The Centers for Medicare & Medicaid Services’ (CMS’) Center for Medicaid and CHIP Services released an informational bulletin July 24 on care delivery and payment models that help states and Medicaid providers meet the needs of super-utilizers—Medicaid beneficiaries with complex health issues and a history of numerous emergency department (ED) visits and hospital admissions. To address super-utilizer needs, some state Medicaid agencies and provider organizations have implemented super-utilizer programs. The bulletin discusses key design and implementation decisions of some of these programs, as well as Medicaid funding mechanisms that support super-utilizer programs.
The bulletin includes a case study on the super-utilizer program implemented by America’s Essential Hospitals member Hennepin County Medical Center. During the program’s first 30 months, Hennepin Country Medical Center’s Coordinated Care Clinic saw a 38 percent reduction in ED visits and a 25 percent reduction in inpatient admissions.