Data Collection and Healthcare Analytics Strategies for Identifying Superusers
May 21, 2014 | Delia Caldwell
While emergency department usage is by its nature random for most individuals, there is a small percentage of the population for whom it is a more common occurrence. These are the superusers, and almost every ED has its share. For efficiency’s sake, what’s the best way to serve these individuals?
To begin with, it’s essential to understand some of the factors that tend to characterize superusers. Where the average individual may visit the ED once or twice in a given year, superusers are more likely to have dozens, scores, or even hundreds of visits in the same period.
Another common characteristic of superusers is that they tend to lack both insurance and the resources to pay in cash. In such cases, the hospital or a government agency generally steps in to absorb the cost, which means that ultimately, either insurance costs or taxes must be raised. A related problem is that some of these patients end up being admitted and readmitted to the hospital for the same condition, a phenomenon that can lead to some frustration on the part of medical staff. Even worse, the hospital can face reduced reimbursement, not to mention significant lost revenue related to those patients with no ability to pay for care.
Because of socioeconomic and behavioral health issues, or a lack of convenient alternatives, superusers pose a significant challenge. In the case of behavioral health issues, for example, inpatient beds and community services are often in dwindling supply.
A Proactive Approach
At FreemanWhite, we believe that it’s far better to be proactive than reactive on this matter, and to find different levels of care that give superusers a reason to have their needs met in a setting other than the ED. The key is being able to identify the superusers, and find trends and common characteristics that might point to better ways to give them access to the care they seek.
For example, hotspotting may indicate a concentration of patients with similar care needs all living within a certain zip code. These patients may be better served with services closer to where they live. In conjunction with hotspotting, outpatient solutions can be managed either by a health care provider, population health manager, or such groups as Accountable Care Organizations (ACOs).
Another approach is to provide basic, proactive education in the ED at the time of treatment regarding alternatives, and helping the patients to sign up for relevant clinics. Many of these patients can also benefit from ongoing human intervention, including care at home, enrollment in primary care, transportation for follow-up appointments and other social services.
By understanding and targeting superusers effectively, organizations may reduce the strain on emergency departments, better meet the needs of superusers, and allow the ED staff to focus their time and energy on patients for whom the ED setting is the most appropriate.