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Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs

Beneficiaries with Complex Care Needs and High Costs (BCNs) are Medicaid beneficiaries who, because of their health and/or social conditions, are likely to experience high levels of costly but preventable service utilization, and whose care patterns and costs are potentially “impactable” (CMCS July 24, 2013 Informational Bulletin (PDF, 423.03 KB)). The Medicaid Innovation Accelerator Program (IAP) provided technical assistance to Medicaid agencies across various areas (i.e., physical/mental health integration and serious mental illness [SMI]) related to Medicaid beneficiaries with complex care needs. As part of this work, IAP created technical resources, including those designed to help Medicaid agencies understand how to analyze data about beneficiaries with SMI, selecting between risk stratification options, and developing data use agreements between state agencies.

Using Data Analytics to Better Understand Medicaid Populations with Serious Mental Illness

This technical resource (PDF, 1.12 MB) outlines preliminary steps that Medicaid agencies can use to identify Medicaid adult beneficiaries with Serious Mental Illness (SMI) and to gain a better understanding of this population to inform future decision-making. This resource also provides examples of potential data outputs that can be replicated using a state’s Medicaid claims and encounters data. Medicaid agencies can use this resource in collaboration with state mental health and substance abuse authorities to foster mutual understanding of Medicaid beneficiaries with SMI, key population attributes, their use of Medicaid services, and Medicaid service costs.

This second technical resource (PDF, 1.17 MB) describes approaches to supplementing and matching Medicaid data with additional data sources that can assist Medicaid agencies with better understanding Medicaid populations with SMI. Data analyses related to housing, corrections/justice involvement and food insecurity are highlighted as examples. The Medicaid IAP created this technical resource to assist Medicaid agencies in developing approaches for engaging external partners to share data and conduct analytics to better understand these impacts.

Using Data Analytics to Better Understand Medicaid Populations with Serious Mental Illness Technical Assistance

IAP provided technical assistance related to SMI data analytics to Medicaid Agencies in Hawaii, Iowa, Indiana, and New Jersey. These technical assistance activities, which ran from March 2020 through August 2020, aimed to help these states use data analytics to gain a better understanding of their adult population with SMI. Additional information about the technical assistance provided can be found in the Medicaid IAP SMI Data Analytics Cohort Factsheet (PDF, 148.6 KB).

Medicaid Beneficiaries with Complex Care Needs and High Costs Technical Assistance

IAP provided technical assistance to the District of Columbia, New Jersey, Oregon, Texas, and Virginia related to BCNs. These technical assistance activities, which ran from October 2015 through August 2016, aimed to help states enhance state capacity to use data analytics to better serve beneficiaries, develop/refine payment reforms to support programs for complex populations, and facilitate the replication/spread of promising results. Additional information about the technical assistance provided can be found in the Medicaid IAP BCN Factsheet (PDF, 44.81 KB).

Physical and Mental Health Integration Technical Assistance

From April 2016 through April 2017, the Medicaid IAP collaborated with Medicaid agencies to expand and/or improve existing Physical and Mental Health (PMH) integration efforts. As part of this program area, IAP provided technical assistance to two groups of states. The first group of states, the Integration Strategy Workgroup, consisted of Hawaii, Idaho, Illinois, and Massachusetts. IAP provided this group with web-based technical assistance on two topics: (1) identifying quality measures applicable to integrated care programs and (2) understanding strategies to build provider capacity.

In the second IAP PMH integration group, Nevada, New Hampshire, New Jersey, Puerto Rico, and Washington received coaching and technical assistance based on individual state needs. Additional information about the technical assistance provided can be found in the Medicaid IAP PMH Factsheet (PDF, 121.69 KB).

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