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Cutting high-risk patient costs with . . . more care?

A pilot King County program is taking aim at high-risk, high-cost medicaid patients with a simple concept: More help.

After moving to her daughter’s home in 2009 to escape an alcoholic, abusive boyfriend, Darlene Clark of Seattle desperately needed help finding permanent housing. Clark, a Medicaid beneficiary, found help in an unexpected place: her health care provider. Through the Harborview Medical Center, Seattle’s public hospital, Clark connected with King County Care Partners’ outreach specialist Caroline Bacon.

Bacon and her colleagues soon found Clark a scarce senior housing placement, and later helped her land a Section 8-subsidized apartment. They also accompanied Clark, who suffers from heart disease, obesity and depression, to her medical appointments
to help her work with her various physicians to reconcile her medications.

Now she says she’s doing much better, can get around with a walker and cane, is able to manage her own medical appointments, and isn’t feeling depressed any more. “They came to my rescue,” says Clark, now 61. “They helped me get out of that situation, and they were just fantastic.”

Clark was one of more than 400 high-cost, high-need Medicaid beneficiaries served by King County Care Partners (KCCP) during the two-year Medicaid care management demonstration program that began in 2009. The program is a collaboration between the Washington State Medicaid program and a set of community partners, including King County Aging and Disability Services (ADS), Harborview Medical Center, Neighborcare Community Health Centers, Healthpoint Community Health Centers and Sea Mar Community Health Centers.

Originally scheduled to end in June 2012, the program is being continued on an interim basis until the state’s “health home” care management model for high-need Medicaid patients is begun. The original program goals were to reduce Medicaid costs, particularly for preventable hospital admissions and emergency department visits, while creating more seamless care and improving outcomes for these very expensive Medicaid fee-for-service patients. KCCP received support from the Center for Health Care Strategies’ Rethinking Care Program, which was funded through a $2.5 million grant from Kaiser Permanente Community Benefit. The initiative supported similar Medicaid case management projects in three other states.

Washington Medicaid officials feel that the KCCP program shows promise of reducing costs and improving quality and outcomes for high-cost Medicaid patients, particularly those with alcohol and chemical dependency problems. The program offers important lessons that state officials are using in developing Washington’s new Medicaid managed care program, health homes strategy and Medicare-Medicaid dual eligible integration programs. Those new initiatives will rely on organizations providing community-based, care management services similar to KCCP.

“For Medicaid patients who actively participated, findings are beginning to go in the right direction in terms of inpatient admissions, increased chemical dependency treatment and decreased homelessness,” said Beverly Court, the KCCP research manager for the
Washington Health Care Authority, which runs Medicaid. “We learned a lot from the KCCP pilot, such as the value of patient activation and motivational interviewing.”

Through KCCP, nurses and social workers working for King County Aging and Disability Services provided community-based care management for high-risk fee-for-service Medicaid patients with chronic medical conditions plus mental health conditions and/or
alcohol and chemical dependency issues.

Services included an in-person comprehensive assessment, collaborative goal-setting with patients, coaching in health self-management, joint visits with physicians, help in connecting with community resources such as employment and housing assistance, frequent monitoring, and coordination of care across medical and mental health systems. KCCP also provided funding for Harborview and other participating clinics to have their own on-site care managers.

The aim was to create a system that integrated medical and other services for high-needs Medicaid patients, led by a community-based organization with deep experience working with community-based resources. “You need to share information about patients and get everyone on the same page,” said Dan Lessler, KCCP’s medical director and a professor of medicine at University of Washington.

A major focus was on using “motivational interviewing” techniques to engage patients in helping themselves, in contrast to the more traditional approach of telling patients how to improve their health. Participating staff at KCCP and the clinics – who received intensive training in motivational interviewing – said it was powerful in working with patients and also helped improve physician interactions.


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Comments:

Posted Fri, Nov 16, 6:35 p.m. Inappropriate

And just how effective was this study -- did anyone participating actually get on their own feet and was able to land a job and care for themselves. Why spend so much money coaxing people to go to a doctor when there are plenty of people out there that need and want a doctor and can't afford it. Help those that want help first. Bacon can continue her groundbreaking work on her own dime -- bet she has a change of heart if she didn't get paid.

Norge

Posted Fri, Nov 16, 11:35 p.m. Inappropriate

Norge, the point of this Medicaid care management/coordination program, as I thought I explained in the article, is to reduce Medicaid costs for these high-cost, high-risk beneficiaries. All around the country, in both private and public health plans, a small percentage of people account for a hugely disproportionate share of the costs. Are we going to allow this small group to continue to drive up costs for everyone, or are we going to find ways to manage and improve their care to keep their healthier and out of the hospital and emergency room -- and thus control costs for taxpayers and insurance policyholders? Employers, health insurers, state Medicaid programs, Medicare, and health care providers have decided they are going to find ways to keep that high-risk group healthier. That's what this King County program is about.

Posted Sun, Nov 18, 4:58 p.m. Inappropriate

This doesn't really reduce any costs at all, it just shifts that burden somewhere else. Too bad that somewhere else isn't on the people who are really are the cause of the problem, they will just continue to dodge taking responsibility for their actions and poor choices.

Djinn

Posted Wed, Nov 21, 10:04 a.m. Inappropriate

Listen to what Aetna's CEO said about this on NPR this morning, in the last two minutes of the interview:
http://www.npr.org/2012/11/21/165629956/fixing-health-care-waste-would-trip-deficit

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