SuperUtilizer Program: Get Better at Controlling Healthcare Costs

Envolve’s sister company, LifeShare, offers the SuperUtilizer program which helps clients seeking to reach and stabilize the highest users of emergency services. Through our years of working with these complex members who are high utilizers of healthcare services, we’ve developed techniques to address needs and assist clients in making significant inroads in aligning with Triple Aim goals of creating a higher quality healthcare experience, improving outcomes and controlling healthcare costs. We strive to enhance existing case management by positively impacting chronic physical health conditions, co-occurring behavioral health disorders and social barriers to care.

The SuperUtilizer program is tailored to meet the needs of individuals who have high healthcare utilization patterns and whose complex physical, behavioral and social needs are not adequately met through traditional care management programs. Through our program, clients can get better about controlling healthcare costs, improve care and positively impact the experience of individuals with complex needs and high healthcare utilization histories. Our engagement approach is to meet individuals where they are by being culturally appropriate, person-centered and accessible to all. Our goal is to ensure those we serve have the information they need to make informed choices about their health and healthcare.

How The SuperUtilizer Program Works

  • Our model is driven by healthcare utilization data, over- and inappropriate healthcare utilization patterns, and individual health history
  • We work with existing care managers to address and identify solutions that resolve social determinants of health issues affecting the individual’s ability to follow clinical interventions.
  • As trends are identified, further qualitative analysis is conducted to determine potential reasons for the results and to formulate effective interventions.
  • Our primary goal is to facilitate the provision of medically necessary covered services that are appropriate for the individual, provided in the most appropriate setting, and meet professionally-recognized, evidence-based standards of care.
  • We provide education on appropriately accessing covered services and assisting with the choice of a Primary Care Provider (PCP).
  • We provide local, close and accessible case management.
  • We use proven approaches, innovative programs, best practices and sophisticated technology resources.
  • Taking the Triple Aim philosophy to the next level, we also support the fourth leg of the Quadruple Aim - improving providers’ work life and satisfaction with health plan processes, while eliminating administrative hassles. 

Healthcare Utilization Program Solutions

High healthcare utilization members require far greater engagement than traditionally needed. Our Superutilizer program is designed to address the numerous social determinants of health, such as access to housing, transportation, food, and employment, that affect health outcomes and drive frequent, intense and extended utilization of high-cost services.

Our solution to controlling healthcare costs is built upon:

  • A proprietary algorithm identifying the difficult-to-reach and most frequent utilizers of emergent services
  • Years of truly localized human services experts to make in-person contact and engage the individual into utilizing the appropriate services
  • Stabilizing the necessary social determinants for individuals by connecting them with appropriate solutions

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