Dataset Information

Subgroups of High-Cost Medicare Advantage Patients: an Observational Study.

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.

Main measures

Spending, utilization, and mortality.

Key results

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.

SUBMITTER: Powers BW

PROVIDER: S-EPMC6374249 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Publications

Subgroups of High-Cost Medicare Advantage Patients: an Observational Study.

Powers Brian W BW Yan Jiali J Zhu Jingsan J Linn Kristin A KA Jain Sachin H SH Kowalski Jennifer L JL Navathe Amol S AS

Journal of general internal medicine 20181203 2

<h4>Background</h4>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.<h4>Objective</h4>To describe a high-cost Medicare Advantage population and identify clinically and operationally significant subgroups of patients.<h4>Design</h4>We used a density-based clustering algorithm to group high-cost patients (top 10% o ...[more]

PMID: 30511290

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Dataset Information

Subgroups of High-Cost Medicare Advantage Patients: an Observational Study.

Background

Objective

Design

Participants

Main measures

Key results

Conclusions

Publications

Subgroups of High-Cost Medicare Advantage Patients: an Observational Study.

Similar Datasets

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