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