Jim Fields, Parie Garg, and Oliver Wyman’s government programs team share a slide from a recent project detailing a chronic care model designed for a hospital clinic.
The hospital group was the market leading provider of Medicaid services in its county, serving dual eligible patients covered under both Medicare and Medicaid. Their pilot program to care for “super utilizers”—the 5% of patients who account for 40% of spend—had gained the attention of the State, which was looking for ways to curtail its Medicaid healthcare costs. Costs had been approaching almost 6% year over year.
Oliver Wyman led an effort to design and expand the pilot and set up a sustainable, economically viable solution that would achieve the State’s cost-control goals. The team conducted a market assessment of assets in the community and county that could be leveraged in caring for the super-utilizer patients, who often have psychosocial and socioeconomic issues in addition to their chronic conditions.
The resulting care model design featured a specialized clinic to help address the special needs of these patients through the integration of physical health, behavioral health, and social support services available across organizations and supported by Medicaid managed care contracting.
For more on taking a whole-patient approach to care model design, read our interview with CareMore Health System CEO Leeba Lessin here.