How to Improve Care for High-Need, High-Cost Medicaid Patients

For roughly two decades, health care organizations have been aggressively experimenting with programs to improve care for high-need, high-cost patients. Most of those efforts focused on care models for chronically ill and frail elders, but organizations are now increasingly developing programs to better serve Medicaid beneficiaries with complex health and social needs. Although select programs appear to be effective, a recent high-profile evaluation of one of them — the Camden Coalition of Healthcare Providers — has raised concerns over the utility of care models for medically and socially complex patients.

Such skepticism is premature. In an article in the new issue of the American Journal of Managed Care, we published encouraging results from a complex-care-management program serving high-need, high-cost Medicaid patients in Memphis, Tennessee. The program, built on top of an existing integrated–care model, lowered total spending by keeping patients out of the hospital. We believe our experience with this program offers important lessons for others seeking to design and implement their own complex-care-management programs.

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