Funder: Kaiser Permanente Community Benefit

Author: Allison Hamblin and Stephen A. Somers, Center for Health Care Strategies, Inc.

December 2011 | Brief


Enhancing care management is one promising way of improving care and reducing costs for Medicaid’s highest-need beneficiaries. While recognized as a valuable endeavor, the concept is often not clearly defined, making it challenging for states and health plans to adopt care management practices.

This brief provides a glimpse of some of the innovative programs being implemented in states across the country that use care management approaches to address the complex physical, behavioral, and psychosocial needs of Medicaid’s highest-risk populations. It sheds light on the program’s high-risk beneficiary subsets and outlines the following core elements that should be considered in the design of complex care management programs:

  1. Stratification and triage by risk/need;
  2. Integration of services;
  3. Designated “care home” and personalized care plan;
  4. Consumer engagement strategies;
  5. Provider engagement strategies;
  6. Information exchange among all stakeholders;
  7. Performance measurement and accountability; and
  8. Financial incentives aligned with quality care.

State examples cited in the brief represent participants in the Rethinking Care Program, a national initiative developed by the Center for Health Care Strategies to help states better integrate care for Medicaid beneficiaries with complex needs.