PHC4 Looks at “Super-Utilizers”
The Pennsylvania Health Care Cost Containment Council has released a new research brief on so-called super-utilizers: a small portion of the population that consumes an inordinate amount of health care. Super-utilizers are defined as individuals with five or more hospital admissions a year.
According to the PHC4 report,
- Three percent of hospitalized patients accounted for 10 percent of hospital payments, or $1.25 billion, in 2016.
- Super-utilizers accounted for three percent of hospitalized patients, 10 percent of hospital payments, 12 percent of hospital admissions, and 15 percent of hospital days.
- 46 percent of that care was paid for by Medicare, 19 percent by Medicaid, and 19 percent was for dually eligible patients.
- The top three reasons for admissions among super-utilizers were sepsis, heart failure, and mental health disorders.
- Diabetes and alcohol and substance abuse disorders were among the leading causes of admission for Medicaid patients.
- The highest rates of super-utilizers were among blacks, low-income individuals, and older people.
The PHC4 report breaks down super-utilizers by county and shows the reasons for super-utilizers’ hospital admissions. Its side-by-side comparison of 2012 and 2016 shows a decline in super-utilizer admissions to hospitals, perhaps because of efforts by hospitals to reduce admissions and avoid Medicare penalties for avoidable hospital readmissions.
Go here to find the PHC4 report Pennsylvania’s “Super-Utilizers” of Hospital Care.
Among the issues addressed in the letter are how the House-passed proposal would detract from the role of Medicaid in fighting the state’s opioid crisis; the proposed reduction in tax credits to help purchase health insurance; the challenge posed by a per capita approach to Medicaid financing; the potential loss of health care jobs; the likelihood of large numbers of Pennsylvanians losing their health insurance and state Medicaid costs rising significantly; and the erosion of consumer protections.
Included in this edition are articles on new criteria for Medicaid coverage of high-cost hepatitis C drugs and the release of a draft of the state’s proposed Medicaid quality strategy; an update on Community HealthChoices, Pennsylvania’s new program of Medicaid managed long-term services and supports; an overview of Medicaid-covered behavioral health services; a summary of recent federal proposals with implications for the state’s Medicaid program; and a report on the nomination of Teresa Miller to lead the new Department of Health and Human Services that Governor Wolf has proposed establishing.
, the National Academies of Sciences, Engineering, and Medicine addresses the question of what social risk factors might be worth considering in Medicare value-based payment programs and how those risk factors might be reflected in value-based payments.
Under the new criteria, patients with lower scores of severity of hepatitis C will become eligible for treatment. Previously, Medicaid patients were required to show more advanced signs of illness before the medicine was provided to them.
Governor Tom Wolf offered such a proposal in his FY 2018 budget message and the Pennsylvania General Assembly is now weighing the merits of this proposal.