High-utilizing complex patients, usually with multiple chronic diseases, are a significant subset of Medicaid populations. States have taken a variety of approaches to try to contain costs and improve outcomes by better managing the care of these patients. A report from the National Governors Association describes some of these programs. (NGA Report) The NGA has provided consulting resources to help states with the task of administering care for the complex patients, through a “Policy Academy”. The work of seven states is highlighted in the report, with specific examples. Three key lessons described are understanding all the characteristics of the complex patient group, which helps focus on all their needs which may affect their health; using data analytics to identify specific patients for focused management; and ongoing monitoring and evaluation of the effectiveness of the care management program, which can be use to adjust the program to maximize its functioning. Another key capability is engaging patients to participate once they are identified, which usually involves in-person efforts, often in the home. And as always, having systems that accurately collect data in as close to real-time as possible is a necessity.
Some politics are at work here. Right now almost two-thirds of governors are Republicans and the federal administration is run by Democrats. Since Medicaid is a joint federal/state program, there is a constant tension between the two about the best way to operate the program. And while for the next couple of years the federal government is paying most of the cost of the reform law’s Medicaid expansion, the burden eventually shifts to the states, which will inevitably want more control over program design. Some states have been innovative in how to improve care for low-income citizens, and this report is designed to highlight the states’ competence in this area, in contrast to the pretty continually botched health care efforts of the federal government.
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at 
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