January 20, 2017: What “High Utilizers” Can Tell Us About Population Health

January 20, 2017: What “High Utilizers” Can Tell Us About Population Health

Slides: Slides


What "High Utilizers" Can Tell Us About Population Health


David Labby, MD, PhD, of Health Share of Oregon and Providence Center For Outcomes Research


Medically complex patients; Adverse childhood events; Population health; High-utilizing patients; Coordinated care organizations; Medicaid; Health risk behaviors; Social determinants of health; Vulnerable populations

Key Points

  • Studying and understanding the life experiences of “high needs/high cost” patients can help us achieve better population health outcomes. High-utilizing patients have life stories with chain reactions of adversity leading to a cumulative burden across the life span.
  • Adverse life events include substance use, parental separation or divorce, mental illness, criminal behavior, emotional or physical neglect, and sexual abuse. The neurobiology of adverse childhood events (ACEs) suggests that such events drive overproduction of stress hormones cortisol, norepinephrine, adrenaline. Trauma impacts a person’s worldview and perceptions of safety and self-worth, leading to a sense of helplessness and high-risk health behaviors.
  • But adverse childhood events are not destiny. There are interventions along the pathway to poor health that can make a difference, and there are critical partnerships in clinical systems in vulnerable communities that can improve health and healthcare.

Discussion Themes

What are the connections between adverse life events, poor health, and medical complexity? Do the different health risks associated with high ACEs occur together and compound each other in persons with the worst health outcomes?

How can we identify persons with high ACEs who are most at risk as early as possible? Has there been progress in terms of EHR phenotyping for ACEs or complex trauma health profiles?

We need a shift in thinking—away from conditions, costs, and services toward better understanding of the social, psychological, and environmental determinants of health.

“Trauma-informed” policies in healthcare and elsewhere can potentially change health outcomes for those most at risk.

For More Information

Read more about Dr. Labby’s Pathways to Health study at Providence Health and Services.

@PCTGrandRounds, @Collaboratory1, @PCORnetwork