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High Utilizer Care Plan Project: A Network Initiative to Decrease Inappropriate Resource Utilization Among High-Risk

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|February 9, 2026
PubMed
Summary
This summary is machine-generated.

High utilizers drive up healthcare costs. A program using multidisciplinary teams and individualized care plans (ICPs) significantly reduced healthcare charges and patient visits to emergency departments and hospitals.

Keywords:
abusive health care usehealthcare usershigh utilizerindividualized care planquality improvement study

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Area of Science:

  • Healthcare Management
  • Health Economics
  • Quality Improvement

Background:

  • Rising healthcare costs in the US are significantly influenced by high utilizers (HUs), a small patient subset.
  • HUs account for nearly 50% of healthcare expenditures, often with disproportionate and unnecessary resource use.
  • Addressing the multifactorial causes of excessive utilization requires innovative, multifaceted solutions.

Purpose of the Study:

  • To evaluate the effectiveness of a comprehensive program in identifying high utilizers (HUs).
  • To assess the impact of individualized care plans (ICPs) on reducing healthcare resource overuse and associated costs.
  • To test the hypothesis that quality improvement processes and ICPs decrease healthcare expenditures and utilization.

Main Methods:

  • A multidisciplinary team identified HUs based on DHHS definitions from July 2021 to July 2025.
  • Individualized care plans (ICPs) were created for each patient and linked to their electronic medical record (EMR).
  • Costs and utilization of inpatient, outpatient, and Emergency Department (ED) facilities were measured pre- and post-ICP implementation.

Main Results:

  • 190 patients were enrolled in ICPs; the mean age was 45.15 years, with 62.6% being female.
  • A $40.91 million reduction in charges was observed over the four-year study period following ICP implementation.
  • Statistically significant decreases were noted in mean ED visits (14.18 to 6.75), inpatient visits (4.43 to 2.41), and inpatient imaging studies (9.35 to 5.41).

Conclusions:

  • High utilizers significantly contribute to excessive healthcare spending.
  • A hybrid approach combining multidisciplinary teams, standardized HU identification, and ICPs effectively reduces healthcare costs.
  • This integrated strategy also decreases Emergency Department (ED) and inpatient visits, along with unnecessary imaging.