By enhancing care for Medicaid’s highest-need, highest-cost beneficiaries, states can potentially achieve not only better outcomes, but also substantial cost savings through more efficient care and reduced utilization. Clarifying Multimorbidity Patterns to Improve Targeting and Delivery of Clinical Services for Medicaid Populations provides new insights to help Medicaid stakeholders target clinical strategies for high-priority populations. CHCS commissioned this Faces of Medicaid analysis by Johns Hopkins University researchers to examine multimorbidity patterns among adult Medicaid beneficiaries with disabilities and explore the implications of specific patterns on hospitalization and cost. The findings demonstrate that:

• A number of specific conditions and combinations of conditions are frequently associated with high per capita costs and hospitalization rates;
• Mental illness is nearly universal among the highest-cost, most frequently hospitalized beneficiaries; and
• The presence of mental illness and/or drug and alcohol disorders is associated with substantially higher per capita costs and hospitalization rates.

The analysis uncovers significant opportunities for prioritizing clinical interventions, including the need to integrate physical and behavioral health services. To help guide Medicaid stakeholders, CHCS together with its partners at Johns Hopkins developed a variety of online resources detailing prevalence, utilization and cost data as well as promising clinical opportunities for identified high-priority conditions. Through the Affordable Care Act (ACA), states have new opportunities to develop more integrated models for beneficiaries with serious mental illness, chronic physical conditions and substance use disorders. This analysis and related resources can help states in pursuing these opportunities and targeting efforts to best meet the needs of high-priority beneficiary populations.

Companion Resources

Multimorbidity Pattern Analyses and Clinical Opportunity Summaries – Developed to help Medicaid stakeholders guide care management activities for critical beneficiary subsets, these clinical opportunity packets summarize prevalence, utilization and expenditure data as well as promising clinical opportunities for 13 high-priority index conditions.

Evidence-Based Clinical Models Not Specific to a Multimorbidity Pattern – This literature review provides a summary of promising clinical models that have been developed and tested for patients with multimorbidity, regardless of the specific underlying conditions.

Full Report – Clarifying Multimorbidity to Improve Targeting and Delivery of Clinical Services for Medicaid Populations – Provides detailed description of the analysis and study methodology.

Bibliography of Evidence-Based Studies – Alphabetical listing of all citations identified in the clinical opportunity and general multimorbidity literature reviews.