Using segmentation to address clinical and social needs for Medicaid patients with complex needs and costly utilization can improve the effectiveness of complex care programs.
Among high-cost Medicare enrollees, those who are seriously ill, frail, and/or had a serious mental illness experience the most potentially preventable spending.
When identifying patients with complex health needs for interventions, algorithms that rely on cost data as a proxy for health status may lead to under-identification of Black patients.
This case study analyzes a successful example of a medical group partnering with a home health agency to provide community-based palliative care for high-risk members of their accountable care organization.
Describes the needs of distinct subpopulations within the dually eligible population with highly complex needs, along with opportunities for tailored interventions that may reduce health care spending.