Examining Healthy U's Dual Eligible Population as Part of an Accountable Care Organization

State Medicaid agencies are turning to Accountable Care Organizations (ACO) to manage care, reduce costs, and improve quality of care. As the University of Utah's Medicaid managed care ACO, Healthy U was tasked with accomplishing the goals of reducing costs and improving quality of care through identifying sub-populations for targeted care management. This study evaluated several sub-populations in the over fifty and dual eligible populations to identify which individuals over the age of fifty who are enrolled in Healthy U should be considered for care management interventions. Populations analyzed included enrollees over 50, over 65, over 85, and dual eligible beneficiaries. Cost, prevalence of chronic conditions, and service use, including admissions, Emergency Department use, re-admissions, and avoidable admissions were compared and contrasted between and within populations. The over 50 population was found to have both the highest total cost and PMPM cost, and the dual eligible beneficiaries had the lowest PMPM and total cost. Differences were found between the populations in the service use categories listed. Chronic conditions and service use associated with chronic conditions were found to vary between the age groups. This study found specific populations that would benefit from targeted care management interventions and possible implementation of a Medicaid Health Home.