Active Redesign of a Medicaid Care Management Strategy for Greater Return on Investment: Predicting Impactability

C. Annette DuBard
Carlos T. Jackson
Peer-Reviewed Article
April 2018

This resource describes the evolution of complex care management targeting strategies in Community Care of North Carolina’s (CCNC) work with the statewide non-dual Medicaid population, culminating in the development of an “Impactability Score” that uses administrative data to predict achievable savings.

  • CCNC has developed a strategy to better identify patients most likely to benefit from this care management, shifting from a focus on “high risk” to a focus on “highly impactable.”
  • Variables related to medication adherence and historical utilization unexplained by disease burden proved to be better predictors of impactability than disease profile or previous costs of care.
  • This “most impactable” population had many social risk factors such as mental illness, unstable support system, lack of transportation, and unstable housing.
  • Comparison of this approach to other targeting strategies (e.g., emergency department super-utilizers or patients with highest Hierarchical Condition Category risk scores) suggests a 2- to 3-fold higher return on investment using impactability-based targeting.
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