ED ‘Superusers’ Have Unmet Needs Beyond Their Symptoms

Urgent care has taken root, among other reasons, based on its capability to treat patients who otherwise would be sitting (and waiting) in local hospital emergency rooms with nonemergent illness and injury. This benefits not only our industry and the patients who need urgent care, but also those patients who will find a less-crowded ED than they might find in a world without urgent care. And some of them—particularly those covered by Medicare and Medicaid, for whom covered ED visits are unlimited—really do need to be there even if their clinical symptoms don’t scream emergency, according to a new study by Kaiser Permanente that identifies ED “superusers.” These ED frequent flyers tend to have more complex social problems and social needs than the typical person. Even so, studies show that ED utilization can still be reduced among the top 1% of superusers (who account for nearly 25% of healthcare costs for Kaiser). One study, authored by three senior Kaiser leaders and published in NEJM Catalyst, suggests that “social, environmental, and behavioral factors account for an estimated 60% percent of health…compared with just 10% from factors traditionally defined as ‘clinical.'” Kaiser is going to try to bring utilization and costs in line by reaching out to superusers before they head to the ED, cold-calling predicted super-utilizers to discuss their basic needs and ask questions like, Do you worry about having a safe place to live or being homeless? and Do you need help finding ways to pay your utility bills? Of the hundreds of members who have agreed to such phone screenings, to date, 78% had at least one unmet social need, and 74% agreed to enroll in Kaiser’s Health Leads program (which connects enrolled members with food banks, housing providers, and other community programs to help meet their basic needs). Kaiser then follows up every 10 to 14 days to provide further assistance if needed. A similar program started by a family physician in southern New Jersey has seen ED visits fall by 40%, and an organization called the Patient Care Intervention Center in Houston is just getting an initiative designed to accomplish the same goals started.