Emergency Department Super-Utilizer Programs: Rural Health Systems Analysis and Technical Assistance Project

Authors
Christopher D. Stamy
A. Clinton MacKinney
Technical Assistance Tool
October 2013

This resource describes how to design, implement, and assess a “super-utilizer” (SU) program to address inappropriate care and reduce costs.

  • SU programs provide person‐centered interventions to improve overall health, bolster care coordination, reduce overutilization, and decrease spending through directed care management of individuals who disproportionately use health care services.
  • Hospitals are usually the ones to establish SU programs, but other organizations, such as payers or social service agencies, can establish them also.
  • Program goals may include fewer ED visits, lower costs for payers, and more primary care visits.
  • Data sources for programs may include ED visit data, claims data, and information from the Electronic Health Record.
  • Programs typically develop a series of activities, starting with initial contact (ideally while the potential participant is in the ED); case management, including referral to substance abuse services and housing assistance; and team outreach, consisting of home visits.
  • Programs can develop partners to help coordinate care, such as mental health centers, urgent care clinics, and primary care clinics.
  • These programs are likely to reduce payer costs, but are also likely to reduce hospital revenue as ED visits drop. To create the best financial incentives, the resource recommends shared savings agreements.
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Population Addressed
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • How can my organization reduce inappropriate emergency department (ED) use?
  • What have successful programs done to reduce inappropriate ED use?
  • What are the financial implications for programs that reduce inappropriate ED use?
Level of Evidence
Expert Opinion
What does this mean?