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Improving Care for Medicaid Beneficiaries with Complex Needs and High Costs – Sharing Resources and Lessons Learned

In the July 24, 2013 Center for Medicaid and CHIP Services Information Bulletin (PDF, 423.03 KB), we described Medicaid “superutilizers” or Beneficiaries with Complex Needs and High Costs (BCNs) as 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.” This subset of Medicaid beneficiaries is an extremely heterogeneous group with varying medical, behavioral, and psycho-social needs. In order to support Medicaid agencies’ efforts, IAP launched a 10-month learning collaborative to: 1. enhance state capacity to use data analytics to better serve the BCN population; 2. develop/refine payment reforms to support BCN programs; and 3. facilitate the replication/spread of BCN programs demonstrating promising results.

Designing, implementing, and evaluating BCN-related activities can be very challenging. As part of IAP, states focused on a variety of populations, including Medicaid beneficiaries with multiple chronic conditions, beneficiaries dually-eligible for Medicare and Medicaid, and beneficiaries with opioid use disorders. While states varied in their target populations, they share common interests and technical support needs ranging from building data capacity around identifying and stratifying their BCN populations to better understanding how to design alternative payment methodologies for these complex populations. We will soon post a fact sheet on Medicaid.gov that includes a more detailed overview of how IAP works directly with five states (District of Columbia, New Jersey, Oregon, Texas, and Virginia) as part of this program area.

In addition, much like we did for IAP’s Reducing Substance Use Disorders program area, we are  launching a four-part webinar series for the BCN program area that is open to all states and interested stakeholders. The goal for this webinar series is to leverage the resources we have cultivated over the past year for a small group states and spread those nationally so that all states can better understand how to apply these lessons learned in their own state environment. As part of each webinar, we will spotlight our IAP states’ success and challenges related to their BCN efforts. Based on where a state is in the process of designing or implementing related efforts, we encourage states to attend all four of the webinars or select the topics of most interest in order to spur internal discussions.

The first webinar will focus on Identification and Stratification of Medicaid Beneficiaries with Complex Needs and High Costs – (October 31, 2016 from 2:00 pm to 3:30 pm ET). During this webinar we will walk states through a framework for understanding the types of data and data analytics often involved in the design and implementation of BCN initiatives (i.e., profiling, hot spotting, impactable assessment, risk stratification). Speakers for this webinar include: Ruben Amarasingham, MD, MBA, President and CEO of Parkland Center for Clinical Innovation, Pieces Technologies Inc. and Tracy Johnson, PhD, Director of Health Care Reform Initiatives for Denver Health. In addition, state representative from Oregon and Washington DC Medicaid will share their perspectives about their use of specific profiling methods, tools and other “homegrown” state efforts. Register here for this webinar: https://www.eventbrite.com/e/bcn-webinar-series-identification-and-stratification-of-medicaid-beneficiaries-with-complex-needs-tickets-28420861562 

The next topics and tentative dates for this national webinar series are:

  • Factoring Social Determinants of Health into Strategies to Impact Utilization and High Costs Among Medicaid Beneficiaries with Complex Needs -  Tentative date: December 12, 2016 from 2:00 pm to 3:30 pm ET
  • Effective Care Management Strategies for Medicaid Beneficiaries with Complex Needs and High Costs – Tentative date: January 9, 2017 from 2:00 pm to 3:30 pm ET
  • Applying Alternative Payment Strategies for Medicaid Beneficiaries with Complex Needs and High Costs – Tentative date: February 27, 2017 from 2:00 pm to 3:30 pm ET

We invite you to visit our recently updated BCN IAP webpage on Medicaid.gov. Stay tuned for more updates via SOTA listserv (email sotaupdates@cms.hhs.gov to be added to the distribution list.) about the upcoming webinar series as well as our plans for additional technical support opportunities for states. 

IAP Commentary
Karen LLanos, Director, Medicaid IAP and Laura Snyder, Social Science Research Analyst, IAP, CMCS


Collections: IAP Commentary