Perspectives on Root Causes of High Utilization that Extend Beyond the Patient

Key Questions Answered
  • What are some common root causes driving high utilization of health care?

  • What are some promising approaches to reduce health care utilization?

Key Themes and Takeaways

This resource describes observations about root causes of high care utilization that emerged from a four-year intervention in a large population of patients with complex needs.

  • In 2012, Mercy Health Saint Mary’s developed a systematic approach to improving care for patients with complex needs. This intervention has yielded the opportunity to observe key factors associated with high utilization.

  • The majority of patients identified as having complex needs were younger than 60 years old, and the population was largely invisible because of their lack of engagement with primary care services, lack of insurance, or lack of participation in care management initiatives.

  • A common root cause driving instability in patients’ lives was overprescribing of narcotics or benzodiazepines. Requiring a review of a patient’s current prescriptions before adding additional Schedule II substances may help.

Policies that promote housing regardless of current substance use, behavior, or history of felony records show promise in reducing high utilization.

Lauran Hardin
Adam Kilian
Michael Olgren
Population Addressed
Adults Under 65 with Disabilities
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Level of Evidence
Expert Opinion
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