Improving disease-centered value-based services is essential to reducing an individual’s healthcare cost.
As per 2022 Medicaid & CHIP Beneficiaries at a Glance – In 2020, 672,727 or 1% of Medicaid Beneficiaries consumed $174 billion of healthcare services top 1% Medicine Super Lasers 2022 accounted for 25 percent of the budget
Addressing the crisis of super-utilizers will make it more efficient to create sustainable equitable health care for Americans
US Health Care Inflation Costs Outpace Economics GDP, US health care per capita costs are twice the average of other wealthy nations. this leads to increased investment by national and state, and local governments in other services such as education and infrastructure
Spending on health care for super-utilizers also provides sustainable benefits and economic opportunities for housing, education, and infrastructure investments and for all citizens.
The US spends enormously on health care, and even though it is twice the cost of OECD countries, we experience the lowest life expectancy and also suffer from the highest rates of chronic diseases.
America seems to be paying more and getting less health care.
Apart from that, buyers are consumers and health care insurance premiums and taxes are also being heavily negotiated.
Because there is currently no definition of healthcare super-utilizers there are disagreements on the long-term effects this demographic has on healthcare expenses.
As a result, high-cost service providers like emergency departments (ED) and hospitals claim there is no cure. We think the most appropriate description is provided by the CMS and refers to
“People who amass significant numbers of emergency department visits and hospital admissions that may have been avoided by relatively inexpensive early intervention and general care.” Persistent super-utilizers (PSU) are special in that they struggle with poverty-related problems such as food and housing instability, lack of transportation, mental health issues, and substance addiction in addition to having complex medical conditions and many chronic diseases
The standard method for assessing the PSU crisis is the healthcare costs related to chronic diseases and other co-morbidities that are classified medically. The health and wellbeing of this group, and consequently healthcare costs, have been proven to be significantly more impacted by outside variables known as social determinants of health (SDoH). Nearly 80.0% of health outcomes are influenced by social factors such as neighborhood, housing, food, education, employment, and transportation.
PSUs’ extremely fragmented, ineffective care is only a manifestation of the unfavorable financial incentives that all Americans face when trying to acquire healthcare. 90% of the $4.1 trillion in healthcare costs in the United States, according to the Centers for Disease Control and Prevention, are related to chronic diseases and mental illnesses.
PSUs are people who have more extreme versions of these identical circumstances and settings. An effective plan for the structural change of American healthcare is to address the PSU health and cost crisis. By doing this, the overall cost of healthcare will be reduced right away, and it will be made clear which specific reforms are required for a fair and long-term U.S. healthcare system.