Case Study

Managing High Risk Medicaid Population: Success in Texas


According to the Kaiser Family Foundation, half of Medicaid beneficiaries are enrolled in MCOs nationally. However, only
20% of Medicaid payment for services is made to MCOs. Disabled and elderly beneficiaries can be found mostly in fee-for-
service (FFS) programs, and it is this group which accounts for the largest portion of Medicaid spending.

Since 2004, the Texas Health and Human Services Commission (HHSC) and AxisPoint Health, an HGS company, have
partnered to provide disease management programs helping high cost, high risk Medicaid patients better manage their
health. Through the programs, community-based care teams deliver one-on-one patient counseling, health assessments,
and personalized care plans to help patients better self-manage their conditions.

This partnership has proven highly successful in generating significant financial savings for the State of Texas, while
significantly improving quality of care, engaging providers, delivering innovative solutions, and increasing patient and
provider satisfaction.