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