Cross-Sector Service Use Among High Health Care Utilizers In Minnesota After Medicaid Expansion

Abstract

Childless adults in the Medicaid expansion population have complex social and behavioral needs. This study compared the cross-sector involvement of Medicaid expansion enrollees who were high health care utilizers to that of other expansion enrollees in Hennepin County, Minnesota. We examined forty-six months of annualized utilization and cost data for expansion-eligible residents with at least twelve months of enrollment (N = 70,134) across health care, housing, criminal justice, and human service sectors. High health care utilizers, approximately 7 percent of our sample, were disproportionately American Indian, younger, and significantly more likely than other expansion enrollees to have mental health (88.1 percent versus 48.0 percent) or substance use diagnoses (79.2 percent versus 29.6 percent). Total cross-sector public spending was nearly four times higher for high health care users ($25,337 versus $6,786), and their non-health care expenses were 2.4 times higher ($7,476 versus $3,108). High levels of cross-sector service use suggest that there are opportunities for collaboration that may result in cost savings across sectors.

How do ED patients with criminal justice contact compare with other ED users? A retrospective analysis of ED visits in California

“…Given that only 6.7% of ED patients with criminal justice contact comprised 40.9% of all ED visits by this group, identifying individuals in need of more coordinated health and social service provision could reduce a portion of this costly health service utilisation. 25 Our results corroborate previous research that demonstrates high rates of acute care use among criminal justice-involved populations, particularly for mental health and substance use disorders, 12–14 16 17 26 and provides new information about the characteristics of ED visits with and without direct criminal justice contact.…”

Perspectives from the Society for Pediatric Research: interventions targeting social needs in pediatric clinical care

“…The "cost" of social needs, and the "benefit" of [41][42][43] It may, therefore, behoove those tracking interventions including payers to consider outcomes beyond mere health service utilization. Thinking about rewarding broader societal outcomes such as school readiness, school attendance, or utilization of services across other sectors 43 may be a step forward for health-care systems and for payers. Although financial incentives may not always be the same for children and for adults, there is still a general push toward outcomes-oriented value-based care provision in pediatrics.…”

“…While studies assessing utilization (and their costs) are needed, a positive return on investment is a high bar that almost no other medical intervention is held to, let alone interventions that have positive social and economic merits irrespective of their medical consequences. 43 Therefore, researchers might consider benchmarking the cost-effectiveness of their interventions against common, well-accepted medical treatments when making the case for inclusion of social needs interventions in the clinical armamentarium. Researchers should also be prepared for the possibility that social needs interventions may actually increase utilization and costs in some settings, at least in the short term, particularly if interventions are valued by patients and supports are difficult to access elsewhere.…”

Identification of Cross-sector Service Utilization Patterns Among Urban Medicaid Expansion Enrollees

“…16,17 A more robust description and segmentation of service patterns among populations that consume a large portion of services across sectors, such as the Medicaid expansion population, would expand and improve on previous efforts to estimate cross-sector utilization. Specifically, it could provide further insight into the cross-sector involvement of health care high utilizers suggested in our previous work and help health care providers, 12 social services and criminal justice agencies understand the total public sector experience of people under their care to improve service delivery and interventions.…”

“…10,11 High health care utilizers also incur higher costs in other sectors, suggesting that cost-drivers across public sectors may be similar. 12 For this reason, connections between public sectors have received increased attention (eg, health care costs and supportive housing, 13 health insurance and jail bookings, 14 multiple sectors 15 ). Although some organizations now utilize integrated crosssector data for evaluation, these data have not been extensively leveraged to explore the comprehensive network of public sector interactions for the Medicaid expansion population.…”