Monday, December 14, 2015

Medicaid update: New data on high-cost, high-need members

Friday’s Medicaid Council meeting focused on CT’s participation in a national technical assistance program to identify and meet the needs of high-cost, high-need patients. This population has received a great deal of attention from policymakers as the best opportunity to both improve access and quality of care as well as control costs. The concept offers exceptional opportunities for CT’s Medicaid program, that cares for some of the state’s most fragile and costly residents. An initial look at the top 10% of children and adult CT Medicaid utilizers, measured by total spending, ED use and inpatient care, finds 4,385 adult and 3,913 child high cost members. Fortunately, there is little evidence of racial or ethnic disparities among high-need Medicaid members in CT – likely due to DSS and CHNCT’s substantial outreach efforts. However both inpatient admissions and total costs among high-need adults are more than twice the rate for high-need children. More study is needed to determine the reason(s). The program offers exciting potential for data-driven solutions targeted to specific problems and great potential to save money in the program.