Jose F. Figueroa, MD, MPH; Zoe Lyon, BA; Xiner Zhou, MSc; David C. Grabowski, PhD; Ashish K. Jha, MD, MPH
Grant Support: By the Peterson Center on Healthcare (grant 15032).
Disclosures: Dr. Grabowski reports personal fees from naviHealth, Vivacitas, and CareLinx and grants from the National Institute on Aging, the Agency for Healthcare Research and Quality, the Donaghue Foundation, the Arnold Foundation, the Commonwealth Fund, and the Robert Wood Johnson Foundation outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0085.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Ms. Zhou (e-mail, firstname.lastname@example.org). Data set: Not available because of a data use agreement with the Research Data Assistance Center. Interested parties can apply for data directly from the Research Data Assistance Center. More information is at www.resdac.org/cms-data/files/mmleads.
Corresponding Author: Ashish K. Jha, MD, MPH, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 42 Church Street, Cambridge, MA 02138; e-mail, email@example.com.
Current Author Addresses: Drs. Figueroa and Jha, Ms. Lyon, and Ms. Zhou: Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 42 Church Street, Cambridge, MA 02138.
Dr. Grabowski: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.
Author Contributions: Conception and design: J.F. Figueroa, A.K. Jha.
Analysis and interpretation of the data: J.F. Figueroa, Z. Lyon, X. Zhou, D.C. Grabowski, A.K. Jha.
Drafting of the article: J.F. Figueroa, A.K. Jha.
Critical revision of the article for important intellectual content: J.F. Figueroa, Z. Lyon, D.C. Grabowski, A.K. Jha.
Final approval of the article: J.F. Figueroa, Z. Lyon, X. Zhou, D.C. Grabowski, A.K. Jha.
Statistical expertise: X. Zhou, A.K. Jha.
Obtaining of funding: A.K. Jha.
Administrative, technical, or logistic support: J.F. Figueroa, Z. Lyon, X. Zhou.
Collection and assembly of data: J.F. Figueroa.
Little is known about the persistence of high-cost status among dual-eligible Medicare and Medicaid beneficiaries, who account for a substantial proportion of expenditures in both programs.
To determine what proportion of this population has persistently high costs.
Medicare–Medicaid Linked Enrollee Analytic Data Source data for 2008 to 2010.
1 928 340 dual-eligible Medicare and Medicaid beneficiaries who were alive all 3 years.
Medicare and Medicaid payments for these beneficiaries were calculated for each year. Beneficiaries were categorized as high-cost for a given year if their spending was in the top 10% for that year. Differences in spending were then examined for those who were persistently high-cost (all 3 years) versus those who were transiently high-cost (2008 but not 2009 or 2010) and those who were non–high-cost in all 3 years.
In the first year, 192 835 patients were high-cost. More than half (54.8%) remained high-cost across all 3 years. These patients were younger than transiently high-cost patients, with fewer medical comorbidities and greater intellectual impairment. Persistently high-cost patients spent $161 224 per year compared with $86 333 per year for transiently high-cost patients and $22 352 per year for non–high-cost patients. Most of the spending among persistently high-cost patients (68.8%) was related to long-term care, and very little (<1%) was related to potentially preventable hospitalizations for ambulatory care–sensitive conditions.
Potential misclassification of preventable spending and lack of detailed clinical data in administrative claims.
A substantial majority of high-cost dual-eligible beneficiaries had persistently high costs over 3 years, with most of the cost related to long-term care and very little related to potentially preventable hospitalizations.
Peterson Center on Healthcare.
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. Ann Intern Med. 2018;169:528–534. doi: 10.7326/M18-0085
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Published: Ann Intern Med. 2018;169(8):528-534.
Published at www.annals.org on 2 October 2018
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