Posts Tagged ‘high utilizers’

Infographic: 7 Critical Steps in Caring for High-Need, High-Cost Patients

November 13th, 2015 by Melanie Matthews

Patients with multiple health problems, often referred to as high-need, high-cost patients, often need assistance with areas outside of the typical medical environment, such as housing and everyday tasks in managing their health, according to a new infographic by The Commonwealth Fund.

The infographic looks at seven key features of programs that are effective in managing these patients.

7 Critical Steps in Caring for High-Need, High-Cost Patients

Asked by its C-suite to quantify contributions of its multidisciplinary care team for its highest-risk patients, AltaMed Health Services Corporation readily identified seven key performance metrics associated with the team. Having demonstrated the team’s bottom line impact on specialty costs, emergency room visits, and HEDIS® measures, among other areas, the largest independent federally qualified community health center (FQHC) was granted additional staff to expand care management for its safety net population.

Care Coordination of Highest-Risk Patients: Business Case for Managing Complex Populations chronicles AltaMed’s four-phase rollout of care coordination for dual eligibles—a population with higher hospitalization and utilization and care costs twice those of any other population served by AltaMed.

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Hospitals: Chronic Disease Leading Cause of Avoidable ER Visits in 2014

December 4th, 2014 by Cheryl Miller

High utilizers continue to be responsible for the majority of avoidable emergency room (ER) visits, with chronic disease edging out pain management as the top complaint among this population, according to respondents to the third comprehensive survey on reducing avoidable ER visits, conducted in August 2014 by the Healthcare Intelligence Network (HIN). A total of 125 healthcare organizations described tactics employed; nearly one third (32 percent) of which were identified as hospitals/health systems. A sampling of this sector’s results follows.

While the majority of hospitals/health systems were likely to have such a program in place (53 percent versus 69 percent of all respondents), of those that didn’t, just 25 percent planned a future program, compared to 47 percent of all respondents. Less than one half of hospital respondents (47 percent) felt that eased telehealth regulations would curb avoidable ER use.

This sector was twice as likely to find high utilizers generating the majority of avoidable ER visits (78 percent versus 31 percent of all respondents) and least likely to target Medicaid (10 percent versus 28 percent of all respondents). Chronic disease was the most frequently presented problem among this sector’s high utilizers (78 percent versus 54 percent).

In terms of patient level solutions, this sector was half as likely to utilize telephonic outreach (33 percent versus 60 percent), and twice as likely not to conduct follow-up phone calls with those discharged from the hospital (30 percent versus 15 percent). In terms of staff level solutions, this sector was more likely to use hospitalists (22 percent versus 10 percent for all respondents) and onsite educators/coaches (22 percent versus 11 percent for all respondents) and least likely to use disease-specific care coordination (11 percent versus 38 percent for all respondents). This sector was also least likely to notify PCPs of care gaps (22 percent versus 41 percent).

When asked to identify the greatest impact on overall ER efficiency, 70 percent of hospital respondents cited fast-tracking of non-urgent care, versus 33 percent of all respondents. Among the challenges of reducing avoidable ER visits, redirecting the non-urgent was considered a top obstacle for 3 percent of hospital/health system respondents, versus 18 percent of all respondents.

And 40 percent of this sector saw reductions in avoidable ER visits of between 0 to 5 percent, versus 26 percent of all respondents.

Source: 2014 Healthcare Benchmarks: Reducing Avoidable ER Visits

2014 Healthcare Benchmarks: Reducing Avoidable ER Visits delivers actionable metrics from 125 healthcare organizations on their efforts to foster appropriate use of hospital emergency departments. Enhanced with more than 50 easy-to-follow graphs and tables, this third edition of comprehensive data points presents year-over-year trends and best practices for engaging ER and hospital staff, primary care physicians, community providers and patients in reducing avoidable ED utilization.