Evaluating the RWJF AF4Q Health

Care Super-Utilizers Program

RWJF Super-Utilizer Summit

Chicago, IL

July 30, 2013

Joel Cantor

Rutgers Center for State Health Policy

This project is supported by a grant from

the Robert Wood Johnson Foundation

Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research

Evaluation Objectives

1. Document the experiences of program sites in adapting

super-utilizer strategies– Describe your model, accomplishments, challenges, lessons learned

– Semi-structured interviews (some by phone), review program documents

2. Assess how patient needs are addressed through new care

management strategies– Illustrate how your program model works

– Two case conferences with your team about a hypothetical patient

3. Document changes in hospital resource use by enrolled

patients– Examine how hospital resource use change

– Benchmark resource use using non-intervention patient comparison data

Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research

Hospital Resource Use Benchmarking

• How has hospital resource use changed for enrolled patients

relative to comparable non-intervention patients?

• Adjust for the expected “natural” decline in hospital resource

use, a.k.a., “regression to the mean”

• Compare total hospital resource use, readmissions, ED visits

following discharge and other outcomes

Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research

Hospital Resource Use Benchmarking (continued)

• De-identified hospital records for enrolled patients

– Hospital billing records, before, during and after enrollment in

care management (e.g., demographics, admitting diagnoses, resources

used such as ICU days, length-of-stay, payer category, charges, month/year of

visit, patient origin zip code, hospital information)

– Data use agreement between your institution and Rutgers CSHP

• Benchmark data from publicly available uniform hospital

billing data

• Statistically match enrolled to comparison patients with similar

utilization history, diagnoses and

comorbidities, payer, demographic and other factors

• Analyze actual versus benchmark trends

Center for State Health PolicyInstitute for Health, Health Care Policy and Aging Research

Thank you

Q&A