September 17, 2019
The Government Accountability Office (GAO) released a report on identifying, predicting, and managing high-cost beneficiaries in Medicaid. The GAO interviewed seven states that were able to successfully predict beneficiary healthcare expenditures. Some states used risk scores and others used claims data and clinical guidelines to help identify high-cost Medicaid beneficiaries. All of the selected states provided care management as a means of managing high costs and coordinating care, with other management strategies varying among states.
From the seven participating states, the effect of care management on reducing costs for high-cost beneficiaries varied. Four of the seven participating states, Pennsylvania, South Dakota, Vermont, and Washington, observed positive results.