A $1.94 million grant from the Center for Medicare and Medicaid Innovation will be dedicated to finding ways to improve quality of health care services while reducing costs for "super-utilizers" of health care, the interim dean of the West Virginia University School of Public Health said Thursday.
"We know that about 5 to 10 percent of people who are Medicaid or Medicare recipients account for 50 percent or more of spending," said Dr. Jeffrey Coben.
Coben said there are several categories of super-utilizers of health care services, including patients with multiple chronic health conditions; patients with behavioral health issues, including substance abuse or depression; patients with negative social conditions including homelessness and poverty; and the terminally ill.
Currently, those patients show up in emergency rooms or doctor's offices when they need medical care.
"The providers are doing what they do best, which is taking care of people when they see them," Coben said. "The problem is, that perpetuates the same cycle."
A joint collaboration with the Department of Health and Human Resources, the State Innovation Model grant will study ways to coordinate health care services and reduce costs through the use of such programs as care coordinators, community health care and home monitoring, he said.
"We want to develop a plan to transform the way health care is provided and paid for," Coben said. "Health care obviously consumes an extraordinary amount of the state's resources."
Under the plan, the DHHR, School of Public Health and other partners are proposing the establishment of the West Virginia Health Transformation Accelerator as an independent nonprofit entity to coordinate state and federal health care transformation activities, and to encourage the move from a fee-for-service payment system to a value-based system.
"Our hope is there would be a process that could facilitate continued collaboration between the public sector and private sector, to bring together health care insurers, providers and consumers," Coben said.
Reach Phil Kabler at philk@wvgazettemail.com, 304-348-1220, or follow @PhilKabler on Twitter.