-payments. As a result, he refilled his prescriptions half the time and suffered a heart attack. He had heart surgery, and now he has a chronic heart condition.
Increased Outpatient Care Is the Solution
Jeffrey C. Brenner, a physician in Camden, New Jersey, decided to do something about the city’s super-utilizers. He created a program with the aid of the Camden Coalition of Healthcare Providers. According to Brenner, these individuals don’t want to go to the ER. He pointed out that by providing them with alternatives, the frequency of their visits can be reduced. His goal was to reduce costs while improving the quality of care.
Brenner’s team focused on 35 super-utilizers that racked up over $14 million in hospital charges per annum. The team intervened in the lives of these individuals, and because of their efforts, the group’s monthly ER visits fell from 61 to 37. Overall, the program cost $300,000 a year and saved approximately $8 million per annum.
Brenner is adamant that in America, we are using the wrong tools for the wrong problem. His team sought out super-utilizers that were homeless or addicts and helped them get their lives back on track. One example involved a homeless man named Peter Bowser who visited the ER 30 times in one year. Once he had a permanent residence, Bowser’s ER visits all but disappeared.
Buoyed by his success in Camden, Brenner aims to spread his initiative across the United States. In Houston, Texas, the hospitals are aware of their own super-utilizers; however, they didn’t know about those that regularly use other medical facilities in the city. Now, the city collates the information and saves it in one database, so super-utilizers are identified and sought out by a medical team.
The medical practitioners visit Houston’s parks and neighborhoods to find these individuals. Once they locate the super-utilizers, they help them organize doctors’ appointments and look to intervene positively in their lives. In the first two years of the Houston Patient Care Intervention Center’s existence, hospital visits have gone down 70 percent, and costs are down 83 percent for patients involved in the program.
Following the Danish Model
It is clear that proactive, responsive outpatient care is capable of significantly reducing the costs of health care in the United States. Perhaps following the lead of Denmark could yield positive results. Admittedly, Denmark is a much smaller nation, but it enjoyed tremendous success when it increased the availability of outpatient primary care services.
Now, Danish residents benefit from email access to doctors, nurse management of complex cases, and after-hours consultations. The number of hospitals in Denmark has decreased from 150 in 1990 to 71 in 2011. Despite having relatively few medical facilities available, the quality of care has increased markedly. For reference, Denmark has one hospital per 79,000 people. The United States has one hospital per 57,300 people with an inferior standard of care.
Brenner persuaded three competing hospitals in Camden to provide information on approximately 380,000 hospital admissions from 2002 to 2007. One percent of patients were responsible for over 10 percent of admissions, costing $46 million.
Although assisting super-utilizers will not solve all of America’s health care problems, it is a step in the right direction. According to one doctor, even three or four patients visiting a hospital three or four times a week dramatically reduces a physician’s ability to treat other patients. Instead of ignoring the elements of society with real problems, we need to help them as a means of reducing the strain on the health care system. Brenner’s work clearly shows that improving a person’s social problems reduces health care costs across the board.