Medicaid addresses 'super-utilizers' in health home programs to cut costs

Many Medicaid programs are creating new or expanding existing home health projects to help cut costs and prevent so-called "super-utilizers" from obtaining unnecessary healthcare services.

These super-utilizers are patients with complex, chronic medical problems, who disproportionately use expensive healthcare services, especially emergency room visits and hospital admissions--just 5 percent of the 68 million Medicaid beneficiaries make up 60 percent of the program's overall spending, reported Stateline.

Since the Affordable Care Act reimburses providers who coordinate care for patients with more than one serious, chronic condition, at least 15 state Medicaid programs are paying for doctors to specifically address these patients. The states--Alabama, Idaho, Iowa, Maine, Maryland, Missouri, New York, North Carolina, Ohio, Oregon, Rhode Island, South Dakota, Vermont, Washington and Wisconsin--are establishing "health homes," where doctors coordinate physical and mental care for these patients.

Missouri was the first state to create a health home in 2012 and has about 20,000 people with severe mental illness enrolled in its homes. After operating for just one year, Missouri's health home program saved almost $3 million by preventing enrollees from hospital admissions and emergency room visits.

Plus, enrollees with co-existing conditions, including hypertension, obesity and diabetes, saw big improvements. After two years in the health home program, 65 percent of enrollees had controlled their hypertension, up from 24 percent.

One of the reasons Medicaid health home programs can successfully reduce unnecessary healthcare use is that Medicaid beneficiaries have "the most complex health problems to tease apart," Jeffrey Brenner, executive director of the nonprofit Camden Coalition of Healthcare Providers in New Jersey, told Scientific American.

"In a typical primary-care model, we don't serve those patients very well. It was a big, audacious, hairy problem where the tools we have been given are inadequate to solve it."

To learn more:
- read the Stateline article
- see the Scientific American article