Rethink care for Medicaid group with multiple chronic conditions

December 1, 2007
Tracey Walker

She is senior editor of Managed Healthcare Executive.

A national examination of disease prevalence among Medicaid beneficiaries underscores ways that managed care plans can rethink care management approaches for high-need, high-cost beneficiaries with multiple chronic conditions.

Data from The Faces of Medicaid II, a recent Center for Health Care Strategies Inc. (CHCS) study, show that beneficiaries with three or more chronic conditions are responsible for a significant portion of Medicaid spending.

"By clearly identifying and prioritizing the complex needs of beneficiaries with comorbidities, health plans can develop coordinated care interventions and integrated delivery systems that incorporate clinical care with behavioral and non-medical supportive services," says Melanie Bella, senior vice president, CHCS, and co-author of the study.

"Many Medicaid beneficiaries with multiple chronic conditions and complex, high-cost healthcare needs remain in the fragmented fee-for-service system," Bella says. "As states increasingly seek ways to better manage the care of high-need beneficiaries, managed care executives can respond by designing and testing new tailored care models that more effectively coordinate the primary, acute, behavioral, social and long-term care needs of this population."

The report cites Washington State, for example. "The state contracts with Molina Healthcare of Washington to provide health risk assessments, develop patient care plans, link multiple providers/care managers, and coordinate services," Bella explains. "A care coordinator on the patient care team plays a key role in prioritizing and directing critical resources for beneficiaries with multiple chronic conditions and behavioral health needs. The program has achieved reductions in inpatient admissions and days in state mental hospital facilities and increases in patient satisfaction."

Like Molina, other plans can recognize the opportunity to improve care for this high-need, high-cost beneficiary population, notes Bella.