Research shows that 50% of health care expenditures are attributable to 5% of the population individuals commonly referred to as “super-utilizers” of care. They are often the sickest patients, many of whom have three or more chronic conditions, and they visit the emergency department multiple times during a year. In response, a trend in health care delivery organizations is the increasing use of special programs or interventions aimed at super utilizers to reduce their health care use and costs.
The Lack of insurance
This includes barriers to primary care access; so lack of insurance or because they have many social needs that are not being addressed. Finding ways to decrease expensive emergency service use by better aligning patients with the care and services they need should both improve health outcomes and reduce costs.
Second, health care systems, emergency departments and insurance companies; hence are constantly looking for ways to improve care and decrease the use of the most expensive health care services. Again, super utilizers are a small proportion of patients but they account for a large proportion of health care expenditures.
It is also because of what researchers call regression to the mean. When a research study looks at people at the extreme end of a distribution of outcomes; so like the highest users of health care the next observation of the same people will look better just by chance, even without an intervention.
In other words, what looks to be a positive effect of an intervention is actually just normal variation in this population of patients who are extreme users of emergency health care services. So, only studies of super utilizers that have a comparison group can give us a good picture the effectiveness of a program or intervention.
Impact on reducing ED use
Our second key finding is that, among the studies with strong research designs and comparisons groups; so there is very little evidence that the interventions being use primarily case management; so approaches are having any significant impact on patient health care use. The strongest studies show weak to no impact of the approaches was use. Case management was the most common intervention evaluate in our study; but only one third of the case management interventions use a strong study design.
Of these, three show a relatively small yet significant impact on reducing ED use. Abir: they really want to stress the importance of conducting more high quality evaluation research in this area. These patients certainly have many medical and social needs that have to be address; but the current research literature does not provide the evidence; so to support claims that super-utilizer interventions that are spreading across health care systems are actual working.
It is always frustrating for policymakers and practitioners to hear that more research is needed. However, in the case of interventions addressing super utilizers of acute prehospital and emergency care; so it is indeed the case that additional high-quality evaluations of innovative interventions; hence are need to build a credible evidence base to improve health care delivery for this population.