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The ability to identify, evaluate and appropriately engage an enrollee is challenging, at best, for commercial plans; it can be even more complex for Medicaid enrollees. It is, nonetheless, an essential element of the medical management process. A comprehensive program targeting preventive health care and healthy living builds the necessary foundation for Medicaid medical management. On top of that, Disease Management (DM) focuses on population management of chronically ill patients, with the goal of slowing disease progression and avoiding costly hospitalizations and complications to reduce medical costs. Finally, Medicaid needs to adopt a case management focus on the sickest 1 to 5 percent of Medicaid enrollees who drive a large portion of controllable costs.
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