Super-utilizers have a big impact on the healthcare industry, accounting for about half of the nation’s Medicare program expenditures – a disproportionate amount – they make up only five percent of the patient population.
Reducing their healthcare utilization and improving their overall health requires various needs to be addressed. According to the American Journal of Managed Care, it is not enough to focus on medical aspects, behavioral and social well-being must be attended to as well.
Introducing community navigators in the intervention stage has proven to be cost-efficient and effective in aiding vulnerable patients to overcome the obstacles in their way of receiving timely care without losing quality.
A study from researchers at the University of Tennessee Health Science Center and Methodist Le Bonheur Healthcare concluded community navigators can reduce subsequent hospital utilization in super-utilizers. The purpose of this study was to ascertain the effectiveness of community navigators in reducing hospital utilization and costs in super-utilizers. To determine the impact of the program, the researchers compared MLH hospital utilization and costs of a program called “Familiar Faces.” Methodist Le Bonheur Healthcare (MLH) system developed its program to address the needs of super-utilizers in one of the poorest zip codes in the Memphis area. The program aimed to help connect patients to health and social resources in their community and tailoring information to specific client needs. To control for typical patterns in utilization and costs in super-utilizers, researchers compared the changes in utilization and costs observed in Familiar Faces clients with similar data for super-utilizers in contiguous zip codes.
Results: Utilization and cost outcomes for intervention and control groups declined significantly from the pre- to postintervention periods. Relative to the control group, super-utilizers working with community navigators had an additional 13 percent reduction in hospital encounters, 8 percent reduction in total hospital days and 9 percent increase in days between encounters.
Read more about the study and its possible implications from Fierce Healthcare
To read more about how the study was conducted and its implications, visit AJMC.