State Complex Care Programs

States bear a heavy health care burden, both for Medicaid beneficiaries and for state and local government employees and retirees.  Most states have turned to managed care plans to help minimize spending growth, but many states still have some non-managed care Medicaid populations and/or self-funded employee and retiree health plans.  As with the general population, spending is concentrated among a few members, so managing the care of those patients is important to restraining costs.  A paper from the National Governor’s Association Center for Best Practices shares learnings on how to build and operate a complex care management program.  (NGA Paper)  The report is a road map to build a successful care management program.  Here are the critical steps:  1) develop internal resources, build stakeholder partnerships and conduct an environmental scan; 2) identify target populations, build a theory of the program, and design tracking and evaluation approach; 3) develop and implement delivery and payment model; and 4) track implementation and evaluate results and communicate findings.  A lot of the report is just details on how to conduct each of these steps.  Oops, out of money now, guess that’s as far as we’ll get, at least it is a nice design.  Maybe should have hired one of the hundreds of vendors or health plans that would pretty much have this all ready to go and experience at doing it and could get it up and running fast.  Nah, lets waste a bunch of internal resources and pay consultants who are politically connected instead.

And here are the key lessons learned:  1) align state and local reform and care management efforts to ensure efficiency and to minimize burden on providers and others; 2) use a data-driven approach, be sure you talk about big data, artificial intelligence, etc.  Just using those words will reduce spending by 5% or more;  3) make sure the right people are brought in and at the table early on, especially anyone who is politically connected and could make a stink that hits the papers;  4) use a care delivery and payment approach that incentivizes use of cost-effective interventions.  Did we mention evidence-based medicine?  But don’t piss off any of the people in number 3 by denying any care.  Now tell me the truth, I can take it, do I sound cynical?  I don’t mean to be.  I am sure this report is well-intentioned and maybe it is helpful, but it is pretty obvious and any state that really wants to control its health spending should turn the people over to reputable health plans or capitated providers and limit payment increases to the per capita rate of GDP or inflation growth.  No need to reinvent the wheel.