Kentucky among states selected to study, address expensive problem of ‘superusers’ of emergency rooms

Kentucky is one of a few states teaming up with the National Governors Association to address the expensive problem of uninsured or Medicaid-covered “superusers” who over-use hospital emergency rooms or other costly health services instead of lower-cost alternatives like primary care.

“I’m proud Kentucky
has been chosen to participate in this important program,” Gov. Steve Beshear said in a news release. “Across the nation, an understanding has been growing that we
must focus our efforts on providing the best in coordinated care,
helping to direct individuals who may be using more expensive, less
effective services to more cost-efficient preventive services that
provide better health outcomes in the long run. It’s by achieving these
outcomes that we will build a healthier future for Kentucky.”

Kentucky, Alaska, Colorado, Kentucky, New Mexico, Puerto Rico and West Virginia will participate in a policy academy designed to help them create systems for these “superusers”, enabling state officials to confront rising Medicaid expenditures while improving quality of care and health, says an NGA release.

These “superusers,” sometimes called “super-utilizers” or “frequent flyers,” often go to a hospital or emergency room for
recurring health issues that can be treated more effectively and less expensively in other
ways. Kentucky Medicaid
spent more than $219 million on emergency-room use in 2012, and 4,400 Medicaid recipients used ERs 10 or more times during that year, says Beshear’s release.

“There’s a handful of people who drive most of our spending,” Dan Crippen, the executive director of the governors’ association, told Kelsey Miller of Kaiser Health News. While the median
ER visit cost $615 in 2009, an office-based visit with a physician
cost $361, according to the federal Medical Expenditure Panel Survey.

“Kentucky has too long
lagged behind in health rankings, and now is the time for us to begin
truly moving the needle in the right direction,” said Cabinet for Health
and Family Services Secretary Audrey Tayse Haynes. “By participating in
this national effort, we can learn what has worked for other states and
share Kentucky’s experiences as well.”

State leaders will first meet as a group with consultants from various
health-care sectors, then officials will spend 18 months implementing
the plans in their communities, says Miller.

Funding for the effort is provided by the Robert Wood Johnson Foundation
and the Atlantic Philanthropies.