High-risk care coordination: Opportunities, barriers, and innovative initiatives in Medicaid

Institute for Medicaid Innovation

As of 2015, approximately half of U.S. adults (those over age 21) suffer from one chronic condition, and 25 percent have multiple chronic conditions.1 Persons with disabilities and multiple chronic conditions are often at higher risk for increased utilization of health services and poorer general health status. Individuals with chronic conditions often receive care from multiple clinicians in disparate healthcare settings. Lack of communication between clinicians can result in inadequate, unnecessary, and duplicative care.2 High-risk care coordination (also referred to as care management and case management) is a strategy that has been used to improve quality of care, safety, and outcomes. Care coordination can minimize gaps in care for high-risk members through effective use of evidence-based services and supports. This report details the ways in which the Medicaid population benefits from care coordination programs and offers case studies from Medicaid health plans demonstrating their efforts. Key components of care coordination programs, common payment mechanisms, and potential barriers to successful implementation are provided along with clinical, research, and policy opportunities that could improve the quality of and access to care coordination services.

Bakst C, Longyear R. High-risk care coordination: Opportunities, barriers, and innovative initiatives in Medicaid; 2020. Institute for Medicaid Innovation. Available online.

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