Start: April 2008

Funder: Kaiser Permanente Community Benefit

Approximately five percent of Medicaid beneficiaries drive more than 55 percent of total spending in states across the country. More than 80 percent of Medicaid’s ”super-utilizer” beneficiaries have three or more chronic conditions, and up to 60 percent have five or more; yet, the majority of these patients receive fragmented and uncoordinated care often leading to unnecessary and costly hospitalizations and institutionalizations.

Rethinking the way states care for Medicaid’s highest-need, highest-cost beneficiaries presents a compelling opportunity to improve care and control costs. The Innovations in Complex Care program (a continuation of the former Rethinking Care Program) was developed by CHCS with support from Kaiser Permanente Community Benefit to serve as a national “learning laboratory” to design and test better approaches to care for Medicaid’s super-utilizers. The project is supporting a range of activities to advance Medicaid’s capacity to serve these beneficiaries as described below:

  • Complex Care Innovation Lab

    CHCS is convening leaders in complex care management from across the country to collectively problem solve and generate innovative solutions to improve care for high-need patient populations. The Innovation Lab is providing them a unique opportunity to: (1) learn from each other; (2) creatively problem-solve; (3) develop and test new approaches; and (4) influence the local, state, and national dialogues on how to better serve this population.

  • Digital Health Initiative

    The highly transient nature of the high-need, high-cost, low-income population makes them uniquely positioned to benefit from mobile and digital tools. With this initiative, CHCS is seeking to educate members of the health startup and entrepreneur communities about the types of challenges these populations face and to encourage the development of tailored digital health tools to meet their needs.

  • Faces of Medicaid Analyses

    This ongoing series of national analyses, many of which have been products of the Rethinking Care Program, provides insights into the prevalence of specific conditions among Medicaid beneficiaries and their patterns of service use.

  • Rethinking Care Program: Integrated Care Collaboratives

    CHCS partnered with four state-led multi-stakeholder collaboratives to test new strategies to improve health care quality and control spending for Medicaid’s highest-need, highest-cost populations. The pilots – in Colorado, New York, Pennsylvania, and Washington –sought to promote strategies to better integrate care for individuals with complex arrays of medical, behavioral health and social service needs.