Health care accounts for approximately 17.4% of the nation’s spending – that’s more than $9,000 per person in one year, according to the CDC. Medicaid’s highest need, highest cost patients represent only 5% of the program’s recipients, but account for more than 50% of its overall costs, according to the Center for Health Care Strategies, Inc.
Chronic illness, homelessness, mental illness and a lack of social support can cause patients to wander aimlessly through the U.S. health care system. The challenge is how to help super-users (those who are admitted to a hospital four or more times in a six-month window) and fall through the cracks of the system while still maintaining profitable health care businesses.
Around a dozen students and advisors from SIU School of Medicine, the University of Illinois Urbana-Champaign, SIU Edwardsville Schools of Pharmacy and Nursing, St. John’s College of Nursing, and the University of Illinois Springfield’s College of Business and Management have partnered to learn more about these super-users and how to help them.
The medical side
The team of students and faculty advisors have identified some super-users with the help of hospitals and community organizations.  They have now formed close relationships with the patients to better understand the root causes of the multiple ER visits. Each of these students and faculty bring their own expertise—medicine, nursing, pharmacy, social work, business and community health—to work together to assist these patients.
To help patients overcome these health care barriers, students and their advisors make home visits. While there, students assess the patients’ living situation, check that they’re taking medicine as prescribed, talk with patients about their eating habits, go over past and upcoming appointments and discuss the patients’ questions and concerns. Students also arrange for transportation for many of the patients, attend the patients’ doctor’s appointments and make sure they understand their illnesses. They also identify community resources, including assistance with housing, Medicare and Medicaid, and meals that could benefit the patients.
The business side
Meanwhile, the business students collect data on the patterns of use, intervention and follow-up care. They are preparing information for members of the health care industry to show the positive economic and social benefits of integrating health care efforts.
Students have determined that using an integrated approach to health care and business methods such as budget impact analysis, interventions to improve patients’ health and keep them out of the doctors’ offices will reduce health care expenditures. The hope is that the health care system can better address the patients’ needs, improve care and reduce the cost of their health care.
Learn more about the nation’s health care expenditures at the Centers for Disease Control and Prevention Website.