Funder: Kaiser Permanente
Author: Richard G. Kronick, Melanie Bella, Todd P. Gilmer
October 2009 | Report
While creating better systems of care for aged, blind, and disabled beneficiaries is a priority within Medicaid, it is a challenge given the vast heterogeneity of this complex population. The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions provides insights for targeting efforts to improve care and control spending for the program’s highest-need, highest-cost beneficiaries.
Building on the 2007 Faces of Medicaid II report, this subsequent analysis examines two data sets — pharmacy claims and five years of diagnostic data — to further refine what is known about Medicaid beneficiaries with multiple chronic conditions. Researchers Rick Kronick, PhD, and Todd Gilmer, PhD, both from the University of California, San Diego, found that by looking at pharmacy data in addition to claims:
- The proportion of Medicaid beneficiaries with disabilities who are diagnosed with three or more chronic conditions increases from 35 percent to 45 percent;
- The frequency of psychiatric illness among Medicaid beneficiaries with disabilities increases from 29 percent to 49 percent, and the prevalence of cardiovascular disease increases from 32 percent to 44 percent; and
- Costs for beneficiaries with three or more chronic conditions increases from 66 percent to 75 percent of total spending for beneficiaries with disabilities.
The addition of pharmacy data particularly reinforces the prevalence of psychiatric illness among high-cost Medicaid beneficiaries. In examining diagnostic and pharmacy data together, psychiatric illness is represented in three of the top five most common pairs of diseases among the highest-cost five percent of Medicaid-only beneficiaries with disabilities.
While there is still much to learn about how to improve care for complex populations, this analysis can help guide Medicaid stakeholders in tailoring interventions more effectively by highlighting subsets of patients or conditions that are most likely to benefit from care management.
This analysis, made possible through a grant from Kaiser Permanente, is a product of CHCS’ Rethinking Care Program, which is developing and testing new strategies to improve health care quality and control spending for Medicaid’s highest-need, highest-cost populations.
CompendiumFaces of Medicaid: Data Analysis Series
BriefFaces of Medicaid: Hospital Readmissions among Medicaid Beneficiaries with Disabilities: Identifying Targets of Opportunity December 2010
BriefFaces of Medicaid: Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services for Medicaid Populations December 2010
Technical Assistance ToolPredictive Modeling: A Guide for State Medicaid Purchasers August 2009
ReportPurchasing Strategies to Improve Care Management for Complex Populations: A National Scan of State Purchasers March 2008
ReportFaces of Medicaid II: Recognizing the Care Needs of People with Multiple Chronic Conditions October 2007
ReportFaces of Medicaid: The Complexities of Caring for People with Chronic Illnesses and Disabilities November 2000