1. Home
  2. »
  3. DRC Resource
  4. »
  5. Medicaid: Efforts to Identify, Predict, or Manage High-Expenditure Beneficiaries

Medicaid: Efforts to Identify, Predict, or Manage High-Expenditure Beneficiaries

Year:
2019
State:
NatDoc: National Document
Website Link:
Publicly Available:
Yes
Billing and Reimbursement:
Certification:
CHW role scope of practice
Evidence Generation:
Documentation of how CHWs can work within care teams, Evidence-based interventions, ROI and bundled payment successes/challenges
Policy:
Sustainable Financing:​
How to engage and work with Medicaid, MCO or bundled payment reimbursement models, Documentation of how CHWs can work within care teams, Evidence-based interventions, ROI and bundled payment successes/challenges
Workforce Development:

Summary

Medicaid spending is projected to hit $1 trillion by 2026. Studies have found a small percentage of beneficiaries account for a large amount of its spending. Many high-cost beneficiaries have poorly managed chronic conditions that can result in costly services—such as emergency room visits—that are preventable.

We asked officials in 7 states what they do to manage health care costs and improve care for high-cost Medicaid beneficiaries. All of the states said they coordinate care across a patient’s providers to better manage physical and mental conditions. Some states also tried to address beneficiaries’ basic needs, such as food and housing.