Addressing high utilization with data
June 2022
The terms "familiar faces," "frequent flyers", or "high utilizers" refer to a group of individuals who frequently interface with first responder systems (e.g., law enforcement, jail, EMS) and experience a combination of untreated mental health conditions, substance use disorders, and socioeconomic issues. Despite public systems being burdened with the costs associated with this population, these individuals ultimately do not receive the proper health care coordination they need. In one study, individuals with high Medicaid utilization were twice as likely to be booked into jail, three times as likely to have mental illness and/or substance use disorder, and incurred more than four times the direct public expenses when compared to other enrollees. CBHJ research has found that individuals with high utilization of EMS services were significantly more likely to have been booked in jail and experienced an overdose than others. Over a five-year period, a group of 48 individuals with high jail utilization averaged over 31 bookings and 42 EMS runs per person.
Frequent jail bookings
Over five years, individuals most frequently booked into jail were booked an average of 16 times, compared to an average of two bookings for others. The top 1% of individuals accounted for 8% of all bookings.
High EMS utilization
Over five years, EMS was dispatched to the individuals with the highest utilization an average of 35 times, compared to an average of two runs for others. The top 1% of EMS utilizers accounted for 16% of all calls dispatched.
Case study: Wayne County Familiar Faces program
As part of the Wayne County Jail/Mental Health Initiative, the 3rd Circuit Court and Wayne County Jail (WCJ) recently partnered to create a Familiar Faces program. The WCJ analyzed booking records for the most recent three years and identified 33 people who had booked into WCJ at least 12 times during the previous three calendar years. The WCJ staff created a Familiar Face icon that automatically alerts booking staff when a Familiar Face is being booked into jail. This alert triggers a special Familiar Face protocol where behavioral health staff conduct an evaluation and a needs assessment. The Familiar Face is linked (or reconnected) with a community provider while in jail and a discharge plan is created to ensure that the person receives continuity of care upon release to the community.
How it helps
Criminal legal systems (e.g. jails, EMS, law enforcement agencies) that take steps to identify and track their highest utilizers will be able to:
- Determine connection to care.
- Identify service gaps and needs.
- Closely monitor services provided to high-risk populations.
- Prioritize concerns and community action steps.
- Collaborate across community systems.
How to track high utilization
At minimum, any approach to addressing high utilization of costly services and resources must start with the ability to identify the highest utilizers within a system. As an example, here are some practical steps or tracking individuals with high utilization within a jail system:
- Run a report of prior year booking information to develop a baseline of high utilization.
- Cross-reference identifiable information to flag individuals who were previously booked multiple times within a given time frame (e.g. past year).
- Pull information for those flagged to create a list of individuals with high utilization that, if possible, can sort or rank individuals by the total number of times they were booked. Doing so can help county partners more efficiently identify individuals of highest priority.
How to address high utilization
There are multiple approaches to address high utilizers. For those who frequently engage with first responder systems, but who are not currently enrolled in treatment, a boundary-spanning case management approach may decrease use of emergency services and increase lower cost treatment engagement. The Chronic Consumer Stabilization Initiative in Texas demonstrated a 70% decrease in contacts between law enforcement and 30 chronic consumers with serious mental illness. For individuals with high utilization who do not wish to engage in behavioral health services, more intensive approaches may be helpful. Examples include assisted outpatient treatment (AOT), assertive community treatment (ACT), or housing interventions.