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High Users of Medicaid Dollars Identified and They Are Not Necessarily Who You Think They Are :

September 21, 2016

Given the shortage of Medicaid dollars it is important to try to identify the “big spenders” of those dollars and then determine if better care models can reduce the expenditures.

Given the shortage of Medicaid dollars it is important to try to identify the “big spenders” of those dollars and then determine if better care models can reduce the expenditures. With just that thought in mind, Agrawal et al. (10.1542/peds.2016-0682) share the results of their retrospective analysis of almost 49,000 children, ages 1 through 18 years, enrolled in ten state Medicaid programs and also ranked in the 95%ile for Medicaid spending between 2009 and 2013.  They characterized the high users of Medicaid dollars first in 2009-2010 and then watched their spending curves over the next several years, characterizing these children into three categories of high resource utilization—“transient,” “intermittent,” and “persistently high.” 

If you think the majority of high-Medicaid users are “persistently high,”,you are mistaken.  Most fall into the “transiently high,” with expenses centered on a year of increased hospitalizations and emergency utilization followed by resolution of these needs in the years that follow. So who makes up the “persistently high patients” if they are not always in the hospital or emergency department and what are the high Medicaid dollars being spent on?  

There is a wealth of information to glean from this analysis and a lot of thoughts will ensue in regard to how best to reduce costs in each of the three high resource use categories.  To help make sense of the findings, we have asked health services expert Dr. Matthew Davis from Northwestern and Lurie Children’s Hospital (10.1542/peds.2015-2517) to provide a commentary that helps put these longitudinal study findings into perspective and raises further questions for us to think about as we try to manage costs while maintaining quality.  Read both the study and commentary—it will be cost effective if you do!

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