Center for Health Policy

Hospitals Can Cut Costs of Superusers

Hospitals can cut costs and improve patient care by setting up care delivery models that target Medicaid patients who have complex, unaddressed health issues and a history of frequent encounters with healthcare providers. These Medicaid “super-utilizers”–patients who accumulate large numbers of ED visits and hospital admissions that might have been prevented by inexpensive early intervention and primary care–are a relatively small group, yet they account for the majority of Medicaid spending, according to The Center for Medicaid and CHIP Services (CMCS).

  • Five percent of Medicaid beneficiaries account for 54 percent of the program’s total expenditures
  • One percent account for 25 percent of the program’s total expenditures
  • Eighty-three percent of the top 1 percent of users has at least three chronic conditions
    More than 60 percent of the top 1 percent has five or more chronic conditions

The agency highlights the details of six of the 10 programs in its 39-page informational bulletin.

Read more: How hospitals can control Medicaid ‘super-users’ – FierceHealthcare

Why Low-Income Patients Prefer Hospital Care to a Doctor’s Office

Patients with low socioeconomic status use emergency and hospital care more often than primary care because they believe hospital care is more affordable and convenient, and of better quality than care provided by primary care physicians, according to the results of a new study published in Health Affairs. “This study debunks the perception that low-SES individuals abuse the emergency room and need to be educated on its proper use,” said David Grande, MD, MPA, assistant professor of Medicine at Penn Medicine and senior author on the study. “To the contrary, these patients eloquently explained to us how we have built a health care system that incentivizes them to wait and get sick in order to get care that is more costly to society.”

Read more here