Super-utilizer success stories
Katie Carpenter | 07.17.13
Super-utilizers have a range of complex medical problems that prevent them from getting the appropriate care they need.
Super-utilizers are 5% of the patients who account for more than half of all healthcare costs.
These patients have a range of complex medical problems, that also may involve mental health issues and economic challenges that prevent them from getting the appropriate care they need.
Many rely heavily on emergency care because their needs were not met by traditional primary care. And, these repeat visits result in huge hospital bills.
But now, there's hope. Take a look...
WellSpan Health’s Bridges to Health program: Carole’s story
In October of 2012, Carole Hicks had a heart attack and needed open heart surgery. Then in December, she lost her job and with that, her healthcare.
She says, “And, the day before I lost my job, my mom died and whole bunch of other things started happening so I was going into a depression.”
Following that in January, Carole had another heart attack. Because she didn’t have insurance anymore, she couldn’t see her doctor for her complex health issues, including coronary artery disease, diabetes, sleep apnea, anxiety and depression and issues with her legs and feet. Carole says:
“One day, when I was at my very worst, Bridges to Health called me and told me about their program. And, I went in, and they have been amazing.”
WellSpan Health’s Bridges to Health program is one of the Super-utlizer programs in Central PA, working to reduce hospital costs while improving the healthcare system to meet the needs of these high-use patients. But most-importantly… the goal is to transform lives.
Take a look at Carole’s health transformation story:
Carole says, “I don’t know where I’d be if it wasn’t for Bridges to Health today.” They’re helping her find a job that suits her disabilities, and getting her on track with her medications and appointments.
This team seeks to understand and address the patient’s barriers to good health.
The program features a compassionate care team made up of a primary care physician, a social worker and a nurse manager who work alongside other health professionals and social workers to surround and support the patient on their journey to better health.
This team seeks to understand and address the patient’s barriers to good health and provide care through a combination of appointments and drop-in visits as well as home and telephone contact.
Carole says, “My team is awesome. From my first day in there, they have been friendly and compassionate- willing to do whatever it takes to make me feel better. We’re taking it one step at a time to bring me back to where I can lead a good lifestyle.”
According to WellSpan, “Bridges to Health” is improving quality while decreasing the cost of care by more than 25 percent. And, it’s helping patients take back control of their health by giving them what they need most- hope.
“I thank God for Bridges to Health every single day every day. I didn’t have a smile on my face in January, but today there’s one there- so that’s a good thing,” she says.
PinnacleHealth’s Community Health Navigation Network: Bruce’s story
Bruce Byrd was in a lot of pain after suffering a heart attack back in September and found himself in the ER every other day seeking care.
But, the fact that he was homeless made his situation that much harder.
With the support of PinnacleHealth’s Community Health Navigation Network, Bruce is off the streets, taking his meds regularly, and has a new lease on life.
Watch Bruce’s story:
Lancaster General Health’s Super-utilizer Project: Jesus' story
Jesus Alvarez, a Lancaster resident, was in and out of the hospital constantly with a complex range of health issues including asthma, heart problems, leg ulcers, and obesity.
His problems and his medical bills were spiraling out of control… Until a program at Lancaster General Health helped him get back on track.
The Super-utilizer project helped him lose 145 pounds with gastric bypass surgery, provided him with a lawyer to help sort out his financial situation, and helped him reduce his visits to the hospital.
And, it’s given him a quality of life that he had never experienced before.
This is his story:
About the Super-utilizer Collaborative:
We spoke with the patients you met above at a regional learning collaborative around “super utilizers” of health care in May. WellSpan received a $125,000 grant from the Highmark Foundation to form this collaborative which will work as a regional team to improve the patient experience, increase access to care, and decrease hospital costs.
Yvonne Cook, president of the Highmark Foundation said:
"The WellSpan collaborative project exemplifies the Highmark Foundation’s mission of improving the health, well-being and quality of life for individuals our communities.”
She added, “We are committed to making advances in care delivery in the communities Highmark serves, and by doing so, the Foundation remains at the forefront of the region's health care issues, well-equipped to pinpoint issues that most urgently need support.”
The model being used to guide the collaborative is based on the research of nationally-recognized Camden, NJ physician, Jeffrey Brenner, MD. Listen to an interview with Dr. Brenner about "hotspotting" high-use patients.
Participants in the collaborative are WellSpan Health, Lancaster General Health, PinnacleHealth, Neighborhood Health Centers of the Lehigh Valley and Crozer-Keystone Health. And, the direction of the collaborative will occur under the regional efforts of Aligning Forces for Quality- South Central PA.
Listen to this episode of Radio Smart Talk on local super-utilizers, featuring WellSpan Health and Lancaster General Health.
Tagged under Aligning Forces for Quality, communication, community, costs, doctor, emergency room, health care, Jeffrey Brenner, Lancaster General Health, patient, PinnacleHealth, quality, superutilizer, video, WellSpan Health