Characteristics of “Superutilizers” Among Patients with Schizophrenia

VBCN - November 2016 Volume 3, No 3

The so-called superutilizers among patients with schizophrenia in the Medicaid population had substantially more medical and psychiatric comorbidities and higher rates of emergency department and inpatient resource use than nonsuperutilizers, according to a study based on a large administrative claims database.

During a 12-month period, nearly 50% of superutilizers, defined as patients with at least 4 hospital admissions annually, had ≥7 hospitalizations that averaged almost 6 days each. Conversely, fewer than 50% of nonsuperutilizers, defined as patients with ≤3 hospital admissions annually, had even 1 hospital admission.

The increased use of inpatient resources among superutilizers was associated with a significantly higher Charlson Comorbidity Index and a 3-fold increase in the rates of substance abuse compared with the nonsuperutilizers, Michael Durkin, MSc, Director, Janssen Scientific Affairs, Titusville, NJ, and colleagues reported in a poster presentation at the 2016 Academy of Managed Care Pharmacy meeting.

“Superutilizers represented about one-fifth of the Medicaid patients with schizophrenia in this study, yet they accounted for nearly three-quarters of all inpatient admissions,” Mr Durkin and colleagues noted. “The development and implementation of targeted clinical interventions to address the needs of this Medicaid subpopulation offers the potential for both improved patient outcomes and system-level economic savings,” they added.

Several studies have shown that a relatively small proportion of patients with schizophrenia account for a disproportionately large share of resource utilization within the Medicaid system. Such findings have given rise to the term “superutilizer” to describe these patients.

Identifying and understanding the characteristics associated with superutilizers could inform decision-making about their care, improve patient outcomes, and help to develop strategies to effectively manage the cost of care without adversely affecting clinical outcomes.

Study Details

Mr Durkin and colleagues examined superutilizer status among patients with schizophrenia who were included in the Magellan Health Services claims database. Eligible patients had a diagnosis of schizophrenia, ≥2 prescriptions for antipsychotic medication, and continuous participation in a managed Medicaid plan from October 1, 2014, to September 30, 2015.

The database query yielded 2273 patients who were eligible for the analysis, 419 (18.4%) of whom qualified as super­utilizers. The median age (approximately 42 years) was similar between the 2 cohorts. Men accounted for a significantly higher proportion of superutilizers compared with nonsuperutilizers (64.9% vs 55.4%, respectively; P <.001).

The superutilizers had a significantly higher mean Charlson Comorbidity Index than nonsuperutilizers (2.23 vs 0.60, respectively; P <.001) and a significantly higher rate of comorbid substance abuse (74.7% vs 25.6%, respectively; P <.001). Overall, superutilizers had a substantially greater psychiatric comorbidity burden than nonsuperutilizers, including bipolar disorder (72.3% vs 39.4%, respectively; P <.0001), depressive disorders (81.4% vs 33.7%; P <.0001), anxiety disorders (68.3% vs 23.5%; P <.0001), and personality disorders (21.5% vs 3.4%; P <.0001).

Overall, 743 of the 2273 patients had more than 1 hospital admission, including 342 nonsuperutilizers. The number of inpatient days per patient averaged 39.47 among the superutilizers, nearly 5 times greater than the remaining 1854 patients (8.07 inpatient days).

The analysis showed that 59.9% of the nonsuperutilizers had no inpatient admissions during the study period. Conversely, 46.8% of superutilizers had ≥7 hospitalizations during the 12-month period, and the hospital stays averaged 5.5 days. The superutilizers accounted for 72% of all inpatient admissions.

In addition, the superutilizers logged significantly more emergency department visits—55.9% of the superutilizers had ≥1 emergency department visits compared with 15.9% of the nonsuper­utilizers (P = .009). In addition, 27.5% of the superutilizers had more than 1 emergency department visit versus 4.1% of the nonsuperutilizers.

This information may help health insurance plans to develop strategies to control the high associated costs of healthcare utilization among Medicaid beneficiaries with schizophrenia.

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