Active Redesign of a Medicaid Care Management Strategy for Greater Return on Investment: Predicting Impactability

Paper
Key Questions Answered
  • What is an “impactability score” and how can it help more effectively identify candidates for care management?
  • What variables determine the likelihood that a patient will benefit from care management?
  • How much savings can be achieved through the use of an impactability score?
Key Themes and Takeaways

This resource describes the evolution of complex care management targeting strategies in Community Care of North Carolina’s (CCNC) work with the statewide non-dual Medicaid population, culminating in the development of an “Impactability Score” that uses administrative data to predict achievable savings.

  • CCNC has developed a strategy to better identify patients most likely to benefit from this care management, shifting from a focus on “high risk” to a focus on “highly impactable.”
  • Variables related to medication adherence and historical utilization unexplained by disease burden proved to be better predictors of impactability than disease profile or previous costs of care.
  • This “most impactable” population had many social risk factors such as mental illness, unstable support system, lack of transportation, and unstable housing.
  • Comparison of this approach to other targeting strategies (e.g., emergency department super-utilizers or patients with highest Hierarchical Condition Category risk scores) suggests a 2- to 3-fold higher return on investment using impactability-based targeting.
Authors
C. Annette DuBard
Carlos T. Jackson
Population Addressed
Adults Under 65 with Disabilities
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Level of Evidence
Expert Opinion
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