Partnership Health Center’s Super-Utilizer Project

In 2016, MHCF awarded Partnership Health Center with a $148,000 grant to implement a two-year Care Management for Super-Utilizers Program. This program employed a targeted approach to treating super-utilizers, the approximately 1% of patients accounting for 22% of total health care expenditures. Patients who qualify as super-utilizers generally suffer from multiple chronic conditions, mental health concerns, and myriad socioeconomic barriers to care, which contribute to multiple emergency room visits and hospital admissions.

In rural Montana communities, coordinating care for these patients is a major hurdle. Throughout the course of the project, Partnership Health Center’s super-utilizer care management teams – comprised of an RN, a behavioral healthcare manager, and family practice physicians – will, through home visits and partnerships with community resources, deliver comprehensive care to patients. The project’s goal is to reduce doctor visits, hospital admissions, and health care costs, increase patient health and satisfaction, and transition patients to primary-care settings.

The early results of this project have been promising with estimated cost savings of $556,000 over a six-month period. The Montana State Medicaid Office, recently confirmed that their preliminary look at real claims data showed that not only did hospitalizations go down, but the cost of hospitalizations also went down from an average of $30,000 to $10,000.