Improving the quality and cost-effectiveness of publicly financed health care
The Faces of Medicaid II: Recognizing the Care Needs of People with Multiple Chronic Conditions
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The majority of Medicaid spending is driven by people with multiple chronic conditions. Greater understanding of these high-need, high-cost beneficiaries can help Medicaid stakeholders design programs to more effectively manage their care, improve their health outcomes, and reduce or control the costs of caring for them.
The Faces of Medicaid II: Recognizing the Care Needs of People with Multiple Chronic Conditions, published by the Center for Health Care Strategies, is a groundbreaking examination of the patterns of multiple chronic conditions among Medicaid beneficiaries. The analysis sought to answer two key questions:
- What is the prevalence of chronic conditions within the Medicaid population; and
- Are there patterns of these conditions that can inform the development of more appropriate guidelines, care models, performance measurement systems, and reimbursement methodologies?
To develop this "portrait" of beneficiaries with comorbidities, CHCS worked with Rick Kronick, PhD, and Todd Gilmer, PhD, experts in Medicaid disease prevalence from the University of California, San Diego. The resulting data show that beneficiaries with three or more chronic conditions are responsible for a significant portion of Medicaid spending. The findings shed light on how Medicaid stakeholders can rethink care management approaches for high-need, high-cost beneficiaries with multimorbidity. Traditional disease management programs focused on single diseases that "silo" beneficiaries into disease specific interventions do not address the complex needs of those with multiple conditions. By clearly identifying the complex needs of these beneficiaries, states, plans and providers can develop integrated and coordinated delivery systems that incorporate clinical care with behavioral and non-medical supportive services.