In the JournalsPerspective

Dual-eligible Medicare, Medicaid beneficiaries subject to persistently high costs

More than half of high-cost patients who were dually eligible for Medicare and Medicaid continued to have high costs over 3 years, according to research published in Annals of Internal Medicine.

“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,” Jose F. Figueroa, MD, MPH, from Harvard School of Public Health and Brigham and Women’s Hospital, and colleagues wrote.

Figueroa and colleagues conducted an observational study to investigate what proportion of dual-eligible Medicare and Medicaid beneficiaries (n = 1,928,340) were subjected to persistently high costs from 2008 to 2010.

The researchers calculated the Medicare and Medicaid payments of participants each year. Beneficiaries whose spending was in the top 10% for a given year were categorized as high-cost. Those who were persistently high-cost were high-cost for all 3 years, while those who were transiently high-cost were high-cost in 2008 but not 2009 or 2010 and those who were not high-cost were not high-cost for all 3 years.

In 2008, the researchers identified 192,835 patients who were high-cost, of whom, 54.8% remained high-cost throughout the study period. High-cost patients were more likely to be younger, with fewer medical comorbidities and greater intellectual impairment.

Beneficiaries who were persistently high-cost had costs of $161,224 per year, whereas those who were transiently high-cost had costs of $86,333 per year and those who were not high-cost had costs of $22,352 per year.

Persistently high-cost beneficiaries spent 68.8% of costs on long-term care and less than 1% on potentially preventable hospitalizations for ambulatory care–sensitive conditions.

“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,” Figueroa and colleagues concluded. – by Alaina Tedesco

Disclosure: Figueroa reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

More than half of high-cost patients who were dually eligible for Medicare and Medicaid continued to have high costs over 3 years, according to research published in Annals of Internal Medicine.

“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,” Jose F. Figueroa, MD, MPH, from Harvard School of Public Health and Brigham and Women’s Hospital, and colleagues wrote.

Figueroa and colleagues conducted an observational study to investigate what proportion of dual-eligible Medicare and Medicaid beneficiaries (n = 1,928,340) were subjected to persistently high costs from 2008 to 2010.

The researchers calculated the Medicare and Medicaid payments of participants each year. Beneficiaries whose spending was in the top 10% for a given year were categorized as high-cost. Those who were persistently high-cost were high-cost for all 3 years, while those who were transiently high-cost were high-cost in 2008 but not 2009 or 2010 and those who were not high-cost were not high-cost for all 3 years.

In 2008, the researchers identified 192,835 patients who were high-cost, of whom, 54.8% remained high-cost throughout the study period. High-cost patients were more likely to be younger, with fewer medical comorbidities and greater intellectual impairment.

Beneficiaries who were persistently high-cost had costs of $161,224 per year, whereas those who were transiently high-cost had costs of $86,333 per year and those who were not high-cost had costs of $22,352 per year.

Persistently high-cost beneficiaries spent 68.8% of costs on long-term care and less than 1% on potentially preventable hospitalizations for ambulatory care–sensitive conditions.

“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,” Figueroa and colleagues concluded. – by Alaina Tedesco

Disclosure: Figueroa reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

    Perspective
    James X. Zhang

    James X. Zhang

    It is well known that patients who are dually eligible for Medicare and Medicaid (“dual eligibles”) have complex and often costly health care needs, and coordination of care for these needs has become a focus of many initiatives. However, how the heterogeneity of this patient population affects the high cost of care and the persistence of such high cost over time is not well understood.

    Figueroa and colleagues conducted a study of Medicare–Medicaid Linked Enrollee Analytic Data Source data for 2008 to 2010 and found that for those categorized as high-cost in the first year ( i.e., those in the top 10% of Medicare and Medicaid payments ), 54.8% remained high-cost across all 3 years. By comparing the patients’ characteristics, the study found that those who are persistently high-cost are much more likely to be on disability status (71.1% vs. 41.4% among the transiently high-cost and 46.6% among those who are not high-cost). The dual eligibles are a heterogeneous patient group consisting of elderly with low income and younger adults with disabilities.

    The results of this study highlight the grave impact of disabilities on medical spending and the persistence of this impact over time. Beyond the high spending on long-term care among those who are persistently high-cost, inpatient costs are among the largest categories of medical spending, reflecting the acuity level of care necessary to treat those patients. These results combined call for further improvement of coordination between the long-term and acute care.

     

    Reference:

    1. Henry J. Kaiser Family Foundation. Dual eligible. Available: https://www.kff.org/tag/dual-eligible/.

    • James X. Zhang, PhD, MS
    • Director, Medicare Innovation Analysis
      Department of Medicine
      Section of Hospital Medicine
      The University of Chicago

    Disclosures: Zhang reports no relevant financial disclosures.