Crozer-Keystone in partnership with CCHP to address superutilization

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Original Article:

The statistics give one pause, but are only part of the medical care equation.

Ten percent of the U.S. population uses 65 percent of the medical costs and in 2009, 1 percent of the population used 27 percent of health care expenditures.

With costs escalating and an aging population that will continue to need more advanced attention, medical care is anticipated to become more expensive, which is a concern for many Americans and businesses.

But, there’s also the question of adequate care and patient experience, especially for those with frequent emergency room and inpatient visits.

“There’s a big need in America based on these statistics,” said Dr. William Warning, director of Crozer-Keystone’s Family Medicine Residency and one of the overseers of the Superutilizer Fellowship. “I don’t think we are serving these patients well if we are admitting them. There are just people who superutilize and can be better managed … and it turns out it’s cheaper.”

One of the ways Crozer-Keystone is addressing this phenomenon is through the Superutilizer Fellowship, which is a partnership with the Camden Coalition of Healthcare Providers in which two physicians, Steven Sluck, D.O. and Stephanie Watkins, D.O., are identifying and caring for superutilizers while developing models for other health care providers to use.

Through a $175,000 Aetna Foundation grant, Sluck and Watkins split their time between Delaware County and Camden, N.J., to delve into the dynamics that create superutilization and how to best address it.

Warning said Crozer identified 557 patients last year that had been admitted into the system three or more times. He said Sluck and Watkins are in the process of paring that to the top superutilizers – those he identified as visiting the hospital 12 or more times a year.

So far, Sluck said many of these patients have behavioral health and complex social needs.

“Some of the things we are learning is that the diagnoses of these patients vary greatly,” he explained. “It’s not a cookie cutter thing.”

That’s why a multi-faceted approach is required, as well as engagement of different resources such as social workers, Sluck said.

Warning said a team of professionals would be called upon to help these individuals and that would include a family physician, a nurse care manager, a doctorate level psychologist, a clinical pharmacist and a social worker.

Dr. Jeff Brenner, who has been championing this work for more than a decade as executive director of the Camden Coalition of Healthcare Providers, agreed.

He explained the dynamic at the forefront of his career.

“I really felt as a single provider in an office, I was meeting people whose needs were larger than I had tools to deal with,” Brenner said.

He found that the former, authoritative approach of a physician telling a patient unequivocally what to do didn’t work with patients who were overwhelmed. Instead, teams of professionals with different techniques to the variety of issues were more effective.

The doctors and hospitals are brilliant, he said. It’s the system that needs change.

“It’s the story of a really, really broken health care system,” Brenner said. “It’s just not adding up anymore.”

And, it will require deep emotional transformation.

“A lot of the patients who use a significant amount of health care services have early life trauma,” he explained. “In some ways, we’re playing out the traumas that got them in the first place.”

Through the support and the follow-up created through the teams, these patients can learn to advocate for themselves, Brenner explained.

It’s an approach that’s found impact at Crozer-Keystone.

Warning and Sluck shared the anecdote of a man who was admitted to the hospital 12 times and had seven emergency room visits on top of that over a 12-month period in 2010-2011.

They started to look at why that occurred and found that the man had a cognitive deficit in which he lost a sense of time and wasn’t taking his medications adequately, so, now, his wife is in charge of that.

“It seems so easy what we did with this patient,” Warning said, “but no one ever said, ‘Whoa! That’s a lot.’”

Both Warning and Brenner hope that these two fellows will continue their work in tackling this behemoth in American health care.

“They’re fun, they’re energetic,” Brenner said. “I want to see them stand up and be leaders.”

For them to do so, Warning added, could result in effective systemic change.

“It’s all about taking the medical care to another level,” he said. “I think it’s what the nation needs. These people exist everywhere and we can make a difference.”

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