In many regions across the country, “super-utilizer” programs providing intensive outpatient care management to high-need, high-cost patients are beginning to emerge. The term “super-utilizer” describes individuals 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 emergency department, from inpatient admission to readmission or institutionalization — all costly, chaotic, and ineffective ways to get better.
To discuss how Medicaid can advance models for this high-need group of patients, CHCS, in partnership with the National Governors Association, hosted the Super-Utilizer Summit on February 11 and 12, 2013 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. The meeting was supported by RWJF and the Atlantic Philanthropies.
Session I: Patient Identification, Data Analysis and Targeting
- Just a Few Thoughts About All this Stuff, John Billings, New York University
- The Camden Coalition of Healthcare Providers’ Approach to Risk Stratified Care Management, Ken Gross, Camden Coalition of Healthcare Providers
- Identifying Super Utilizers, Davis Mancuso, PhD, Washington State Department of Social and Health Services
- Community Care of North Carolina, Allen Dobson, MD, Community Care of North Carolina
Session II: Care Teams and Successful Care Interventions
- Super Utilizer Summit, Maria Raven, MD, University of California, San Francisco, School of Medicine
- Hennepin Health: People, Care, Respect, Jennifer DeCubellis, Hennepin County, Minnesota Human Services and Public Health Department
- Health Quality Partners’ Advanced Preventive Service, Ken Coburn, MD, Health Quality Partners
Session III: Creating Super-Utilizer Programs within a State
- Creating Super Utilizer Programs: Public and Private Models, Jan Stallmeyer, Aetna Medicaid
- Patients with Complex Medical and Social Needs in Minnesota Medicaid: “Thermal Spotting,” Jeff Schiff, Minnesota Health Care Programs
- Medicaid Chronic Care Initiative: Strategies for High Utilizers, Eileen Girling, Department of Vermont Health Access
Session IV: Integrating and Sustaining Super-Utilizer Programs within Delivery Systems
- Integrating and Sustaining Super Utilizer Programs within Delivery Systems, Michelle Mills, Center for Medicaid and CHIP Services
- New York State Care Management for High Need Patients, Greg Allen, State of New York
- Integrating and Sustaining Super-Utilizer Programs within Delivery Systems, Bill Hagan, United Healthcare
- Spectrum Health: The Medical Group, R. Corey Waller, MD, Center for Integrative Medicine
