Persistent Expenses Associated With High-Cost Medicare, Medicaid Beneficiaries

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Beneficiaries identified as “high cost” were likely to stay high cost over a 3 year period.
Beneficiaries identified as “high cost” were likely to stay high cost over a 3 year period.

The majority of individuals eligible for both Medicaid and Medicare who were identified as high-cost beneficiaries in a 1-year period remained high-cost beneficiaries over 3 years, according to a study published in the Annals of Internal Medicine.

Researchers collected data from 2008 to 2010 using the Medicare-Medicaid Linked Enrollee Analytic Data Source, and calculated annual payments to enrollees of Medicare and Medicaid. “High-cost” was defined as spending within the top decile of that particular year, while not high-cost was defined as 90% of spending and below. The study researchers compared spending among those who were high-cost for all 3 years with those who were high-cost for only 2008, and those who were not high-cost at all during the study period.

This study included 1,928,340 individuals, 192,835 of whom were high-cost in year 1. Of these, 54.8% stayed high-cost over the 3-year study period, compared with the 45.2% of beneficiaries whose high-cost was transient. Persistent high-cost patients were comparatively younger than their transient counterparts and were more likely to have cognitive disabilities and fewer comorbid medical conditions.

This patient population constituted 34.0% of all spending, while comprising only 5.5% of the total dually eligible group, spending $161,224 annually vs $86,333 among those who were transiently high-cost and $22,352 among those who were not high-cost. Among high-cost patients, 68.8% of spending was for long-term care, while less than 1% was spent on ambulatory conditions that were potentially preventable.

The study researchers concluded that “more than half of patients who were dually eligible for Medicare and Medicaid and were designated as high-cost in 1 year remained persistently high-cost across 3 years. These patients were younger and were much more likely to have intellectual and cognitive disabilities, although they had fewer chronic conditions. Spending in persistently high-cost patients was largely attributable to long-term care use. Strategies to control costs in dual-eligible beneficiaries may be more effective if they focus on reducing spending in long-term care rather than on reducing potentially preventable hospitalizations.”

Disclosures: Dr  Grabowski discloses affiliations with navi-Health, Vivacitas, and CareLinx. Please refer to reference for a complete list of authors' disclosures.

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Reference

Figueroa JF, Lyon Z, Zhou X, Grabowski DC, Jha AK. Persistence and drivers of high-cost status among dual-eligible medicare and medicaid beneficiaries: an observational study [published online October 16, 2018]. Ann Intern Med. doi: 10.7326/M18-0085.

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