Seeking Solutions: High utilizers cost the community millions

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WICHITA, Kan. (KSNW) — Many Wichita community leaders speak of the desire to help individuals in crisis but say there’s also a real dollars-and-cents cost to the way our system works now. Taxpayer dollars end up paying for services for many people stuck in the cycle.

Wichita State spent several years finding out just what that cost is. They looked at the expenses for Ascension Via Christi St Joseph, COMCARE of Sedgwick County, and the Substance Abuse Center of Kansas (SACK).

The researchers focused on high utilizers – people with mental illness or substance use disorders who regularly cycle through the emergency department, crisis services, detox and sobering.

Often, they are uninsured or under-insured and end up back on the street without fully managing their illness. Then it starts the cycle again.

“These are complex individuals. These are people who have decades of trauma,” Joan Tammany, COMCARE executive director, said. 

“They just circle and cycle through all the different levels of care in our community and in our state and don’t ever get exactly the right level of care that they need because it no longer exists,” said Robyn Chadwick, Ascension Via Christi St. Joseph president.

With a growing behavioral health crisis, in 2015, the Kansas Health Foundation gave Ascension Via Christi a grant to study these high utilizers. The goal was to find the gaps in services and how much they are costing the community.

Wichita State University’s Public Policy and Management staff did the research. The researchers analyzed data from 2015 to 2018, studying 519 high utilizer cases from Ascension Via Christi St Joseph, COMCARE, and SACK.

“We’re seeing them in the hospitals. We’re seeing them in the mental health centers. We’re seeing them receive substance use disorder services,” said Dulcinea Rakestraw, WSU Public Policy and Management Center research evaluation manager.

The first finding was that 25% of people were high utilizers of more than one organization, meaning they would use not just the emergency department but possibly COMCARE and SACK, too.  

“There is a high crossover of these individuals,” Rakestraw said. 

The next finding was the cost. 

“When individuals access crisis services, those come at a really high cost,” Rakestraw said. 

Between the three organizations, the utilizers received nearly $56 million of care over the four years. Of that, $17 million was paid through taxpayer-funded services like Medicaid and Medicare, other grants and donations from the public.

In 2018, the median cost was more than $72,000 for each patient at the hospital, $20,000 for COMCARE, and $1,000 for SACK.

 “What it has clearly indicated and shown to us is there are huge gaps in care,” Chadwick said. 

The study found that once a high utilizer was released from care, they would not follow up for continued care.

“They’re feeling good, they’re discharged from the hospital, they don’t want to see a mental health professional the same day or the next day,” Tammany said.

The study also found wait times to transfer patients to longer-term facilities were too long.

“We’re lucky if we can get them to hold that thought long enough to get them transported from here to a facility,” Chadwick said.

She said some wait times are two months long.

Since the release of the study in 2019, it has prompted more collaboration. As a result, the three organizations have developed a shared crisis plan to get high utilizers more help more effectively.

It also kick-started the Substance Abuse and Mental Health Coalition

“If we could have services in place that take care of people and address the needs they have, it will save tax dollars for the state, and it will save money for our hospital system, which then, in turn, frees up space for other people who need emergency services,” Chadwick said. 

The coalition is continuing its work and considering several initiatives like finding a centralized area for services to come together, finding a space for a COMCARE expansion and piloting new programs, such as a system that shares patients’ information between organizations.

This article is a collaborative effort involving two members of the Wichita Journalism Collaborative, KSN-TV and The Journal, a print and digital magazine published by the Kansas Leadership Center. To report on this story, Journal contributor Mark Wiebe and KSN reporter Hunter Funk traveled to San Antonio to learn about the mental health system there. The Wichita Journalism Collaborative funded the trip through a grant from the New York City-based Solutions Journalism Network. The Wichita Journalism Collaborative, an alliance of seven media organizations and three community groups, formed to support and enhance quality local journalism. In addition to KSN, media partners include The Active Age, The Community Voice, The Journal (Kansas Leadership Center), KMUW, The Sunflower and The Wichita Eagle. Community partners committed to participating in the initiative include AB&C Bilingual Resources, The Elliott School of Communication at Wichita State University and Wichita Public Library.

Copyright 2021 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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