How to Classify Super-Utilizers: A Methodological Review of Super-Utilizer Criteria Applied to the Utah Medicaid Population, 2016-2017.
Popul Health Manag
; 23(2): 165-173, 2020 04.
Article
em En
| MEDLINE
| ID: mdl-31424319
ABSTRACT
A limited number of patients, commonly termed super-utilizers, account for the bulk of health care expenditures. Multiple criteria for identifying super-utilizers exist, but no standard methodology is available for determining which criteria should be used for a specific population. Application is often arbitrary, and poorly aligned super-utilizer criteria might result in misallocation of resources and diminished effects of interventions. This study sought to apply an innovative, data-driven approach to classify super-utilizers among Utah Medicaid beneficiaries. The authors conducted a literature review of research methods to catalogue applied super-utilizer criteria. The most commonly used criteria were applied to Utah Medicaid beneficiaries enrolled during July 1, 2016-June 30, 2017, using their previous 12 months of claims data (N = 309,921). The k-medoids algorithm cluster analysis was used to find groups of beneficiaries with similar characteristic based on criteria from the literature. In all, 180 super-utilizer criteria were identified in the literature, 21 of which met the inclusion criteria. When these criteria were applied to Utah Medicaid data, 5 distinct subpopulation clusters were found non-super-utilizers (n = 163,118), beneficiaries with multiple chronic or mental health conditions (n = 68,054), beneficiaries with a single chronic health condition (n = 43,939), emergency department super-utilizers with chronic or mental health conditions (n = 7809), and beneficiaries with uncomplicated hospitalizations (n = 27,001). This study demonstrates how cluster analysis can aid in selecting characteristics from the literature that systematically differentiate super-utilizer groups from other beneficiaries. This methodology might be useful to health care systems for identifying super-utilizers within their patient populations.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Medicaid
/
Mau Uso de Serviços de Saúde
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
/
Systematic_reviews
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Popul Health Manag
Assunto da revista:
SAUDE PUBLICA
/
SERVICOS DE SAUDE
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Geórgia