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Purchasing Strategies to Improve Care Management for Complex Populations: A National Scan of State Purchasers

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Abstract:

A small portion of Medicaid beneficiaries with significant health care needs drive the majority of program expenditures. In response, a number of states are developing increasingly sophisticated approaches to improve care and control costs for aged, blind and disabled and Supplemental Security Income (ABD/SSI) populations.
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This new CHCS report examines emerging care management approaches in 12 states: California, Indiana, Minnesota, Mississippi, New York, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Texas and Washington. Interviews with Medicaid officials and select contractors in these states reveal critical insights about how to design care management approaches for beneficiaries with complex health care needs.
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The scan states are using an array of innovative care models that fall between fee-for-service and fully capitated managed care to improve performance in terms of both quality and costs for ABD/SSI populations. The report outlines how states are identifying high-risk beneficiaries and developing tailored care management approaches to meet their needs. It also details state experiences in testing new financing mechanisms and more robust measurement strategies designed specifically for adults with chronic illnesses and disabilities.
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As more states look to enhance care management approaches for high-need, high-cost populations, we hope that this report offers helpful considerations to guide state program design decisions.