MANAGING HIGH-RISK POPULATIONS

Centers for Disease Control and Prevention’s (CDC) 6/18 Initiative

The Centers for Disease Control and Prevention (CDC), through partnerships with health care purchasers, payers, and providers, aims to improve health and control costs through the 6/18 initiative.

FOCUS:

The 6/18 initiative targets six common and high-cost health conditions – tobacco use, high blood pressure, health care-associated infections, asthma, unintended pregnancies, and diabetes – using 18 proven interventions.

CDC partners with 15 state Medicaid programs and their respective state public health departments to implement and improve the 6/18 interventions in their populations served. States responded on their experience and how it has positively impacted their states.

One such state, South Carolina, worked on enhancing tobacco cessation benefits in their Medicaid program. They worked to include several payer interventions suggested by the 6/18 initiative, including:

  • Expanding access to evidence-based tobacco cessation treatments, including individual, group and telephone counseling and FDA-approved cessation medications.
  • Removing barriers that impede access to covered cessation treatments, such as cost-sharing and prior authorization.
  • Promoting the increased use of covered treatment benefits by tobacco users.

South Carolina’s Medicaid agency partnered with DHEC, the state’s public health agency, who assisted in the 6/18 initiative through leveraging surveillance data and reinforcing South Carolina’s tobacco quitline for free counseling with skilled behavioral health coaches. Beginning July 1, 2017, SCHDDS made treatment options available for all full-benefit Medicaid members including all seven FDA-approved medications with no prior authorizations, co-pays, and included medically appropriate combination therapies.

Maxim Healthcare Services

The University of Maryland St. Joseph’s Medical Center (UMSJMC) and Maxim Healthcare Services – a home health provider – partnered to tackle social determinants of health for the hospitals high-risk patients.

FOCUS:

Through an opt-in program, UMSJMC uses Maxim’s non-medical community health workers (CHWs) to address social determinants of health for these patients discharged from the hospital. As a result, the hospital’s spending decreased by 35 percent and cut readmission rates in half.

Maxim Healthcare Services’ Community-Based Care Management program provides patients with a CHW focused on helping them navigate the barriers to their care, engage in their recovery, and ultimately reduce healthcare costs. Rather than providing medical services, CHWs harness community resources to keep patients healthy and address the behavioral and psychosocial needs of high-risk patients in-home. That includes transportation, housing, employment, access to medical services, and other social determinants of health, all of which can be barriers to proper care following discharge from the hospital.

As a result, only 8 percent of patients who chose to participate in the program were readmitted to the hospital within 30 days of discharge. That’s compared to 18 percent of patients who opted out of the program. At 90 days post-discharge, 23 percent of program participants had returned to the hospital, compared to 34 percent of non-program participants. Following the program’s launch in 2015, there has been a 65 percent reduction in readmissions. Over a two-year period, the reduced readmissions have generated more than $3 million in savings.