How to Curb Medicaid ‘Super-Utilizers’ in Hospitals

White J
Publication Year: 2013
Population Focus: Complex care, Medicaid beneficiaries, Vulnerable/disadvantaged
Demographic Group: Adult
Type of Literature: Grey


Insights Results

Overview of article

  • This article explores different approaches for hospitals to take to address the needs of super utilizers

Key takeaways/implications

  • As a way to keep super-utilizers from being such a financial burden, CMS has proposed several strategies hospitals can use. The key concept in these strategies is forming partnerships with primary care physicians and various healthcare providers to give patients better access to consistent care, along with other essential health services like mental health resources
  • An example of a program based on this principle is Camden Coalition’s program where for the past 10 years, the hospital has partnered with physician practices and other providers to improve the care for disadvantaged resident in Camden, NJ. The program has led to reduced emergency room visits and inpatient stays
  • Steps that must be taken for a program like Camden Coalition’s include: 1) Identifying the patients served (i.e., discerning how much of the patient mix falls in the disadvantaged category and whether they’re receiving Medicaid or are uninsured entirely); 2) Knowing what’s causing them to constantly seek hospital care; 3) Targeting the issues; and 4) Run a cost/benefits analysis to make sure the hospital is fully aware of the immediate cost that can be incurred by such interventions along with the potential benefits and savings in the long-term