Dive Brief:
- The Pennsylvania Health Care Cost Containment Council has classified 3% of patients hospitalized in Pennsylvania in fiscal year 2014 as "super-utilizers"—people who have been admitted at least five times in one year.
- Those 21,308 patients represent 11% of total admissions and 14% of hospital days for 2014, the report says. In terms of costs, they were responsible for 14% of Medicare payments for inpatient stays and 17% of Medicaid payments in 2012.
- The report did not try to determine how many of those hospitalizations should have been preventable via improved outpatient care, but the authors assume that some could have been, Joe Martin, executive director of PHC4, told Philly.com.
Dive Insight:
The report lists the top reasons for super-utilizer hospitalizations as heart failure, blood infections and mental-health disorders.
According to Michael Consuelos, SVP of clinical integration for hospital trade group Hospital and Healthsystem Association of Pennsylvania, super-utilizers typically have complex needs and limited access to primary and specialty care.
Consuelos found the degree to which behavioral health was a factor to be one of the most striking aspects of the report, he told Philly.com.
He notes that the report illustrates the importance of addressing the "social determinants of health," such as poverty, as well as the need to improve the coordination of mental and physical medical care—for example, by co-locating mental-health and medical providers.