Maryland Saves Millions Through High-Risk Patient Management Initiative

Pilot service program for high-risk, high-cost Medicaid patients

From 1993 to 1997, staff at the University of Maryland Baltimore County's (UMBC) Center for Health Program Development and Management (CHPDM) contributed to the design, project management and evaluation of Maryland's High-Risk Patient Management Initiative.

The purpose of the $20.2 million initiative, later called HealthChoice, was to demonstrate that, by using case management for potentially high-cost Medicaid patients, the state's Medicaid program could achieve savings in expenditures along with improved health outcomes.

Key Results

During the grant period, the project team:

  • Tested, refined and validated a screening tool for identifying potential high-cost inpatients.
  • Developed case studies for the 100 most expensive high-cost patients as well as another 2,000 Medicaid recipients who "screened in" as potential high-cost patients.
  • Convened advisory work groups to discuss and encourage the development of integrated care management systems.
  • Identified the characteristics of care systems that efficiently meet the needs of people with multiple health problems, physical limitations and inadequate social supports.
  • Organized private forums to educate Maryland providers and consumers about managed care financing and especially about diagnosis-related risk adjustment.
  • Supported the development of a project management office for the initiative.
  • Put a database system in place for case management and screening.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $172,852.

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