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

Warren Polk Newton; Ann Lefebvre

doi:10.1370/afm.1747

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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...
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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
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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....
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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
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Competing Interests: None declared.