While creating better systems of care for aged, blind, and disabled beneficiaries is a priority within Medicaid, it is a challenge given the vast heterogeneity of this complex population. The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions provides insights for targeting efforts to improve care and control spending for the program's highest-need, highest-cost beneficiaries.
Building on the 2007 Faces of Medicaid II report, this subsequent analysis examines two data sets -- pharmacy claims and five years of diagnostic data -- to further refine what is known about Medicaid beneficiaries with multiple chronic conditions. Researchers Rick Kronick, PhD, and Todd Gilmer, PhD, both from the University of California, San Diego, found that by looking at pharmacy data in addition to claims:
The addition of pharmacy data particularly reinforces the prevalence of psychiatric illness among high-cost Medicaid beneficiaries. In examining diagnostic and pharmacy data together, psychiatric illness is represented in three of the top five most common pairs of diseases among the highest-cost five percent of Medicaid-only beneficiaries with disabilities.
While there is still much to learn about how to improve care for complex populations, this analysis can help guide Medicaid stakeholders in tailoring interventions more effectively by highlighting subsets of patients or conditions that are most likely to benefit from care management.
This analysis, made possible through a grant from Kaiser Permanente, is a product of CHCS' Rethinking Care Program, which is developing and testing new strategies to improve health care quality and control spending for Medicaid's highest-need, highest-cost populations.