Constructing a framework to manage high utilizers in social and health care

Abstract

Objectives of the Study:

The study analyzes to what extent social and health care expenditures are generated by a small percentage of people, generically referred to as "high utilizers". The research is focused on understanding the types of social and health services that experience high cost utilization and suggest how this high utilization could be managed and curbed. Understanding the main drivers and nature of high utilization would help the municipalities to deliver better overall quality of services, enhance the wellbeing of individuals and to reduce the high burden of illness of high utilizers, while also reducing the overall cost of social and health care.

Academic background and methodology:

The paper is a retrospective registry study and is based on anonymous register data. The longitudinal data covers service usage from the years 2011 and 2012. The data pertained to 28 255 individuals for year 2011, and 28 929 for year 2012. Data analysis is performed by descriptive statistics methods. Service usage is analyzed in a joint municipality of Peruspalvelukuntayhtymä KALLIO, located in central Finland.

Findings and conclusions:

This study defines "high utilizers" (HU) as the top 5% individuals incurring the highest cost per capita in social and health care associated expenditures. This top 5% group of HU accounted for 64% percent of KALLIO's social and healthcare costs in year 2011, and 65% percent in year 2012, confirming the findings of previous research made. Persistence over a 2-year period among HU is remarkably high. Approximately 53.7% of high utilizers remain high utilizers the following year, confirming that a large share of social and health care resources are associated with a limited number of individuals who are facing recurring needs. Observed HU were generally older, as approximately 50% of HU being aged 65 years or above, compared to other users where only 13.7% were aged 65 years or above in year 2011. Since a relatively small percentage of people account for the largest share of social and health care related costs, there is an opportunity window for new innovative services that could curb the high use. Targeting care and timing efforts systematically would require supportive information systems and accurate patient selection processes, as the high utilization is varied among different services. Further research is needed to understand what could be prevented and how to build feasible management models and proactive efforts.