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