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Research ArticlePoint/Counterpoint

Is a Strategy Focused on Super-Utilizers Equal to the Task of Health Care System Transformation? No.

Warren Polk Newton and Ann Lefebvre
The Annals of Family Medicine January 2015, 13 (1) 8-9; DOI: https://doi.org/10.1370/afm.1747
Warren Polk Newton
1Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
2North Carolina Area Health Education Centers, University of North Carolina, Chapel Hill, North Carolina
MD, MPH
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  • For correspondence: Warren_Newton@med.unc.edu
Ann Lefebvre
1Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
2North Carolina Area Health Education Centers, University of North Carolina, Chapel Hill, North Carolina
MSW, CPHQ
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  • Yes... and no.
    Lee A. Green
    Published on: 15 January 2015
  • Community of Solution may be a strategy for "super-utilizers"
    Jack Westfall
    Published on: 14 January 2015
  • Published on: (15 January 2015)
    Page navigation anchor for Yes... and no.
    Yes... and no.
    • Lee A. Green, Professor and Chair

    In the classic academic paradigm of thesis, antithesis, and synthesis, the synthesis in this case is almost too easy. Is a focus on super-utilizers "the" answer? No, but is it "an" answer? Absolutely.

    Of course anything potentially valuable that's done cynically can be detrimental. Just because some insurers or health systems misuse the concept of the super-utilizer doesn't invalidate it, though. Administrators...

    Show More

    In the classic academic paradigm of thesis, antithesis, and synthesis, the synthesis in this case is almost too easy. Is a focus on super-utilizers "the" answer? No, but is it "an" answer? Absolutely.

    Of course anything potentially valuable that's done cynically can be detrimental. Just because some insurers or health systems misuse the concept of the super-utilizer doesn't invalidate it, though. Administrators looking at spreadsheets may not distinguish the expensive myeloma patient needing bone marrow transplant from the expensive patient with remediable social determinants and medical home needs - but family physicians can and do. That's why family physicians practicing a PCMH model, using team-based and systems-based care approaches, not insurance companies or administrators with no, or only subspecialty, clinical experience, should be driving super-utilizer intervention programs.

    Done right, the understanding and skillset needed to help super-utilizers is a close fit for, really a subset of, the concepts and skillset needed to be a proper medical home practice. If addressing the needs of super-utilizers can be the hook that lets family physicians lead their health systems to develop and implement those concepts and skills, great! All patients, not just super-utilizers, win. If those health systems take a naive, poorly thought out approach, falling for the siren song, it's our job as family physicians to stuff some wax in their ears, educate them, and get them on a constructive course.

    Competing interests: None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (14 January 2015)
    Page navigation anchor for Community of Solution may be a strategy for "super-utilizers"
    Community of Solution may be a strategy for "super-utilizers"
    • Jack Westfall, Family Doctor

    Newton and Lefebvre are brave to buck the current trend of focusing on the "super-utilizers" in our society. Today's medical literature and lay media is full of articles on super-utilizers and how to identify them, treat them, help them, and cut medical costs. But these "super-utilizers" are really individual people with so many health and social needs. They are not a drag on society or the reason for high medical costs....

    Show More

    Newton and Lefebvre are brave to buck the current trend of focusing on the "super-utilizers" in our society. Today's medical literature and lay media is full of articles on super-utilizers and how to identify them, treat them, help them, and cut medical costs. But these "super-utilizers" are really individual people with so many health and social needs. They are not a drag on society or the reason for high medical costs. Super-utilizers are sentinel patients in a dis-integrated health and medical system. They are the proverbial canaries in a coal mine letting us know that something in their community is not working well. And, as sentinels, they tell us we are all at risk. Fixing a "super-utilizer" does not fix the system. Super-utilizer is a derogatory term that should not be used to describe a suffering human.

    The old notion of the Community of Solution may be part of the answer. The Community of Solution recognizes that there are problem sheds, places where health is just not as good; where social determinants of health have broken down, where primary care, public health, and behavioral health don't work together. But Communities of Solution also have asset sheds; people and programs and practices that can and will come together to address community and system issues. Our problems are not individual "super-utilizers". Our problems are the cold-spots they live in.

    Cold-Spotting http://www.jabfm.org/content/26/3/239.full
    Community of Solution http://www.annfammed.org/content/10/3/250.full

    Thanks to Newton and Lefebvre for calling this to our attention. Follow the song of the canary, not the siren.

    Competing interests: None declared

    Show Less
    Competing Interests: None declared.
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The Annals of Family Medicine: 13 (1)
The Annals of Family Medicine: 13 (1)
Vol. 13, Issue 1
January/February 2015
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Is a Strategy Focused on Super-Utilizers Equal to the Task of Health Care System Transformation? No.
Warren Polk Newton, Ann Lefebvre
The Annals of Family Medicine Jan 2015, 13 (1) 8-9; DOI: 10.1370/afm.1747

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Is a Strategy Focused on Super-Utilizers Equal to the Task of Health Care System Transformation? No.
Warren Polk Newton, Ann Lefebvre
The Annals of Family Medicine Jan 2015, 13 (1) 8-9; DOI: 10.1370/afm.1747
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