Analysis of High‐Utilizers’ Experience with Specialized Care Plans

Background:

Individual Care Plans were developed at a tertiary care center within the HealthPartners’ system to coordinate care for “high‐utilizers”–patients with frequent ED visits and hospital admissions often associated with high‐risk patterns of narcotic use and common presentations. Previously reported data indicate that Care Plans reduce ED visits and hospitalizations by 65% and improve coordination of care. Care Plans are developed by a committee of physicians, physician assistants, care management staff, ED staff, and administrators and then entered into a patient’s electronic medical record in a highly visible location to assist future providers when they access the patient’s record.

Purpose:

How patients with Care Plans perceive their care is not well understood. We sought to better characterize patient experiences with HealthPartners’ Care Plans by utilizing patient surveys.

Description:

Sixty‐four patients were called between August and October 2013. Patients were contacted a maximum of three times. Surveys were administered via telephone to consenting participants. Each participant was asked six general questions and, if their Care Plan was primarily related to high‐risk opioid use, they were asked six additional questions. Participants who were unaware of their Care Plans were not asked additional survey questions.

Conclusions:

Seven patients (11%) were both aware of their Care Plans and participated in the survey. Forty‐seven patients (73%) were unreachable because they did not answer or had an incorrect/non‐working number listed in their chart.

Of the thirteen consenting participants, 54% were aware of their Care Plan. Of those aware of their Care Plan, 33% were satisfied with their Care Plan, 50% endorsed fewer ED visits, 17% used other hospitals more often, and 33% agreed their health care had improved.

Of the six respondents who had Care Plans due to high‐risk opioid use, 83% did not believe narcotic pain medication was a problem for their health, 67% did not want to reduce their narcotic use, and 67% endorsed using less narcotic medications.

Qualitative analysis of patient comments indicate patients would prefer direct input into their Care Plans and clearer means for re‐evaluation of Care Plan necessity.

In our analysis, we found that patients for whom Care Plans are ultimately implemented endorse low levels of satisfaction, but have fewer ED visits and use fewer opioids. Most patients indicate they continue to stay within the HealthPartners’ system. These high‐utilizers are also largely unreachable through standard means of communications, which poses unique challenges for engaging patients who wish to assist in development of their Care Plan or have their Care Plan regularly reassessed. Common patient coordination methods, such as discharge phone calls and outpatient case management, are unlikely to be effective for high‐utilizer patients.