Dollars from data: using information technology to identify the health system's most frequent users can lower states' costs.

• Author: Waugh, Lisa
• Position: HEALTH CARE

Flor Rosario was in and out of Allentown, Penn., hospitals almost weekly for several years because of a recurring cycle of anxiety and asthma that left her unable to breathe easily.

Ten miles away in Bethlehem, Jenny Hassan would end up in the hospital emergency room once or twice a week, often arriving by ambulance. Her bipolar disorder prevented her from properly managing her diabetes and keeping a job. According to the local newspaper, The Morning Call, both these women's lives were spiraling out of control until a health care coordination program helped address the complex underlying issues that were preventing them from stabilizing their lives and their health.

Rosario and Hassan were what are called "super-utilizers"--the 5 percent of patients who account for 55 percent of overall health care costs, according to the Kaiser Commission on Medicaid and the Uninsured.

The Top 5%

Because of their many, often mismanaged, health conditions, people like Rosario and Hassan too frequently end up in costly ambulances and hospital emergency rooms, as well as county jails and social safety net programs, such as homeless shelters. Their health care bills account for a disproportionate share of health spending and drive up Medicaid costs.

Along with several chronic medical conditions--diabetes, asthma, kidney disease, congestive heart failure--around 30 percent of super-utilizers also have behavioral health issues, such as substance abuse, anxiety or depression, that complicate their medical care. Added to that is the fact that various mental health issues tend to be exacerbated in patients as their medical problems worsen and their independence decreases.

With the rising costs of Medicaid and other state-funded health services, identifying super-utilizers and helping them manage their care has emerged as a promising strategy to control costs.

"Patients with multiple chronic illnesses tend to have extremely high and unpredictable health care expenses," says Colorado Senator Irene Aguilar (D).

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"As a physician, I have seen the benefits of improved care coordination for people with multiple chronic illnesses," she says. "As a legislator I am convinced of the cost savings associated with programs for super-utilizers."

The Data Piece

The challenge is finding the super-utilizers, and that's where information technology helps.

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Some states are tracking down super-utilizers thanks to improvements in data...