These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: Persistence and Drivers of High-Cost Status Among Dual-Eligible Medicare and Medicaid Beneficiaries: An Observational Study.
    Author: Figueroa JF, Lyon Z, Zhou X, Grabowski DC, Jha AK.
    Journal: Ann Intern Med; 2018 Oct 16; 169(8):528-534. PubMed ID: 30285049.
    Abstract:
    BACKGROUND: 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. OBJECTIVE: To determine what proportion of this population has persistently high costs. DESIGN: Observational study. SETTING: Medicare-Medicaid Linked Enrollee Analytic Data Source data for 2008 to 2010. PARTICIPANTS: 1 928 340 dual-eligible Medicare and Medicaid beneficiaries who were alive all 3 years. MEASUREMENTS: 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. RESULTS: 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. LIMITATION: Potential misclassification of preventable spending and lack of detailed clinical data in administrative claims. CONCLUSION: 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. PRIMARY FUNDING SOURCE: Peterson Center on Healthcare.
    [Abstract] [Full Text] [Related] [New Search]