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.
FACES OF MEDICAID DATA SERIES
Since 2000, CHCS’ Faces of Medicaid series has shed light on the prevalence of specific conditions among Medicaid beneficiaries, patterns of service use, and costs. By better understanding the Medicaid population, states and health plans can identify new opportunities to improve care, enhance health outcomes, and control spending.