Manager   •   over 6 years ago

Q: What is the cost impact of super-utilizers on the health care system? Can we quantify the monetary impact of one super-utilizer on the health care system?

A: There is no national average for how much super-utilizers cost, partially because of variation across state Medicaid programs in terms of how much services cost and what benefits are covered. However, there are some useful state-level estimates. For example, California’s Department of Health Care Services just released an analysis of its highest cost Medicaid patients. On average, the top 5% most costly patients to the system were responsible for 70% of costs to the Medicaid program as a whole, and their care resulted in an average annual cost of $55,300 per person. The analysis gives great insight into this population and is well worth checking out. You can find it here: Separately, and illustrative of how much costs can vary, New York state has shared data showing that its top 100 high-cost beneficiaries cost an average of more than $450,000 each on an annual basis.


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