Transforming Care Delivery and Outcomes for Multivisit Patients

SummaryMultivisit patients (MVPs), also called high utilizers or super utilizers, are patients with needs not well met by the health care delivery system as it is currently designed. In the Harris Health System, MVPs are defined as those with a number of annual ED visits two standard deviations above the mean, totaling greater than 15 visits per year to Harris Health’s central campus or 10 visits per year to its northeast campus. This relatively small population is associated with a disproportionately large demand on services and resources. Because standard care management practices are often ineffective in stabilizing MVPs’ high utilization, some clinicians and population health professionals consider them unimpactable, imbuing these patients with a stigma that further marginalizes this population and undermines effective care delivery. In this case study, the authors describe their experience transforming care for MVPs in the Harris Health safety-net system in Houston, Texas. Specifically, they outline implementing a clinical paradigm shift and the resulting operational process changes derived from insights about patterns of high utilization in both the ED and inpatient settings. By developing interactive, cross-continuum partnerships, they transformed their approach, delivered more relevant care with consistent messaging to MVPs, and reduced overall utilization and per-visit length of stay. Instead of expecting MVPs to use the health care system in its current form, Harris Health chose to transform care delivery to better meet these patients’ needs. This experience is particularly relevant for health care leaders as the industry collectively seeks to address structural and systemic bias in health care while innovating strategies to creatively use constrained resources to meet complex needs. As health systems undergo shifts toward value-based care delivery models, Harris Health’s approach of caring for MVPs can serve as an impactful and crucial framework.