Pro's and Con's of accepting Medicaid...

Business as usual just isn't going to pencil out in caring for this cohort. If you take the 45y/o -54y/o
CNP cohort - probably the highest risk of bad outcome - an OR CCO is given about $7-8K/yr to manage
all of their care. Even before being diagnosed with CNP the cost of managing the patients described below
was $20K. It's hard not to predict that specialty care and pharmacy costs are going to be a big target.

Pain Pract. 2015 Oct 7. doi: 10.1111/papr.12357. [Epub ahead of print]
Cost Burden of Chronic Pain Patients in a Large Integrated Delivery System in the United States.
Park PW1, Dryer RD2, Hegeman-Dingle R1, Mardekian J1, Zlateva G1, Wolff GG3, Lamerato LE3.
Author information

Abstract
OBJECTIVES:
To estimate all-cause healthcare resource utilization and costs among chronic pain patients within an integrated healthcare delivery system in the United States.

METHODS:
Electronic medical records and health claims data from the Henry Ford Health System were used to determine healthcare resource utilization and costs for patients with 24 chronic pain conditions. Patients were identified by ≥ 2 ICD-9-CM codes ≥ 30 days apart from January to December, 2010; the first ICD-9 code was the index event. Continuous coverage for 12 months pre- and postindex was required. All-cause direct medical costs were determined from billing data.

RESULTS:
A total of 12,165 patients were identified for the analysis. After pharmacy, the most used resource was outpatient visits, with a mean of 18.8 (SD 13.2) visits per patient for the postindex period; specialty visits accounted for 59.0% of outpatient visits. Imaging was utilized with a mean of 5.2 (SD 5.5) discrete tests per patient, and opioids were the most commonly prescribed medication (38.7%). Annual direct total costs for all conditions were $386 million ($31,692 per patient; a 40% increase from the pre-index). Pharmacy costs comprised 14.3% of total costs, and outpatient visits were the primary cost driver.

CONCLUSIONS:
Chronic pain conditions impose a substantial burden on the healthcare system, with musculoskeletal conditions associated with the highest overall costs. Costs appeared to be primarily related to use of outpatient services. This type of research supports integrated delivery systems as a source for assessing opportunities to improve patient outcomes and lower the costs for chronic pain patients.

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Pro's and Con's of accepting Medicaid...