High-cost Medicare patients more likely to be younger, low-income

Samantha Liss

Jan. 9, 2019

Dive Brief:

• Medicare beneficiaries who are persistently high-cost patients are on average younger, more likely to be a minority and dually-eligible for both Medicaid and Medicare because of end-stage renal disease, according to a recent report published in Health Affairs.    
• These persistently high-cost patients also were more likely to live in low-income neighborhoods and had more chronic conditions compared to less costly Medicare patients, according to the study's analysis of Medicare claims from 2012 to 2014. 
• One of the greatest predictors of a high-cost patient was whether they qualified for Medicare because of chronic kidney disease. These patients were nearly 26 times more likely to be high-cost than peers that are likely to never be high-cost.  

Dive Insight:

As health providers take on more responsibility managing and improving the health of a population of patients, it becomes increasingly important for them to understand the characteristics and needs of those patients so that providers can tailor treatment effectively.  

"Understanding what proportion of the Medicare high-cost population is likely to remain so in subsequent years is critical for managing high need, high-cost patients," the study authors write. 

The report helps to uncover why certain patients remain high cost and what interventions may help. 

For example, patients with chronic kidney disease, diabetes and congestive heart failure face an increased risk of becoming persistently high-cost and require continuous outpatient treatment and a number of specialists. 

There's less of a risk for heart attack sufferers to become high-cost patients, likely because treatment is intensive but can last for a short duration, according to the study. 

A separate report that looked at high-need patients, or those with three or more chronic conditions who have a hard time caring for themselves, suggests avoiding broad brush solutions.   

"Even among high-need patients, we found there is considerable variation in use and spending. This suggests the high-need population should be segmented into subgroups with common needs and health challenges," according to The Commonwealth Fund study.

https://www.healthcaredive.com/news/high-cost-medicare-patients-more-likely-to-be-younger-low-income/545648/