But it's not the best thing in the world for patients or for taxpayers who foot much of the bill through Medicare and Medicaid—most super-utilizers being eligible for benefits under both entitlement programs. This dual-eligible population is "the most expensive subset of patients in the country," said Brenner.
By analyzing the medical records from the three major hospitals in Camden from 2002 through 2011, Brenner found that 1% of the city's patients generated 30% of emergency room expenses and that 20% of patients were responsible for 90% of ER costs. Not surprisingly, these extremely high-cost patients were predominantly dual-eligibles.
Brenner has identified several drivers that lead to a person becoming a complex healthcare consumer, including blindness, deafness, physical immobility, co-morbidities, a low literacy level, a lack of family support, not owning a car, addiction, and mental illness. Having several of these risk factors often makes a person an "extreme user" of healthcare, he said, noting that "the ROI is with finding expensive patients who are willing to change, and that's hard to do."
"There are no easy answers for these complex patients," Brenner concluded, encouraging the audience of mainly hospital administrators to embrace the challenge of finding better means of caring for this difficult patient population.
In a follow-up interview with Brenner, I asked him about the issue of complexity—both in terms of super-utilizer patients' health problems and the healthcare system that so far appears to be failing them and costing the rest of us billions of dollars in the process.