Timothy Darragh

An effort to reduce the number of patients who are "super-utilizers" in Pennsylvania's Lehigh Valley requires providers to enter into what one expert calls the "messy space" — a relationship that's closer and more personal than the traditional doctor-patient relationship.

Ambulances benefits from frequent users. Place a call for patient transport and a bill is generated. But what if the ambulance service was paid to keep patients out of the hospital? A new model pioneered in Fort Worth, Texas has caught the interest of other communities.

Health care super-users are often chronically ill, alone and with limited incomes. They typically need the medical skills of a trained health-care professional, but also the listening, counseling and support offered by social workers and clergy.

Can "super-utilizers" be helped? A partnership of health care workers, case managers, social workers, parish nurses, clergy and community members in Allentown, Penn. thinks so. The group is building a program to help those with manageable chronic illnesses stay out of the hospital.

For many of the patients who are known as "super-utilizers" of the health care system, the issue of simply getting to treatment is critical and sometimes more problematic than getting the treatment itself. The picture is often complicated by the disabilities and haphazard lives of these patients.