‘Super users’ of health care system the target of reforms

Building on local strengths key to cooling medical hot spots

An intriguing idea was recently put forward by the Government of Saskatchewan, that of addressing medical hot spots. It has been reported that just five people were responsible for visiting Saskatchewan emergency rooms over 500 times in the last year. One patient alone is said to have required over one million dollars in health services.

A report earlier this summer showed that just 20 individuals in Saskatoon were costing a total of two million dollars per year in health and social services. With a third of Saskatchewan’s health expenditures going to serve just one percent of patients, it’s no wonder the government is wanting to explore a different approach to health services.

Saskatchewan is not alone in this concern. Provinces and regions across the country are sitting up and taking notice too. Tightening health budgets across the country are leading people to take a different look at just where health care dollars are flowing.

The term, health care ‘super utilizers’ or ‘super users,’ was first coined by Dr. Jeff Brenner of Camden, New Jersey to describe individuals who, despite very high levels of health intervention and expense, are still suffering from very ill health. His work also outlines the existence of ‘medical hot spots’  specific areas in a community that often incur the highest health bills.

The proposal from the Saskatchewan government to focus on medical hot spots and health care super-utilizers opens a fascinating dialogue about how we could re-imagine health care to be more effective, more equitable, and cost less, both in the province and across the country.

Surely there must be a way to help those most in need that is more effective and less expensive.

Some of the answers may come from innovative models developed elsewhere. Dr. Brenner and others have used regular interdisciplinary team huddles, community-engaged outreach workers, and other creative means of adjusting the rigid world of health care delivery to meet the complex and chaotic needs of patients. There is indeed much we can learn from these successes, but before we import too much from afar, we have some success stories of our own too, including from my neighbourhood on the West Side of Saskatoon.

In an interview on medical hot spots on an episode of CBC’s Black Coat White Art that described this area of Saskatoon as exactly such a hot spot, Dr. Brenner referred to two local initiatives  Station 20 West and SWITCH — as “disruptive change,” the sort of delivery system game-changers required to address persistent, complex problems.

SWITCH, the Student Wellness Initiative Toward Community Health is a student-run, interdisciplinary, clinic operating in inner city Saskatoon. For years, SWITCH, and its host, the West Side Community Clinic, have been taking a full service, low threshold approach to decrease barriers to health care and reach out to the hardest-to-serve patients. Station 20 West, a facility that includes a grocery store, housing cooperative, university outreach centre and more all in one location, moves beyond health care to focus on the upstream determinants of health  housing, income, nutrition, education and more  really acting like an outpatient hospital for the whole person.

Other Saskatchewan successes include the Prince Albert Police Service Community Mobilization meetings that bring various agencies around a single table to help address the needs of high-risk families, and the multiple levels of housing and social support offered by Saskatoon’s Lighthouse.

The key to success in cooling medical hot spots will rest in scaling up existing local interventions like these  and others across Canada  magnifying existing strengths to help cope with the growing challenges of high-needs individuals.

Of course, addressing the needs of super-users is only a first step. In many ways, these are the people that we have already failed. Meeting their needs is essential, but we should also be looking to help prevent those currently struggling from becoming the super-users of the future by creating the conditions for better health.

Smart investments in the social determinants of health, including community economic development, can turn struggling neighbourhoods from medical hot spots into thriving, healthy communities.

A version of this commentary appeared in The Huffington Post, Saskatoon Star Phoenix and the Winnipeg Free Press

 Dr. Ryan Meili is the Director of Upstream, an expert adviser with EvidenceNetwork.ca, a Saskatoon doctor and the author of A Healthy Society.

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