As states grapple with growing budget concerns, rising health care costs, and the possibility of expanding Medicaid, interventions targeted toward the highest-need, highest-cost populations present an important way for states and Medicaid health plans to reduce spending and improve care for high-risk consumers.
Established in 1997, Network Health is a Massachusetts-based, nonprofit, comprehensive health plan that provides health care coverage to more than 215,000 Massachusetts residents—over 125,000 of whom are Medicaid beneficiaries and 70,000 of whom are enrollees in low- or no-cost insurance through Massachusetts' Health Connector. Like many health plans across the country, Network Health is looking for ways to better stratify and target resources for their high-need, high-cost populations.
To improve how it identifies members at risk, Network Health recently turned to a Faces of Medicaid analysis completed by the Center for Health Care Strategies (CHCS) and Johns Hopkins University (JHU) in 2010 that examined multimorbidity patterns among adult Medicaid beneficiaries with disabilities. The study revealed that this population has particularly high rates of physical and behavioral health comorbidities, coupled with exceedingly high health care costs. Numerous patterns of comorbidities were examined and certain patterns proved more costly than others, highlighting the opportunity to focus interventions toward particular subsets of the population.