Through the Rethinking Care Program, CHCS worked with multi-stakeholder collaboratives in four states – Colorado, New York, Pennsylvania, and Washington – to design and test new care management interventions for their highest-need, highest-cost beneficiaries. The state-led pilots sought to promote strategies to better care for the top 5-20 percent of Medicaid beneficiaries whose care needs account for a significant portion of Medicaid expenditures.
Pilot projects were designed to: (1) identify patients who are most likely to benefit from enhanced care management; (2) develop tailored care management interventions; and (3) rigorously measure quality and cost outcomes. Below are descriptions of the pilot efforts and resources detailing lessons from select pilot efforts:
- Colorado Medicaid worked with two health plans, Colorado Access and Kaiser Permanente, to provide enhanced care management to the state’s highest-cost, highest-risk adults with multiple chronic conditions.
- New York Medicaid implemented six regional demonstration pilots that tested an interdisciplinary model of care to improve health care quality, ensure appropriate use of services, improve clinical outcomes, and reduce the cost of care for beneficiaries with medically complex conditions. The pilots, based in New York City, Long Island (Nassau County), Western Region (Erie County), and Westchester County, served as the “testing grounds” to inform design and development of the state’s Medicaid Health Home program.
- Pennsylvania’s Serious Mental Illness (SMI) Innovations Project included two pilots in the Southeastern and Southwestern regions of the state designed to integrate physical and behavioral health care services for adult Medicaid beneficiaries with serious mental illness and co-occurring physical health conditions. The pilots paired a physical health managed care organization (MCO) with their respective county behavioral health MCO.
- Washington Medicaid provided intensive care management and care coordination for adults with chronic physical needs and mental illness or substance abuse issues. King County Care Partners, a partnership of King County Aging and Disability Services, Harborview Medical Center, and four community health center networks, coordinated the Seattle area pilot.