Targeting Medicaid Super-Utilizers to Decrease Costs and Improve Quality

July 24, 2013
The information bulletin was released by the CMS Center for Medicaid and CHIP Services (CMCS).  "Super-utilizers"” are defined as the five percent of Medicaid beneficiaries with the highest use of acute care services (emergency department visits and hospitalization). The bulletin describes key policy decisions that states and provider organizations with existing "super-utilizer" programs under Medicaid have considered in designing and implementing their programs. Additional information in the bulletin includes a range of possible approaches to address each policy decision, and details of existing Medicaid funding mechanisms and policies that can support “super-utilizer” programs. “Six . . .