Adults with chronic conditions make up approximately 40 percent of the Medicaid population. Yet costs for their care account for more than 80 percent of Medicaid’s expenditures. While a limited number of innovative approaches for caring for this population are being piloted, the majority of these Medicaid patients’ health care remains relatively unmanaged.
This study, conducted by Mathematica Policy Research, Inc. and commissioned by CHCS, offers important lessons to improve care for some of Medicaid’s highest-risk and highest-cost beneficiaries, those with multiple chronic conditions. The evaluation examined 10 demonstration projects implemented within the Medicaid Value Program: Health Supports for Consumers with Chronic Conditions, a two-year initiative designed by CHCS and funded by Kaiser Permanente and the Robert Wood Johnson Foundation.
Findings from the independent evaluation reinforce the following conclusions:
- Medicaid purchasers, plans, and providers are willing and able to test groundbreaking models of care for beneficiaries with multiple chronic conditions;
- Formal measurement of these innovations is critical to quality improvement and to building an evidence base where none now exists; and, most important,
- Integrating services—such as physical, behavioral, substance abuse, and long-term care—for high-risk Medicaid beneficiaries appears particularly promising in generating quality improvements and reducing hospital admissions.
States, health plans, and other Medicaid stakeholders interested in designing new approaches to caring for consumers with multiple chronic health needs can learn from the experiences of the Medicaid Value Program grantees. Download the full evaluation, executive summary, team case studies and intervention logic models for more information.