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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.

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2012 Safety-Net Association of Pennsylvania