Across the country, robust “super-utilizer” programs providing intensive outpatient care management to high-need, high-cost patients are taking root. The term “super-utilizer” describes individuals whose complex physical, behavioral, and social needs are not well met through the current fragmented health care system. As a result, these individuals often bounce from emergency department to emergency department, from inpatient admission to readmission or institutionalization — all costly, chaotic, and ineffective ways to provide care and improve patient outcomes.
To explore how Medicaid could best advance models for this high-need group of patients, the Center for Health Care Strategies (CHCS), in partnership with the National Governors Association, hosted a Super-Utilizer Summit in February 2013. The meeting was made possible through the Robert Wood Johnson Foundation (RWJF) and The Atlantic Philanthropies. The Summit brought together leaders from super-utilizer programs across the country, states, the Centers for Medicare & Medicaid Services, RWJF’s Aligning Forces for Quality alliances, health plans, and other key stakeholders to share strategies for changing how our health care system interacts with these high-need, high-cost patients.
This report presents the Summit’s common themes and key recommendations for building better systems of care for high utilizers. The appendices include practical materials related to existing complex care management programs that can be educational resources for states and policymakers considering ways to implement, spread, and sustain such programs.