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Defined: Super-Utilizers

One group of patients, also known as frequent fliers, account for a disproportionate share of health care spending: super-utilizers.

FALL 2013
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super-utilizers [sü-pər yü-tə-ˌlīz-ərs] n: patients with multiple chronic conditions who overuse emergency departments and hospital inpatient services, and who are the focus of increasing efforts to coordinate care and thus keep them out of the hospital.

Also known as “frequent fliers,” these patients often have a history of substance abuse or mental illness and have trouble getting consistent primary care because they are homeless, lack transportation or health insurance, or don’t understand how to use the health care system.

Because their care is poorly coordinated, super-utilizers account for a disproportionate share of health care spending. In 2002, Jeffrey Brenner, a physician in Camden, N.J., examined insurance claims data from local hospitals and discovered that 20% of the patients in Camden were responsible for 90% of the hospital costs. Brenner joined with three local hospital systems and other providers to form the nonprofit Camden Coalition of Healthcare Providers. They launched a citywide program that provides super-utilizers with coordinated care that’s more cost effective. A care management team made up of a social worker, a health outreach worker and a nurse practitioner helps the patients obtain medical and social services, get transportation to medical appointments, find housing, and apply for government benefits.

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