Improving the management of care for high-cost Medicaid patients.
Increased policy attention is being focused on the management of high-cost cases in Medicaid. In this paper we present an algorithm that identifies patients at high risk of future hospitalizations and offer a business-case analysis with a range of assumptions about the rate of reduction in future hospitalization and the cost of the intervention. The characteristics of the patients identified by the algorithm are described, and the implications of these findings for policymakers, payers, and providers interested in responding more effectively to the needs of these patients are discussed, including the challenges likely to be encountered in implementing an intervention initiative.
Billings
John
J
New York University's Robert F. Wagner Graduate School of Public Service, USA. john.billings@nyu.edu
Mijanovich
Tod
T
D000465:Algorithms; D003362:Cost-Benefit Analysis; D019468:Disease Management; D017048:Health Care Costs / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods*; D012945:Social Values; D013221:State Health Plans / Q000191:economics / Q000706:statistics & numerical data; D014481:United States