Subgroups of High-Cost Medicare Advantage Patients: an Observational Study.
J Gen Intern Med
; 34(2): 218-225, 2019 02.
Article
in En
| MEDLINE
| ID: mdl-30511290
ABSTRACT
BACKGROUND:
There is a growing focus on improving the quality and value of health care delivery for high-cost patients. Compared to fee-for-service Medicare, less is known about the clinical composition of high-cost Medicare Advantage populations.OBJECTIVE:
To describe a high-cost Medicare Advantage population and identify clinically and operationally significant subgroups of patients.DESIGN:
We used a density-based clustering algorithm to group high-cost patients (top 10% of spending) according to 161 distinct demographic, clinical, and claims-based variables. We then examined rates of utilization, spending, and mortality among subgroups.PARTICIPANTS:
Sixty-one thousand five hundred forty-six Medicare Advantage beneficiaries. MAINMEASURES:
Spending, utilization, and mortality. KEYRESULTS:
High-cost patients (n = 6154) accounted for 55% of total spending. High-cost patients were more likely to be younger, male, and have higher rates of comorbid illnesses. We identified ten subgroups of high-cost patients acute exacerbations of chronic disease (mixed); end-stage renal disease (ESRD); recurrent gastrointestinal bleed (GIB); orthopedic trauma (trauma); vascular disease (vascular); surgical infections and other complications (complications); cirrhosis with hepatitis C (liver); ESRD with increased medical and behavioral comorbidity (ESRD+); cancer with high-cost imaging and radiation therapy (oncology); and neurologic disorders (neurologic). The average number of inpatient days ranged from 3.25 (oncology) to 26.09 (trauma). Preventable spending (as a percentage of total spending) ranged from 0.8% (oncology) to 9.5% (complications) and the percentage of spending attributable to prescription medications ranged from 7.9% (trauma and oncology) to 77.0% (liver). The percentage of patients who were persistently high-cost ranged from 11.8% (trauma) to 100.0% (ESRD+). One-year mortality ranged from 0.0% (liver) to 25.8% (ESRD+).CONCLUSIONS:
We identified clinically distinct subgroups of patients within a heterogeneous high-cost Medicare Advantage population using cluster analysis. These subgroups, defined by condition-specific profiles and illness trajectories, had markedly different patterns of utilization, spending, and mortality, holding important implications for clinical strategy.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Chronic Disease
/
Health Care Costs
/
Medicare Part C
Type of study:
Health_economic_evaluation
/
Observational_studies
/
Prognostic_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
J Gen Intern Med
Journal subject:
MEDICINA INTERNA
Year:
2019
Document type:
Article
Affiliation country:
United States