DSS plans for high-cost, high-need members focuses on behavioral health

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At yesterday’s online MAPOC Complex Care Committee meeting, DSS described their innovation plan to address the needs of high-cost, high-need Medicaid members. (meeting video and slides) The project was made possible by a technical assistance grant from the National Governor’s Association. Five agencies and the Medicaid Administrative Service Organizations, CHNCT and Beacon Health, have worked with the committee to identify the top 10% of members – adults and children — in cost, ED and inpatient use, each separately. Interestingly we found that there is not a lot of overlap between those groups. The top 10 conditions for each of the six categories are listed on the slides. The team then turned to identifying interventions that could have an impact. Consequently the group decided to focus on members with behavioral health needs; many have co-morbid medical conditions. The project will focus on enhanced care management by Beacon Health. 1,236 high-need adults identified from the data will receive intensive care management in the community including intensive outreach from peer counselors to help them develop a personalized care plan and connect them to that care. Yale-New Haven is the highest volume hospital by far with almost four times the number of ED visits and in patient stays as the next highest. Beacon will conduct the evaluation using a matched set of members who do not receive those services due to geography. Questions from the committee included how the state will ensure that the new PCMH+ ACOs do not collect shared savings based on this care coordination funded by the state, measuring connections to primary care, needs of people with intellectual disabiliites, how to address members served by home or nursing home care, and why Yale-New Haven has so many high-utilizing members.