Denver Health Medical Center Studies How to Reduce Healthcare Costs Among Super-Utilizers

Aug 05, 2015, 14:58 ET from Denver Health Medical Center

DENVER, Aug. 5, 2015 /PRNewswire/ -- Researchers at Denver Health Medical Center conducted a cross-sectional and longitudinal analyses of 4,774 publicly insured or uninsured super-utilizers at Denver Health between 2011 and 2013. "Super-utilizers" are defined as people who use a large share of health care resources due to multiple chronic conditions and often, social or behavioral health risk factors. According to the study, which was published in the August issue of Health Affairs, a peer reviewed journal issued by Project HOPE, at any given time, three percent of adult patients at Denver Health meet the super-utilizer criteria and account for 30 percent of healthcare costs. However, the study also demonstrates that super-utilizers are not the same patients over time. Many super-utilizers have high usage episodes that are relatively short in duration. Only a small group of patients (approximately one-quarter) remain high utilizing one year later.

"The study, which was funded by a grant from the Center for Medicare and Medicaid Innovation (CMMI) identified clinically important subgroups among super-utilizers that may respond to different approaches to reduce avoidable health care use," said Dr. Tracy Johnson, Director of Health Reform Initiatives at Denver Health and the principal investigator of the study. "We have used these in-depth analyses of Denver Health patients who have experienced multiple hospitalizations to implement unique population health services tailored to their specific health and social risk profiles. This includes establishing a new primary care clinic that exclusively serves medically complex adults as well as adding new staff to follow up on hospitalizations and help support on-going care needs. This enhanced care team includes nurse care coordinators, clinical pharmacists, behavioral health consultants, social workers and patient navigators."      

The identification of clinically distinct subgroups has important implications for policy makers and for future program design aimed at containing healthcare costs. Previous studies have not fully explored why certain patients require frequent care in a manner that informs researchers when, where and how to optimally intervene.

Johnson hopes that the published analysis and subsequent program development by Denver Health can be a model for other organizations across the country as they tackle the complex issues of super-utilizers.  

CMS Disclaimer:  The Health Affairs publication was made possible by Grant Number 1C1CMS331064 from the department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The analysis presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the independent evaluation contractor.

Denver Health is the Rocky Mountain Region's Level I academic trauma center, and the safety net hospital for the Denver area. The Denver Health system, which integrates acute and emergency care with public and community health, includes the Rocky Mountain Regional Trauma Center, Denver's 911 emergency medical response system, Denver Health Paramedic Division, eight family health centers, 16 school-based health centers, the Rocky Mountain Poison and Drug Center, NurseLine, Denver CARES, Denver Public Health, the Denver Health Foundation and the Rocky Mountain Center for Medical Response to Terrorism, Mass Casualties and Epidemics.

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SOURCE Denver Health Medical Center