Hospitals can cut costs and improve patient care by setting up care delivery models that target Medicaid patients who have complex, unaddressed health issues and a history of frequent encounters with healthcare providers. These Medicaid “super-utilizers”–patients who accumulate large numbers of ED visits and hospital admissions that might have been prevented by inexpensive early intervention and primary care–are a relatively small group, yet they account for the majority of Medicaid spending, according to The Center for Medicaid and CHIP Services (CMCS).
- Five percent of Medicaid beneficiaries account for 54 percent of the program’s total expenditures
- One percent account for 25 percent of the program’s total expenditures
- Eighty-three percent of the top 1 percent of users has at least three chronic conditions
More than 60 percent of the top 1 percent has five or more chronic conditions