By NANCY HICKS / Lincoln Journal Star
Monday, Aug 04, 2008 - 12:00:03 am CDT

Nebraska hopes to save tax dollars and improve the health of really expensive Medicaid patients through a contract with a Florida-based company.

U.S. Care Management will work with more than 850 Medicaid patients who each used more than $50,000 in Medicaid benefits last year, according to Vivianne Chaumont, director of the Medicaid Division of the Health and Human Services Department.

The project is focused on clients who have multiple chronic conditions, she said.

A year ago, the state spent more than $80 million in state and federal dollars for the care of 869 Medicaid recipients, whose bills for the year totaled at least $50,000 each. That does not include outpatient prescriptions. 

The state Medicaid program paid 111,598 claims for these recipients, said Marla Augustine, HHS spokeswoman. 

This is the group targeted for the enhanced care coordination  program.  

More than 50 percent of the patients will have a chronic medical problem and a mental illness, said Steve Gutos, director of outreach for U.S. Care  Management, which has worked with 11 other states on Medicaid care management programs.

Based on national data, Nebraska could see a savings of $1.30  for every dollar spent on the enhanced care coordination program, said Chaumont.

The state will pay the company $90.79 per month for each Medicaid client served during the first of the three-year contract, according to HHS staff.  

HHS leaders don’t know exactly what the savings might be.  “That’s why we want to do the program and see what savings we get,” said Chaumont in a telephone interview. 

The enhanced care management contract is one way to try to reduce rising Medicaid costs.  Last year the state spent about $1.45 billion on Medicaid, with about 60 percent of the money coming from federal tax dollars.

The company will hire three Nebraska registered nurses as care managers to work in local communities, two nurses to do telephone work and two resource development staff to develop relations with agencies, medical staff and government programs, Gutos said. 

The nurses will work with individual  clients, who agree to participate, to change behavior, improve health and hopefully reduce hospitalizations.

The case manager (nurse) will do a thorough assessment, including medical, social and behavioral information, said Gutos. 

That information is put into a database and a care plan is generated, he said.  

The help could range from education for a patient so he or she can understand why they need to take medication to working directly with medical providers, according to information supplied by HHS. 

The program will not include all high-cost Medicaid recipients.  Excluded are Medicaid recipients in nursing homes, in programs for the developmentally disabled, who are state wards, and people who participate in Medicare and Medicaid, who are primarily low income seniors.

The state received eight bids for the enhanced care coordination project, according to information from HHS.