Medicaid: Efforts to Identify, Predict, or Manage High-Expenditure Beneficiaries
Authors: U.S. Government Accountability Office
State: NatDoc: National Document
Website link: https://nachw.org/wp-content/uploads/2023/02/GAO-2019-managing-hi-cost-Medicaid-beneficiaries.pdf
Publicly Available: Yes
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
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
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.
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