Understanding and Addressing Hot Spots Critical to Bending the Medicaid Cost Curve

Medicaid Health Plans

Better Access to coordinated care Quality Assurance and Improvement Delivery System Innovation Predictable Costs Cost Savings Reduced Waste, Fraud and Abuse
2

36 States and DC Have Medicaid Health Plans

WA MT ND MN ID WY NV UT CA CO KS MO TN AZ NM TX LA FL AK OK AR MS AL GA SC NE IA IL IN OH WV VA SD WI MI PA NY CT RI NJ DE MD DC
VT NH

ME

OR

MA

KY
NC

HI

Current Medicaid Health Plan Penetration

UPMC for You Connected Care

Faced with a high rate of BH and PH admissions, readmissions and emergency room utilization. Those with SMI die 25 to 32 years younger than the general population. Most deaths (60%-70%) result from physical conditions with treatable risk factors, such as metabolic disorders, cardiovascular disease, diabetes and modifiable risk factors such as obesity and smoking. Facilitated care coordination among the PH and BH care management staff and identified members who had an inpatient admission or emergency room visit.

Health Partners of Philadelphia Health Partners Healthier You Disease Management Programs Targeted toward asthma and diabetes populations and are designed using evidencebased guidelines in support of the practitioner-patient relationship Overall goal: Improve health outcomes and empower members to achieve self management of their lifelong condition.

ConclusionWhat Medicaid Health Plans Offer

Improving accountability by using data and information systems to understand patterns of care Improving efficiency by linking patients to primary care and working to reduce avoidable hospitalizations Focusing on prevention, avoiding complications and costly exacerbations of chronic illnesses Working to make a healthier generation of children Reducing fraud, abuse and inefficiencies in care Transparently reporting on quality and working continuously to improve it