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CMCS Releases Bulletin on “Super-Utilizers”

Monday, July 29, 2013

On July 24, 2013, the Center for Medicaid and CHIP Services (CMCS) released a bulletin that outlines the benefits of "super-utilizer" programs. Super-utilizers are CMCS recipients who have complex, unaddressed health issues and frequently visit health care providers, particularly emergency departments. As the bulletin points out, health care spending, particularly in Medicaid, is extremely disproportionate, with just 5% of beneficiaries accounting for 54% of costs. Programs targeting super-utilizers combine medical coordination services with preventive care to help decrease the frequency of emergency room visits, improve the overall health of these at-risk populations, and reduce health care expenditures.

The bulletin outlines some key considerations that states should consider in determining whether or not to implement a super-utilizer program, such as how to fund the program, who the payers are, how to target the program, and what services to provide. Additionally, the bulletin then describes how Medicaid can help support super-utilizer programs.  

View the Bulletin

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