In many regions across the country, "super-utilizer" programs providing intensive outpatient care management to high-need, high-cost patients whose complex physical, behavioral, and social needs are not met through the current fragmented health care system. As a result, these individuals often bounce from emergency department to inpatient admission to readmission or institutionalization, in costly, chaotic, and ineffective ways
Super-utilizer programs strive to improve care coordination and overall quality, and help control spending through reductions in avoidable utilization, such as repeat emergency department visits and inpatient readmissions. Since low-income individuals overwhelmingly comprise this high-need population, Medicaid programs are well-positioned to partner with community-based programs to design strategies to more effectively reach super utilizers.
To discuss how Medicaid can advance models for this high-need group of patients, Center for Health Care Strategies
(CHCS), in partnership with the National Governors Association, hosted the Super-Utilizer Summit earlier this year in Alexandra, Virginia. The summit brought together leaders from more than 10 states, super-utilizer programs across the country, the Centers for Medicare & Medicaid Services, several Robert Wood Johnson Foundation (RWJF) Aligning Forces for Quality alliances, health plans, and other key stakeholders to share strategies for changing how our health care system interacts with these individuals...