Sg2 Case Study: Extensivist Program Curtails Costs and Days

For this multihospital network whose mission focuses on the poor and uninsured, establishing an extensivist program proved critical to targeting the complex needs of its community’s most vulnerable patients.


Seton Healthcare Family, part of Ascension, had an opportunity to improve outcomes and reduce costs associated with overreliance on the ED, frequent admissions, avoidable readmissions and fragmented care for the sickest and most socioeconomically vulnerable. It designed and funded an extensivist approach to shepherd patients with chronic conditions from an acute inpatient or ED episode through discharge, home care and establishment of a strong primary care relationship.

  • The extensivist care team included physicians, advanced practitioners, social workers, respiratory therapists, dietitians and community health workers.
  • The team collaborated to develop a comprehensive care plan; provide direct services at home; offer care navigation, coordination and medical management; and facilitate connection or reconnection to primary care.
  • Funded services included behavioral health and medications.
  • The program enrolled patients in 3 groups:
    • Low complexity (~15%): patients had an acute episode related to 1 or 2 well-managed chronic conditions; most had public insurance; they typically reconnected with primary care within 30 days.
    • Midrange complexity (~70%): patients had 3 or more chronic conditions and prevalent psychosocial issues; many qualified for public insurance but were not enrolled; they typically integrated into primary care within 90 days.
    • High complexity (~15%): patients had 5 or more chronic conditions, often including serious behavioral illnesses; most had no insurance; their ongoing medical needs were not met in usual primary care.

Soon after the program’s launch, Seton began conducting a case-control study comparing benchmarks for patients enrolled in the extensivist program with a medically/sociodemographically similar group receiving usual care.

Measures evaluated over the program’s first year of operation included:

  • Admissions
  • Inpatient days
  • Average length of stay
  • Emergency department visits
  • Costs
  • Patient and provider satisfaction

Early data suggested downward trends in:

Related resources:

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Source: Sg2 Interview With Seton Healthcare Family, 2012.

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