H E A L T H C A R E S U P E R - U T I L I Z E R S Stephen Brown MSW - - PowerPoint PPT Presentation

▶

Sep 28, 2022 168 likes •387 views

H E A L T H C A R E S U P E R - U T I L I Z E R S Stephen Brown MSW LCSW PMP Director of Preventive Emergency Medicine University of Illinois Hospital & Health Sciences System Stephen Brown MSW LCSW: UI Health W H A T I S A W I C K E

SLIDE 1

H E A L T H C A R E S U P E R - U T I L I Z E R S

Stephen Brown MSW LCSW: UI Health

Stephen Brown MSW LCSW PMP Director of Preventive Emergency Medicine University of Illinois Hospital & Health Sciences System

SLIDE 2

W H A T I S A “ W I C K E D P R O B L E M ”

The phrase was originally used in social sciences. A wicked problem is a problem that is difficult or impossible to solve because of incomplete, contradictory, and changing requirements that are often difficult to recognize. It affects multiple players that may not be aware of the other. Moreover, because of complex interdependencies, the effort to solve one aspect of a wicked problem may reveal or create other problems.

The key to finding an answer is to acknowledge it is a complicated problem, and that no individual,

rganization, agency or governmental body can solve this by themselves

Stephen Brown MSW LCSW: UI Health

SLIDE 3

W H E R E Y O U L I V E A F F E C T S H O W L O N G Y O U L I V E

Your socioeconomic status affects your health

Third world countries with similar life expectancies to Washington Park

Where you live, access to education, to employment, and other variables are called The Social Determinants of Health

Stephen Brown MSW LCSW: UI Health

Housing Status
Food Insecurity
Transportation
Mental Illness
Substance Abuse
Interpersonal Violence

Examples

SLIDE 4

P O P U L A T I O N H E A L T H

A minority of patients accumulate most of the cost & utilization In most states, 5% of Medicaid patients make up 48% of the cost

a.k.a “Power Law Distribution” Stephen Brown MSW LCSW: UI Health

SLIDE 5

C O M O R B I D I T I E S

a.k.a “Power Law Distribution” Stephen Brown MSW LCSW: UI Health

SLIDE 6

Extraordinary psychosocial / disease burden

Disease

73% 38% 21% 21% 15% 24% 48% 43% 51%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%

M2S Depression M2S Anxiety Substance Use Disorder Smoking Low Social Support No PCP Low Med Adherence % homeless/top 50 <= 8th Grade Reading Level

Psychosocial

4% 15% 9% 11% 13% 48% 0% 10% 20% 30% 40% 50% 60% 0 Diseases 1 Chronic Disease 2 Chronic Diseases 3 Chronic Diseases 4 Chronic Diseases 5 or More

72% have 3 or more chronic diseases

Stephen Brown MSW LCSW: UI Health

SLIDE 7

1 22.15% 22356 4951 2 35.32% 4553 1608 3 44.72% 1592 712 4 52.04% 736 383 5 60.46% 306 185 6 82.68% 127 105 7 84.17% 120 101 8 75.31% 81 61 9 81.82% 44 36 10 78.95% 38 30 11-20 86.09% 115 99 21-30 85.71% 21 18 31 _ 100.00% 11 11 27.57% 30100 8300

22.15% 35.32% 44.72% 52.04% 60.46% 82.68% 84.17% 75.31% 81.82% 78.95% 86.09% 85.71% 100.00% 1 2 3 4 5 6 7 8 9 10 11-20 21-30 31 _

% OF PSYCH DX BY NUMBER OF ANNUAL ED VISITS

Calendar Year 2014 46,186 Visits 30,100 Unique Patients 8,300 Patients had a Psych Diagnosis (27.7%)

Number of Annual ED Visits Psych DX % of Total

High rates of mental illness & substance abuse

There is a 80% probability that a patient who accumulates 8 or more visits in the previous 12 months has either a mental illness or a substance abuse disorder

SLIDE 8

Annual # of hospitalizations Hospitalization rate Annual Costs Relative Costs by number of acute sites of care accessed

H I G H R A T E S O F C O S T S & U T I L I Z A T I O N

SLIDE 9

H E A L T H C A R E & H O M E L E S S N E S S

Homelessness is virtually unrecognized in healthcare, yet this health-related social need carries risks as great as cancer or advanced cardiovascular disease

SLIDE 10

source: UI Health EPIC Project

68

Number of homeless identified via survey of ED and psychiatry staff in June 2015

20 had no encounters in the previous year
48 had healthcare costs that 4.8x higher than
ur average patient

635

Found to date through labor-intensive chart audits

U I H E A L T H

Stephen Brown MSW LCSW: UI Health

SLIDE 11

source: UI Health EPIC Project

45%

…of the top 100 ED frequent visitors are homeless

57%

…of UI Health’s 600+ homeless (350) have had at least

ne ED visit within the previous 12 months

U I H E A L T H E M E R G E N C Y D E P A R T M E N T F R E Q U E N T V I S I T O R S

Stephen Brown MSW LCSW: UI Health

20%

...of ED “super-utilizers” (~300 patients who have had 8+ visits in the previous year)

SLIDE 12

W H A T D O W E M E A N B Y H O M E L E S S N E S S ?

transitional episodic chronic

Both individuals (48%) and families (52%) who become homeless due to a housing, health care, or other financial

crisis. They come into the shelter system and stay about

three months and often move into housing. Primarily individuals who have been homeless for a year or more, or four times in the last three years. They tend to be

lder with significant mental illness, substance abuse and

many have a chronic medical condition(s).

