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Local Hospitals Look For Ways To Better Help Superusers

Dr. William Warning (left), director of Crozer-Keystone's Family Medicine Residency, with fellows in the innovative "superutilizer" program, Drs. Uchenna Emeche (seated) and Wendell Kellum photo credit: Pat Loeb

Dr. William Warning (left), director of Crozer-Keystone’s Family Medicine Residency, with fellows in the innovative “superutilizer” program, Drs. Uchenna Emeche (seated) and Wendell Kellum photo credit: Pat Loeb

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By Pat Loeb

PHILADELPHIA (CBS) — How many times have you sought hospital treatment in the last year?

If you’re like most people, the answer is once or not at all.

But for a tiny fraction of patients, the answer is in the double, or triple, digits.

They’re called superusers, super-utilizers, frequent fliers and that one percent of patients accounts for as much as 30 percent of health care costs.

Hospitals around the country are looking for ways to treat these patients more effectively so they don’t have to make so many return visits and some of them may be soon be getting help from the doctors coming out of an innovative fellowship run jointly by Crozer Keystone Health System and the Camden Coalition of Healthcare Providers.

“We have an issue in this community of people we’re not serving well, who were just falling through the healthcare cracks in our community and need really high-intensity, co-ordinated care to bring them back under control,” says Dr. William Warning, director of Crozer Keystone’s Family Medicine Residency program, who works with the fellows during their two days a week at the Delaware County system.

Doctors, Warning suggests, must act more as team leaders than individual practitioners, and their team will not be strictly medical care givers because the patients have complex needs that transcend their physical symptoms.

“Even if they have something like asthma or uncontrolled diabetes, usually what we found is that the asthma or the diabetes is not what triggers them to go into the hospital so often,” says Dr. Uchenna Emeche, one of this year’s fellows. “It may be issues with being unable to read, being unable to see the vial of insulin.”

The fellows are learning to identify patients with the complications that are likely to lead them to “superuse,” to determine what interventions are needed and to connect the patients with the resources they need.

“We find out we have a lot of resources that are untapped, that we don’t know about as physicians, that we need to bring together for the health of the patient,” says Warning. “It may be social services, it may be mental health services, it may be housing, stable housing. If you’re moving every month, you’re going to lose your medications and that’s a problem. We need to know about that. We need to have an advocate out there to help with that.”

Dr. Wendell Kellum, another of the fellows, says the superusers show the flaws in the current health care system.

“We need new models,” says Kellum. “Some of the most needy patients, for whom our system is most ineffective aren’t really seen with the priority the needs call for. We don’t see the need for reform because it’s only one percent of the population. But when one percent accounts for 30 percent of the cost we have to fix it. We have to do a better job for those people.”

“We want to make care better for everyone. This is an area where desiring the best for patients and desiring reform because of the urgency of medical costs come together.”

Emeche is not sure any health care system can do it alone. “It will have to be coupled with community development,” she says.

“If we can get the community to rally behind itself and say, ‘You are my neighbor. I will help you in some way to make sure you are living as healthy a life as you can.’ A very difficult road to get there but if we have people who are responding to the needs of others in little ways– to check on your neighbor once a week to make sure she’s taking her medication– that would be helpful. But that would require people taking it on themselves or organizations within a community taking on that role,” says Emeche.

“What we need is not more medicine, it’s more humanity.”

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