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    How to connect with the sickest, neediest patients

    Changes to the Medicaid program could disproportionately affect many of the neediest, sickest Americans, according to data from the Commonwealth Fund’s Survey of High Need Patients.

    The nationwide survey of patients with complex medical needs, shows that nearly half of adults with Medicaid are aged 50 years or older and many have multiple chronic conditions, behavioral health problems, or physical limitations or disabilities.

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    “The Medicaid population is not just prime working-age people; there are a lot of older people who are approaching Medicare eligibility age, but not quite there yet,” says Jamie Ryan, senior program associate, Delivery System Reform, The Commonwealth Fund.

    “These findings are important to managed care executives because they paint a picture of a subset of Medicaid patients who are not often discussed,” adds Ryan. “It’s important to remember that the Medicaid population is fairly heterogeneous and includes both clinically and socially complex people of all ages. The financial and medical stability provided by Medicaid can be hugely helpful to this group of older, sicker adults.”

    Furthermore, the survey found that nearly a quarter of adult Medicaid enrollees are eligible for Medicare as well, based on being aged 65 years or older.

    “A lot of these older adults are sicker than average,” Ryan says. “They may have multiple major chronic conditions such as heart disease or kidney failure, or have functional limitations in their ability to perform daily tasks like meal preparation or bathing, or they may have a disability.”

    Two-thirds of sicker older adults with Medicaid live in states that expanded Medicaid eligibility under the Affordable Care Act. This group would be adversely affected by state or federal decisions to roll back Medicaid expansion, according to Ryan.

    Among sicker adults aged 50 to 64 years, those who do have Medicaid are less likely to forgo care due to costs. 

    The survey also showed that while nearly all of the high-need patients surveyed have consistent access to healthcare—95%—they grapple to get coordinated medical, behavioral, and social services needed to stay healthy and avoid costly hospital visits. Specifically, they had limited access to: care coordinators, assistance in managing functional limitations, emotional counseling, and transportation services.

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    A prerequisite for connecting high-need patients to care is resolving the information disconnect between care coordinators, medical and mental health providers, and payers, according to says Neil Smiley, CEO of Loopback Analytics.

    “Siloed healthcare data hampers care coordinators’ ability to get the full picture of patient needs and history needed to fully inform a plan of care,” Smiley says.

    Next: Here's what the experts say

     

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