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By identifying the socioeconomic characteristics of high utilizers, many providers hope to reach out to vulnerable populations before they need emergency medical treatment.
For example, it was found that the degree of agreement between the center and the hospital on the date of the client's discharge was a key factor that distinguished low bed utilizers from high utilizers (low utilizers and the state hospital agreed more often).
How short a step is it from using data--claims and utilization data, pharmacy data, health survey data and demographic data--in predicting future claim costs and even who in a population might be tomorrow's high utilizers, to saying: OK, the data indicate that in four years, you could be really sick.
WASHINGTON -- The Partnership to Fight Chronic Disease (PFCD) hosted a Capitol Hill briefing today that focused on innovative programs that are working to improve solvency in the Medicaid program by focusing on the program's high-cost utilizers.
Reports of avoidable ED visits by dual eligibles increased five-fold in the last three years, from 2 to 11 percent, while utilization by other populations—high utilizers, Medicare and Medicaid—remained roughly the same.
Actually, low health care utilizers (healthy people)--no matter their age--are needed.
The medical and pharmacy claims integrated analysis revealed that over 25 percent of rosiglitazone utilizers had a medical claim diagnosis or concurrent medication which potentially increased their risk for an adverse cardiovascular event prior to May 2007.
The typical components of an overall utilization management program include preadmission certification, concurrent review of length of stay, and retrospective studies to identify utilization patterns and high utilizers.
This 25-page resource describes the 18-month population-based and patient-centered pilot to curtail wasteful healthcare utilization in Ohio ERs, especially by those Medicaid beneficiaries identified as "Ultra Utilizers.
The service also includes utilizers to provide technical customer support.
Learn more about stratifying high-risk, high-cost patients and super utilizers at http://store.