CMS: Controlling Medicaid "Super-Utilizers" Will Lower Costs

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Initiatives that target Medicaid "super-utilizers" — patients with complex, unaddressed health issues who frequently visit healthcare providers — have shown early promise in reducing costs as well as improving care and wellness, according to CMS.

A relatively small group of patients accounts for the majority of Medicaid spending, with 5 percent of beneficiaries accounting for 54 percent of the program's total expenditures. Evidence suggests inexpensive early interventions and primary care could reduce the number of emergency department visits and hospital admissions for super-utilizers and lower their cost of care, according to CMS.

The Center for Medicare and Medicaid Innovation has given awards to two initiatives that target super-utilizers. Cooper University Hospital in Camden, N.J., received $2.8 million to expand its Camden Coalition super-utilizer program to more than 1,200 patients for an expected $6.2 million in savings over three years.

New Brunswick-based Rutgers, The State University of New Jersey, has been awarded $14.4 million to test community-based super-utilizer programs led by safety-net provider organizations in Pennsylvania, Colorado, Missouri and California. These initiatives are expected to save $67.7 million over three years. The Cooper and Rutgers initiatives will issue their first annual reports in 2014.

More Articles on Medicaid Costs:
90 Hospital-Affiliated Practices Test Patient-Centered Medical Neighborhood
48 States Expected to Start Paying Physicians Higher Medicaid Rates
How a 2-Pronged Population Health Initiative Saved Oklahoma Medicaid $139.2M 

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