HIDI HealthStats | April 2015

Hospital Super-Utilizers and the Importance of Transitions of Care in Missouri

The disproportionate concentration of health care consumption and expenditures among a small portion of the population is a well-documented facet of the health system in the U.S. The top 1 percent of the population consistently consumes more than one-fifth of health care resources, the top 5 percent account for half of all spending and half of the population accounts for 97 percent of health care utilization and expenditures. This differential is even more pronounced among patients with low socioeconomic status — the top 1 percent of Medicaid beneficiaries in the U.S. accounts for one-quarter of all program spending and the top 5 percent accounts for 54 percent of total health care expenditures.

The asymmetrical distribution of hospital utilization in Missouri mirrors national trends. During 2013, half of all Missouri inpatient and emergency department patients accounted for 96 percent of total costs and the top 10 percent accounted for 63 percent of total costs. The top cost decile included 145,684 unique patients who accounted for more than $5.7 billion in hospital spending for an average of $39,258 per person. This was more than 15 times the average expenditure for other patients during 2013.

Because of new paradigms in accountable care and population health management, one particular segment of high-cost patients — hospital “super-utilizers”— has been the focus of emerging models of patient-centered care delivery that concentrate on both medical and socioeconomic conditions. Throughout 2013 in Missouri, 18,544 individual patients, or 1.3 percent, visited an emergency room or were hospitalized on 10 or more occasions. These patients were significantly more likely to be uninsured or covered by Medicaid, which suggests opportunities exist for improved health outcomes and reduced health spending through Medicaid reform and expansion, including tenets set forth by emerging and innovative models designed around coordinating care for super-utilizing patients. The foundational elements of these models include robust data analysis and patient-centered transitions of care from the hospital to patients’ communities. This brief will focus on each.

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