Here’s a startling fact about rising health care costs in the US: fifty percent of total costs can be directly linked to just five percent of the total US patient population. These patients, commonly referred to as high-utilizers or super-utilizers, tend to have complex medical needs and, often, limited resources. In fact, they look a lot like the clients we see at Project Angel Heart.
With the need to address rising health care costs in the United States top of mind for everyone from working-class families to elected officials, many experts believe that addressing the needs of this specific patient population could have tremendous impact.
I recently attended Social Determinants of Health: From Tools to Action, a summit focused on high-utilizers and hosted by the Mile High Health Alliance, What I learned is that, while this problem is complex, simple solutions—like food access and proper nutrition—are the key to improving outcomes within this population.
“You can’t even get to the medical issue until you’ve figured out: Do they have a place to sleep, do they have housing they’re not going to lose, do they have food in their refrigerator, and do they have a refrigerator?” said Christopher Palmieri, the president and CEO of the nonprofit Commonwealth Care Alliance.
Short-Term Support for Long-Term Gains in Health
How can we support patients during their most fragile and critical times–like during transitions from a hospital or other care facility to home, flare-ups of their illness, or other temporary setbacks in their lives?
Sixty to eighty percent of patients who are high-utilizers now won’t be a year from now. There may be short-term solutions that can help patients recover and get back on their feet more quickly, shortening the duration and frequency of hospital visits while reducing their total health care costs.
One such solution is our Meals for Care Transitions program, which supports patients at high risk for hospital readmission during the initial 30 days after discharge. The program has resulted in better health outcomes and a significant reduction in readmissions. It is proof that supporting the social needs of patients can impact health and costs.
Food – A Top Need in Patient Screening Tools
During a keynote presentation by Mary Carl, the managing director of programs at Health Leads, I learned that food is a top need for many high-utilizer patients. A phone screen of more than 5,000 patients in Southern California conducted by Health Leads identified top social needs as:
- Financial support – 31%
- Caregiver support – 29%
- Access to healthy meals – 27%
- Not enough food in the household – 26%
In another study, conducted by the University of Colorado, home health nurses revealed that more than 50 percent of patients expressed a need for meal preparation as part of their home health care.
The physical and mental health of high-utilizer patients can decline greatly as they cycle in and out of the emergency room and inpatient health facilities. Working alone, clinicians will find it difficult to address all of the needs of these patients. However, creative and inexpensive solutions can be found when health care organizations work directly with social service organizations to provide resources.
Project Angel Heart is just one of many community-based organizations making efforts to better serve Coloradans dealing with chronic illness by developing partnerships with health care organizations. We’re looking forward to seeing these types of collaborations grow as we work to reduce health care costs and help high-utilizers access better care.
Leslie Scotland-Stewart is the Director of Business Development for Project Angel Heart’s Meals for Care Transitions program. She worked in sales and marketing for a variety of Fortune 500 companies before deciding to focus her career on health and wellness. After helping build a startup company that helps executives become healthier leaders, she joined Project Angel Heart in a business development role. She has a passion for all things health, including nutrition, exercise, and mindfulness. Leslie has her MBA from the University of Denver and teaches fitness classes on the side. She loves spending time with her family, going to the zoo, hiking, or doing anything that will keep the family active. She also loves to travel and is always in pursuit of the most delicious coffee and dark chocolate!