Monday, January 23, 2017

HEALTH CARE - The 'Super-Utilizers' Issue

"A way to save money when half of all health costs is spent on a fraction of patients" PBS NewsHour 1/17/2017

IMHO:  If the Republicans had their way, these people would just be thrown out.  'They cost too much' (a nice Christian attitude).


SUMMARY:  Health care “super-utilizers” make up just 5 percent of the U.S. population but they account for 50 percent of health care spending.  As health care costs continue to rise, providers are trying to figure out how to find these patients and get to the root of their problems.  But the looming repeal of the Affordable Care Act may disrupt those efforts.  Special correspondent Sarah Varney reports.

JUDY WOODRUFF (NewsHour):  How some lesser-known changes to health care might fare, given President-elect Trump's vow to repeal the Affordable Care Act.

One of those involve so-called “super utilizers” — high-cost patients who frequently turn to emergency rooms for problems better handled by primary care doctors and social workers.

Special correspondent Sarah Varney reports.

This story was produced in collaboration with our partner Kaiser Health News.

SARAH VARNEY, Special correspondent:  Protective gown.  Rubber gloves.  Face mask.  Dayna Gurley is getting dressed for work.  She's a social worker charged not with treating infectious diseases, but with figuring out why her clients all but live in Houston's hospitals.

DAYNA GURLEY, Social Worker:  What's been going on?

SARAH VARNEY:  This patient, who asked not to be identified, has chronic massive ulcers, AIDS, hears voices, and, at times, spends three weeks out of the month at multiple hospitals around Houston.

Gurley is part of a promising effort in the U.S. health care system:  Honing in on so-called “super-utilizers,” patients with complex problems who frequent emergency rooms and cost public and private insurers dearly.

Super-utilizers make up just 5 percent of the U.S. population, but they account for 50 percent of health care spending.  As health care costs continue to rise, providers are trying to find these patients and get to the root of their problems.

An effort to do just that started in New Jersey's poorest city, CamdenFamily physician Dr. Jeffrey Brenner was inspired by how police departments were using crime data to detect hot spots.  To find Camden's health care hot spots, Brenner dug into ambulance records and E.R. data to show how high-cost patients were shuttling between city hospitals.

DR. JEFFREY BRENNER, Camden Coalition of Healthcare Providers:  In America, we're medicalizing social problems, and we're criminalizing social problems, and we're wasting huge amounts of public resources.

SARAH VARNEY:  To steer super-utilizers away from expensive emergency care, Brenner's team, including social workers Latonya Oliver and Bill Nice, seek patients out in local neighborhoods.

BILL NICE:  There's been a few patients that I have had like that…

SARAH VARNEY:  They work intensively with people like Peter Bowser.

Bowser was once homeless, and went to the E.R. 28 times in one year.

PETER BOWSER:  Because I was telling people when I was staying in the shelter, I said, ‘When I get my place,' I said, ‘I'm going to maintain it.'

SARAH VARNEY:  But after they helped get a permanent roof over his head, Bowser's trips to the E.R. all but stopped.

BILL NICE:  And I think you would prefer to spend your time here than the hospital any day of the week…

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