80% 10% 10%

More individuals than families who regularly go in and out of shelters. They tend to be younger and leave shelters when they get income, or use shelters seasonally.

Three Typologies

Stephen Brown MSW LCSW: UI Health

SLIDE 13

Among all homeless, the chronically homeless make up 10-20% of the general population…

0% 25% 50% 75% 100% Typical

86 % 14%

Prevalence

0% 25% 50% 75% 100% Typical

20 % 80 %

Cost

…yet account for nearly 80-90% of the total cost of services to the entire population

We’ve found that chronically hom eless people, w ho are about 12% of the hom eless population, m ake up 80% of the total governm ent costs spent, from em ergency room visits to jail tim e…. We are w asting a huge am ount of m oney in this country keeping these people hom eless.”

Jake Maguire, Director of Communications for the 100,000 Homes Campaign

W H Y F O C U S O N T H E C H R O N I C A L L Y H O M E L E S S ?

Stephen Brown MSW LCSW: UI Health

SLIDE 14

$0 $750 $1,500 $2,250 $3,000

Supportive Housing Nursing Home Emergency Room Hospital

$57 $73 $125 $164 $700 $1,185 $2,500

Per Diem Public Facility

Without the stability of a place to live, the homeless seek services in facilities that are exceedingly more expensive

A N E X P E N S I V E , F R A G M E N T E D D E F A C T O “ S Y S T E M ”

Stephen Brown MSW LCSW: UI Health

SLIDE 15

S H O R T E R L I V E S

Risk of Early Death

The average American is expected to live to 78 years old The chronically homeless’ average life expectancy is 53 years old

Stephen Brown MSW LCSW: UI Health

SLIDE 16

Up to half of the chronically homeless may have a Traumatic Brain Injury (TBI)

H E A L T H R I S K S

The chronically homeless have high rates

f head, neck and breast cancers

60% of the chronically homeless that use cocaine & heroin have asthma or COPD 46% report at least one suicide attempt

Stephen Brown MSW LCSW: UI Health 56% 33% 23% 4%

0.05

0.05 0.15 0.25 0.35 0.45 0.55 0.65 0.75

Mental Illness Substance Abuse HIV/AIDS Domestic Violence

There are high rates of mental illness, substance abuse, HIV/AIDs & Domestic Violence

SLIDE 17

source: UI Health EPIC Project

3

…of the 27 referred into housing have died.

6

…have head, neck or breast cancer. All are in advanced states and all have been out-of-care

U I H E A L T H B E T T E R H E A L T H T H R O U G H H O U S I N G

Stephen Brown MSW LCSW: UI Health

5

…have had undiagnosed traumatic brain injury, dementia or intellectual disability, and no family support.

(11.7%) (18.5%) (22.2%)

SLIDE 18

$0 $15,000 $30,000 $45,000 $60,000

Supportive Housing Homeless

$18,000 $60,000

Annual Costs Housing

Programs in other cities have demonstrated it costs a third to a half to house the homeless rather than having them remain homeless.

I T S C H E A P E R T O H O U S E T H E H O M E L E S S

Stephen Brown MSW LCSW: UI Health

SLIDE 19

P A Y M E N T I S A W I C K E D P R O B L E M

$150m $75m

before after

HUD social service police ambulance healthcare shelter psychiatric care

Management Prevention

How do we get from here..to here

HUD social service police ambulance healthcare shelter psychiatric care

Who?

Bankers
Finance

Stephen Brown MSW LCSW: UI Health

SLIDE 20

C O U L D W E H A V E S E E N I T C O M I N G ?

…If we could connect public sector data silos

Many chronically homeless have risk factors that originate in childhood, yet develop into issues that span a lifetime,

Parents with substance abuse or mental illness Gang Involvement Non-related adult 50x risk of abuse Drop-out Lead Poisoning Foster Care Incarceration Chronic Inebriation Early Death

0-2 6-12 2-5 13-25 26-40 40+

Criminal Activity Truancy

Stephen Brown MSW LCSW: UI Health

Episodic Homelessness Chronic Homelessness Oppositional Defiant Disorder

SLIDE 21

1 of top 5 reasons for truancy in Washington Park is Parental Mental Illness or Substance Abuse Most frequent hotspots for 911 dispatches for psychiatric crises are the end of CTA EL lines 4 of 11 individuals shot by police were lead poisoned in youth 85% of residents in PGM are chronic inebriates (10+ years) 40% of foster children that age out of the DCFS system are homeless in their 20s.

T H E F O G I S L I F T I N G

70% of those with a personality disorder suffered trauma as children