States see significant savings from programs that target Medicaid superusers

Complex care populations represent just 5% of those enrolled in Medicaid nationally but account for approximately half of overall program spending. (Getty/juststock)

States can see a significant return on investment by designing programs targeted at high-need, high-cost Medicaid enrollees, according to a new report.

The report (PDF), produced by the National Governors Association, takes stock of how 10 states and one territory designed, implemented and measured such programs. It also offers a set of best practices for other states interested in following suit.

Complex care populations, the report noted, represent just 5% of those enrolled in Medicaid nationally but account for approximately half of overall program spending. So with the help of the NGA, Alaska, Colorado, Connecticut, Kentucky, Michigan, New Mexico, Puerto Rico, Rhode Island, West Virginia, Wisconsin and Wyoming are building programs to better meet their needs.

Perhaps the most impressive results came from Alaska, which saved $2.21 for every $1 it invested in face-to-face coordination services for complex-care patients. Emergency department usage also dropped 25% among the individuals involved in a program that provided telephonic case management services to a select population.

RELATED: Improving care for high-cost Medicare, Medicaid beneficiaries

Puerto Rico also had a success story to share with its program, in which an interdisciplinary care team helps patients manage their health and connect with community-based care. One year in, the program reduced the average per-member-per-month cost from $499 to $283, and it achieved outcome improvements such as 91% of those with depression reporting a reduction in their symptoms.

Other notable examples include:

  • Michigan, which combined various data sources to demonstrate a link between high emergency department utilization and homelessness—empowering the state to make policy changes to address the housing needs of that population.
  • Wisconsin, which closely collaborated with Medicaid managed care organizations to create a complex care management program for a target population.
  • Rhode Island, which built a collaborative, multipayer, multiagency approach to expand community health teams across the state.

To make such programs work, the report recommends that states: 

  • Secure alignment across state and local health reform initiatives.
  • Take a data-driven approach to identifying target populations and tracking outcomes.
  • Cultivate strong relationships with all the necessary stakeholders.
  • Develop a care delivery and payment approach that incentivizes access to cost-effective interventions.  

"States are leading the way in understanding that the quality of care and the amount of money invested in it has to change," Hemi Tewarson, director of the NGA’s health division and a report co-author, told USA Today. 

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