OBSERVATIONS - november 10, 2009
New Study Reveals Greater Complexity Among Medicaid’s High-Cost Patients
While the aged, blind and disabled are only 25 percent of the 60 million Americans enrolled in Medicaid, their care consumes the majority of Medicaid expenditures. To understand this population better, the Center for Health Care Strategies (CHCS), with support from Kaiser Permanente’s Community Benefit department and the Robert Wood Johnson Foundation, has worked with investigators at the University of California-San Diego to determine patterns of co-morbidity among fee-for-service Medicaid beneficiaries.
In 2007, CHCS published The Faces of Medicaid II: Refining the Portrait of People with Multiple Chronic Conditions. That study used 12 months of diagnostic claims data to show that Medicaid’s highest-cost patients have a very high prevalence of multiple co-morbidities. Faces II identified associations among certain common medical diagnoses, but not between physical conditions such as diabetes and behavioral health problems.
CHCS has now issued The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions. Faces III extends the prior effort by adding in pharmacy claims and expanding the timeframe to five years of diagnostic data. The additional data allow a more precise look at the population: Adding one year of pharmacy claims expanded the proportion of beneficiaries with three or more conditions while also nearly doubling the observed prevalence of psychiatric illness from 29 percent to 49 percent over diagnostic claims alone. Similarly, adding pharmacy data revealed psychiatric illness as part of three of the five most common paired conditions, where the prior analysis had had none. Extending the diagnostic data to a five-year look more than doubled the prevalence of three or more conditions, to 67 percent from the 29 percent seen with a single year of diagnostic claims.
The Faces reports starkly illustrate that the challenge of improving Medicaid outcomes is directly linked to the complexity of the people the program needs to serve. These reports also support the argument that care must be transformed to confront co-morbidity, especially co-occuring physical and mental health problems. For many people, the concept of “personalization” is now associated with the commercialization of the genome. But eventual success in Medicaid demands a different personalization—to meet the highly diverse and individualized care needs of the complex but real people served.
- Paul Wallace, MD,
Medical Director for Health and Productivity Management Programs,
Senior Advisor Avivia Health, The Permanente Federation, Kaiser Permanente
|
November 6, 2009 - Getting Physical With Health Reform
October 12, 2009 - Can Your Doctor Trust Your Electronic Health Data?
August 11, 2009 - Low-Cost, High-Quality Health Care in America - How Do They Do That?
June 17, 2009 - Meaningful Use of Health IT
May 14, 2009 - Just Tell Me: How Thick is the Ice?
April 21, 2009 - Achieving a Healthier Food System: A Wicked Problem
January 29, 2009 - Gathering Support for Health Federal Transportation Policy
|
About
