Congestive heart failure; 8 26,963 73,932 36 nonhypertensive Chronic obstructive pulmonary 9 25,476 78,714 32 disease and bronchiectasis Complication of device; implant or 10 25,159 79,173 32 graft a Clinical Classifications Software (CCS) categories based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnoses; b Super-utilizers are patients with 4 or more hospitals stays per year. Source: Weighted national estimates from a readmissions analysis file derived from the Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID) from 18 States, 2012 Source: 14: Top 10 principal diagnoses for hospital stays attributed to super-utilizers Source: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb190-Hospital-Stays-Super-Utilizers-Payer-2012.pdf Super-utilizers can revert or change their utilization patterns Estimates vary as to the percentage of super-utilizers who continue their patterns of use. An analysis of high cost Medicaid beneficiaries from 2002-2006 showed 60% continued to be among the top 10% in utilization in two subsequent years.[25] A more recent analysis (2015) of a smaller group of publicly insured and non-insured super-utilizers showed 3% of patients met super-utilizer criteria and accounted for 30% of adult charges. Seventy-two percent of super-utilizers were no longer super-utilizers after twelve months. This analysis showed that super-utilizers have multiple co-morbid conditions, and often cycle in and out of the super-utilizer category on a monthly basis. The author suggests this cycling in and out and eventually dropping out of super-utilizer status reflects a number of factors, e.g., the natural course of disease flare-ups, the impact of care on disease, and mortality. [24]
8 Congestive heart failure; nonhypertensive 26,963 73,932 36 9 Chronic obstructive pulmonary disease and bronchiectasis 25,476 78,714 32 10 Complication of device; implant or graft 25,159 79,173 32 a Clinical Classifications Software (CCS) categories based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnoses; b Super-utilizers are patients with 4 or more hospitals stays per year. Source: Weighted national estimates from a readmissions analysis file derived from the Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID) from 18 States, 2012 Source: 14: Top 10 principal diagnoses for hospital stays attributed to super-utilizers Source: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb190-Hospital-Stays-Super-Utilizers-Payer-2012.pdf Super-utilizers can revert or change their utilization patterns Estimates vary as to the percentage of super-utilizers who continue their patterns of use. An analysis of high cost Medicaid beneficiaries from 2002-2006 showed 60% continued to be among the top 10% in utilization in two subsequent years.[25] A more recent analysis (2015) of a smaller group of publicly insured and non-insured super-utilizers showed 3% of patients met super-utilizer criteria and accounted for 30% of adult charges. Seventy-two percent of super-utilizers were no longer super-utilizers after twelve months. This analysis showed that super-utilizers have multiple co-morbid conditions, and often cycle in and out of the super-utilizer category on a monthly basis. The author suggests this cycling in and out and eventually dropping out of super-utilizer status reflects a number of factors, e.g., the natural course of disease flare-ups, the impact of care on disease, and mortality. [24]
CHT%20Program%20Literature%20Review%20Part%20I%20Addressing%20high%20risk%20high%20cost%20patients%20to%20improve%20health-quality%20and%20reduce%20cost.docx