A multidisciplinary pilot program for Medicaid beneficiaries with complex needs in Washington State offers valuable insights to guide the design of state care management approaches, including health homes. The King County Care Partners pilot was part of the Rethinking Care Program, a national initiative coordinated by the Center for Health Care Strategies and supported by Kaiser Permanente Community Benefit to test new care management approaches for Medicaid’s highest-need, highest-cost beneficiaries.

The King County Care Partners program, which began in February 2009, is a community-based program designed to empower individuals to address their own health care needs and enhance coordination, communication, and integration of medical and social services across safety-net providers. The two-year randomized controlled pilot focused on high-risk Medicaid beneficiaries with both physical and behavioral health conditions.

Findings from the two-year pilot suggest that those who participated in the intervention were likelier to have increased access to care, lower inpatient medical costs, relatively fewer unplanned inpatient admissions, and fewer deaths. In particular, those in the intervention group:

  • Had a lower increase in inpatient medical admissions – 8% versus a 20% increase in the comparison group.
  • Had a 2% decrease in average PMPM cost for inpatient medical admissions following an ED visit (e.g., unplanned admissions) compared to a 49% cost increase for the comparison group.
  • Had a 5% increase in outpatient medical costs versus a 12% decrease in the comparison group, suggesting greater access to needed health care services in the community.
  • Were less likely to experience homelessness – there was a 20% decrease in beneficiaries who experienced at least one month of homelessness following the intervention compared to an 18% increase in the comparison group.

Individuals with both chronic physical and behavioral health conditions are among Medicaid’s highest-cost populations. As states across the nation explore ways to curb costs and improve quality for Medicaid’s highest-need, highest-cost populations, the King County pilot findings offer tangible new strategies for achieving this dual goal.

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