title: Medicaid care management: description of high-cost addictions treatment clients.
abstract: High utilizers of alcohol and other drug treatment (AODTx) services are a priority for healthcare cost control. We examine characteristics of Medicaid-funded AODTx clients, comparing three groups: individuals <90th percentile of AODTx expenditures (n=41,054); high-cost clients in the top decile of AODTx expenditures (HC; n=5,718); and 1760 enrollees in a chronic care management (CM) program for HC clients implemented in 22 counties in New York State. Medicaid and state AODTx registry databases were combined to draw demographic, clinical, social needs and treatment history data. HC clients accounted for 49% of AODTx costs funded by Medicaid. As expected, HC clients had significant social welfare needs, comorbid medical and psychiatric conditions, and use of inpatient services. The CM program was successful in enrolling some high-needs, high-cost clients but faced barriers to reaching the most costly and disengaged individuals.
authors.affiliation: Health and Treatment Research and Analysis Division, The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, New York, NY 10017, USA. cneighbors@casacolumbia.org
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Neighbors
authors.forename: Yi
authors.initials: Y
authors.lastname: Sun
authors.forename: Rajeev
authors.initials: R
authors.lastname: Yerneni
authors.forename: Ed
authors.initials: E
authors.lastname: Tesiny
authors.forename: Constance
authors.initials: C
authors.lastname: Burke
authors.forename: Leland
authors.initials: L
authors.lastname: Bardsley
authors.forename: Rebecca
authors.initials: R
authors.lastname: McDonald
authors.forename: Jon
authors.initials: J
authors.lastname: Morgenstern
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000191:economics / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics*; D008875:Middle Aged; D009518:New York; D012042:Registries; D019966:Substance-Related Disorders / Q000191:economics / Q000534:rehabilitation*; D014481:United States; D055815:Young Adult
keywords: Addictions treatment; Care management; Costs; Healthcare reform; Medicaid