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High Cost Users

This report focuses on the distribution and characteristics of high cost users in the South West LHIN. It examines the key findings regarding the definition, patterns of utilization, and expense summary of high cost users.

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High Cost Users

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  1. High Cost Users South West LHIN Hospital CCAC Leadership Forum September 13, 2013

  2. Distribution of Costs, 2010/11

  3. How is a “high cost user” defined? • The 10% of patients with the highest combined cost in 2010/11 for the following: • Acute care • Day surgery • Emergency rooms • Inpatient rehabilitation and mental health • Complex continuing care • Home care • Long-term care • Physician claims

  4. Key Findings Regardless of whether we focus on the high cost users at the Health Link, LHIN or provincial level, the following key findings are applicable: • A patient who is a high cost user in one fiscal year may not be a high cost user in future years • Rare conditions, such as transplants, low birth weight babies, and burns have the highest average acute care cost, while chronic conditions, hip fracture, hip replacement, and palliative care have the highest total cost. Health links have the potential to impact certain groups of high cost users • High cost users are a diverse group, but typically have two key characteristics: • They receive treatment from multiple health care sectors • And/or have long lengths of stay in inpatient settings

  5. Key Findings (continued) • For most sectors, the average number of episodes and cost per episode is similar for high cost users and all users. However, high cost users access a larger number of health care sectors. • Patient characteristics and patterns of health care utilization among high cost users are similar across geographic areas. • The profile of high cost users is consistent with the population structure of the area.

  6. Patients don’t always remain high cost users

  7. The South West LHIN’s Top Users • 77,740 patients total in top 10% • 100% of those patients are also in the top 10% of high cost users for Ontario • Top 3 CMGs with the highest total acute care costs for patients in the top 10% are • COPD • Unilateral knee replacement • Heart failure

  8. Huron Perth Health Link* Top Users • Perth County: Top 3 CMGs with the highest total acute care costs for patients in the top 10% • Unilateral knee replacement • COPD • Viral/unspecified pneumonia • Huron County: Top 3 CMGs with the highest total acute care costs for patients in the top 10% • COPD • Unilateral knee replacement • Cardiac Valve Replacement * Note: data from the Ministry separates Huron and Perth as separate Health Links

  9. Number of Sectors Used • 2% used 1 sector • 22.7% used 2 sectors • 66.3% used 3-4 sectors • 9% used 5 or more sectors

  10. Proportion of patients by sector type • Of the top 10% of patients in the South West LHIN: • Nearly 100% had a physician visit • 95.4% of those patients had 6 or more physician visits • 86.6% of those patients had 10 or more physician visits • 67% had an acute care discharge • 69% had an emergency visit • 27.3% of those patients had 3+ emergency visits • Only 33.5% received a home care service • 12% spent time in long-term care • The patterns of utilization are similar at the provincial level

  11. The South West LHIN Expense Summary • The top 10% of patients in the South West LHIN account for 78% of the total expenses for South West LHIN residents • The top 3 most expensive sectors are: • Acute care (42.8% of expenses) • Long-term care (16.4% of expenses) • Physician visits (15.4% of expenses)

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