Is a Strategy Focused on Super-Utilizers Equal to the Task of Health Care System Transformation? Yes

Uchenna Emeche

doi:10.1370/afm.1746

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Author response: PCMH SU difference
Uchenna Emeche

Published on: 16 January 2015
Tactic in larger strategy to reform and innovate health care delivery
Jason Turi

Published on: 15 January 2015

Published on: (16 January 2015)
Page navigation anchor for Author response: PCMH SU difference
Author response: PCMH SU difference
Uchenna Emeche, Associate Medical Director
I agree with you Jason.
One point that I was not able to go into as much as I wanted (and the one point distinguishing SU work from PCMH) is the inherent understanding that health extends beyond the 4 walls of a physician's office. The ideals of PCMH are not yet being implemented in many PCMH practices which primarily focus on meeting clinical goals. Some PCMHs also focus on higher utilizing patients who ofte...
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I agree with you Jason.
One point that I was not able to go into as much as I wanted (and the one point distinguishing SU work from PCMH) is the inherent understanding that health extends beyond the 4 walls of a physician's office. The ideals of PCMH are not yet being implemented in many PCMH practices which primarily focus on meeting clinical goals. Some PCMHs also focus on higher utilizing patients who often are super utilizers not just on the inpatient side, but the outpatient side as well. However, the interactions with these higher utilizing patients is often based on what is billable, as opposed to how and what will truly impact change in a patient's health.
SU work is so transformational because it moves beyond an understanding that health extends beyond the walls of an office by employing strategies with patients and community partners that reinforce this concept -- meeting patients where they are as opposed to meeting patients where we want them to be. These are the strategies we need to move the needle on cost and quality of care -- how can we efficiently get patients (especially super-utilizers) to a point where they experience improved health (both perception and outcomes)? Shifting our collective mindset from what can we do to or for patients to how can we form effectively partnerships with them -- and figuring out who is best suited to form these partnerships with patients; physicians can't do it alone for every high utilizing patient. Outcomes from this strategy are already driving some initiatives in payment reform which will ideally allow for such strategies to spread and become sustainable.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (15 January 2015)
Page navigation anchor for Tactic in larger strategy to reform and innovate health care delivery
Tactic in larger strategy to reform and innovate health care delivery
Jason Turi, Associate Clinical Director, Care Management Initiatives
Nascent super utilizer interventions should be conceptualized as tactics in broader health care system reform and innovation initiatives. These interventions are often times being implemented in conjunction with payment reform, health IT overhaul, in/out patient clinical redesign efforts, and integration of social and behavioral services just to name a few. Learning and relationship building both within and between organ...
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Nascent super utilizer interventions should be conceptualized as tactics in broader health care system reform and innovation initiatives. These interventions are often times being implemented in conjunction with payment reform, health IT overhaul, in/out patient clinical redesign efforts, and integration of social and behavioral services just to name a few. Learning and relationship building both within and between organizations and systems is an important product of these interventions and is desperately needed in our current fragmented system of care delivery. Focusing on complex patients often uncovers larger system barriers that directly impact efforts to realize the Triple Aim, these lessons can be broadcasted to leadership to initiate rapid cycle improvement efforts and further root cause analysis of problems and experiment with possible solutions.
Competing interests: None declared
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Competing Interests: None declared.