CMS Offers a Window into Super-Utilizer Programs
July 25—Medicaid super-utilizer programs—care delivery models that target Medicaid beneficiaries with complex, unaddressed health issues and a history of frequent healthcare encounters – demonstrate early promise in improving care and reducing costs, according to a recent informational bulletin by the Centers for Medicare & Medicaid Services (CMS).
The bulletin takes a deep dive into the topic of super-utilizer programs, sharing information on how states can design and implement such a program. The report’s content is based on interviews with ten super-utilizer programs across the United States.
A key area of the bulletin focuses on the characteristics of effective super-utilizer programs. According to CMS, these programs:
- Are guided by the needs of the individuals in the program and their community’s capacity and infrastructure for primary care and behavioral health
- Offer an array of services, including care coordination, in-person medical care, in-person behavioral health care, assistance with social needs, and health coaching
- Leverage real-time data to identify and engage potential patients in a timely fashion
- Rely on interdisciplinary care management teams that create personalized care plans, engage in frequent outreach efforts, and connect clients with behavioral health and social services
- Have convenient locations where people can easily receive services
- Are staffed with trained individuals who have the appropriate skill set and experience for the population
- Respond to feedback loops, such as dashboards and patient surveys, to verify whether patient needs are being met
Publication Date: Thursday, July 25, 2013