The state is working with 16 acute care hospitals to get "super utilizers" — patients who access the emergency room most often — to the right kind of care.
Super utilizers make up for 1 percent of Medicaid patients but absorb about 10 percent of the state's Medicaid budget, said Dr. John Langefeld, chief medical officer at the Department for Medicaid Services.
A super utilizer is defined as someone who goes to the ER 10 times in a year or someone who goes to an ER at least once and has three hospital stays in a year.
Langefield said people have long come to the ER for reasons that have nothing to do with their health. "They might be homeless, they might be hungry, they might be lonely," he said. It is a problem that has been around as long as emergency rooms have existed, he said. About 80 percent of those patients have mental health problems in addition to medical needs.
Most would be better served in a medical setting outside of an ER but don't know how to access that care, he said.
Advances in technology now make it possible for the hospital ER to communicate with other facilities, community groups and local health departments to create coordinated care for these patients.
Almost all super utilizers have other needs, such as problems with housing or transportation, that also must be addressed, said Dr. Stephanie Mayfield, the state commissioner of the Kentucky Department for Public Health.
Since 2013, the state has been working with 16 acute care hospitals, including the University of Kentucky, to better serve super utilizers. And, Mayfield said, soon the effort will go statewide.
How does it help the public at large? If a super utilizer can be treated at home or in a doctor's office it frees up the ER staff to care for people with true emergencies. Medical care is also less expensive outside of the ER so it is a more efficient use of Medicaid dollars.
"Our desire is not to exclude anyone," said Mayfield. Instead a team can be created to care for the super utilizer and make sure they can get both appropriate medical care and other support like help with housing, mental health counseling or food.
University of Louisville Hospital and St. Joseph are part of the state effort but have also been looking for ways to treat both super utilizers and dementia patients on their own.
Ken Marshall, president of the University of Louisville Hospital, is working with managing that facility's super utilizers, generally about 10 or 15 patients who show up at the emergency room every day or every other day. (The state actually found two Medicaid patients who during a year had been to the ER 121 times each.)
Focusing on the problems that bring those people to the ER can have a broad impact on wait times, he said. The key, he said, is usually solving a non-medical, social issue or family problem that compel them to come to the ER.
St. Joseph in Lexington is working with a pilot program to more effectively treat dementia patients who come to the ER, said John Smithhisler, St. Joseph president.
The medical stress that brings a dementia patient to the ER, coupled with the unfamiliar surroundings and the bustle of activity can easily become overwhelming. When these patients become agitated they are harder to treat, Smithhisler said. Even getting basic information from them can be difficult. St. Joseph is exploring ways to create an environment and process that won't overwhelm them