Typology of High Users of Health Services Among a Rural Medicaid Population

Objectives: To identify a typology for high system users among a rural Medicaid population that could assist policy makers and providers in better and more efficiently serving this population. Design and Sample: Exploratory secondary data analysis of a large integrated Medicaid database in a western state. Five hundred and thirty-nine Medicaid recipients receiving 2 or more state services and receiving 10 or more unique medications. Measures: Data analysis examining health care use, medication use, and demographic characteristics using SAS to identify patterns of use of services in the population. Results were confirmed with a statewide sample of 2,287 Medicaid users. Results: 3 characteristics—(1) use of 36 or more health care services in a year; (2) no gap in health care service use over the entire year; and (3) use of >12 health care services in 1 month—describe high-risk groups of Medicaid users. Conclusions: Public health nurses, particularly as case managers and program planners, can look at service use patterns through client histories and their own agency records, in order to identify high-risk groups who may benefit the most from programs that address their support, education, and coordination of health care needs.