Issue Areas

Adults with Complex and Special Needs

Up to 80% of Medicaid spending is on approximately 20% of enrollees, particularly those with severe chronic illnesses and disabilities and the frail elderly. Improving the quality of care for these high-need populations can both improve health outcomes and better manage health care costs. CHCS works with Medicaid stakeholders to design, implement, and evaluate programs that address the needs of adults with chronic conditions and disabilities. The following subtopics link to related CHCS resources and initiatives:

Related Initiatives

Highlights

Extending Lessons from a Medicaid Pilot to Improve Care for Medicare and Dual Eligible Beneficiaries

This spotlight highlights UPMC Community Care, a new program for Medicare beneficiaries with serious mental illness in Allegheny County, Pennsylvania. The program, which integrates physical and behavioral health care for enrollees, is based on a model of care piloted through CHCS' Rethinking Care Program.

SMI Innovations Project in Pennsylvania: Final Evaluation Report

Jung Y. Kim, Tricia Collins Higgins, Dominick Esposito, Angela M. Gerolamo, and Mark Flick, Mathematica Policy Research

As states across the nation explore ways to curb costs and improve quality for Medicaid's highest-need, highest-cost populations, the Pennsylvania pilot findings offer tangible strategies for doing so.

Structuring New Service Delivery Models for Individuals with Intellectual and Developmental Disabilities

Alice Lind and Nancy Archibald, Center for Health Care Strategies

This policy brief discusses key elements of new service delivery models for individuals with intellectual and developmental disabilities and provides examples of such models now being implemented.

Early Lessons from Pennsylvania's SMI Innovations Project for Integrating Physical and Behavioral Health in Medicaid

Jung Kim, Tricia Higgins, Angela Gerolamo, and Dominick Esposito, Mathematica Policy Research, and Allison Hamblin, Center for Health Care Strategies

This brief describes two Pennsylvania regional pilot programs to integrate physical and behavioral health services for adult Medicaid beneficiaries with serious mental illness (SMI) and co-occurring physical health conditions.

State Options for Integrating Physical and Behavioral Health Care

Allison Hamblin, Center for Health Care Strategies; and James Verdier and Melanie Au, Mathematica Policy Research

This policy brief from the Integrated Care Resource Center explores promising state options for integrating physical and behavioral health services within managed delivery systems, including examples of current state programs and critical considerations for implementation.

Faces of Medicaid: Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services for Medicaid Populations

Cynthia Boyd, Bruce Leff, Carlos Weiss, Jennifer Wolff, Allison Hamblin, and Lorie Martin

CHCS commissioned this Faces of Medicaid analysis by Johns Hopkins University researchers to examine multimorbidity patterns among adult Medicaid beneficiaries with disabilities and explore the implications of specific patterns on hospitalization and cost. The analysis uncovers significant opportunities for prioritizing clinical interventions, including the need to integrate physical and behavioral health services.

Integrating Care for Dual Eligibles: An Online Toolkit

This online toolkit is designed to share innovative approaches for integrating Medicaid and Medicare services. It offers policy-related materials, hands-on tools and templates to help guide state efforts, as well as resources from states that have successfully implemented integrated care programs.