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Caring for the 'superutilizers' In a twist on the old saying, "Physician, heal thyself," Lancaster General Health is experimenting with delivering health care more efficiently and effectively.
Editorial
The idea is to coordinate the care of a small group of patients whose significant health problems and social needs are not being fully addressed.
These patients tend to hopscotch between hospitals and emergency rooms when they feel ill, leading to uncoordinated care and poor outcomes that lead to the next hospital or emergency room visit -- a costly and unhealthy cycle.
They are known as "superutilizers," because they account for 5-10 percent of patients but consume about 50 percent of U.S. health care costs.
Dr. Jeffrey Brenner, a family physician, recognized the problem in Camden, N.J., where one percent of patients was responsible for 30 percent of medical costs.
Brenner founded Camden Coalition of Healthcare Providers, an effort aimed at focusing on primary care, with a nurse practitioner and a social worker making home visits and helping these patients with matters such as paperwork, filling prescriptions and addressing health complaints as they arise.
The result: Brenner's first 36 patients saw a 40 percent drop in average monthly visits to hospitals and emergency rooms, and a 56 percent reduction in their average hospital bills.
Here in Lancaster County, a similar approach is being taken by LG Health to address the superutilizer population.
The health system's Superutilizer Project is assigning a psychologist, social worker, pharmacist, lawyer and case manager to work with such patients.
The project, launched in September 2011 at a cost of $71,000 for about 30 patients, has cut health care visits by 13 percent and emergency room visits by a third.
While costs rose 47 percent for those patients during the project's first year, the newness and small size of the project means a single hospitalization could throw the numbers off significantly, according to project director Dr. Jeffrey R. Martin, associate director of Family and Community Medicine at LG Health.
Martin sums up the data-driven approach in very human terms. The project's team, he said, is "worrying with people. They're walking with them through every aspect. They're going to their homes and seeing where they live."
And that's one of the keys to the program's success: targeting people's needs, and that means making sure the care fits the whole person. (In Camden, for example, some patients are encouraged to enroll in Alcoholics Anonymous or attend church services.)
The logic of the approach squares with federal statistics: People with chronic conditions, such as diabetes and heart disease, account for more than 75 percent of the more than $2 trillion spent on annual U.S. medical care costs, according to the Centers for Disease Control and Prevention.
In an age of rising health costs, delivering less expensive care that serves patients better is just what the doctor ordered.
LG Health's project assigns a psychologist, social worker, pharmacist, lawyer and case manager to work with superutilizer patients.
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