Characteristics and spending patterns of persistently high-cost Medicare patients

Health Affairs

Volumn 38, Issue 1, 2019, Pages 107-114

  Figueroa, José F ^a   Zhou, Xiner ^b   Jha, Ashish K ^c  

^a BRIGHAM AND WOMEN S HOSPITAL   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

^c HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACUTE HEART INFARCTION; ADULT; AGED; ALZHEIMER DISEASE; AMBULATORY CARE; ARTICLE; BLACK PERSON; CHRONIC KIDNEY FAILURE; CHRONIC OBSTRUCTIVE LUNG DISEASE; CONGESTIVE HEART FAILURE; DEPRESSION; DIABETES MELLITUS; END STAGE RENAL DISEASE; ETHNIC GROUP; FEMALE; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HIP FRACTURE; HISPANIC; HOSPITALIZATION; HUMAN; LOWEST INCOME GROUP; MAJOR CLINICAL STUDY; MALE; MEDICAID; MEDICAL FEE; MEDICARE; MEDICATION THERAPY MANAGEMENT; OUTPATIENT CARE; TRANSIENT ISCHEMIC ATTACK; CHRONIC DISEASE; ECONOMICS; ETHNOLOGY; STATISTICS AND NUMERICAL DATA; UNITED STATES;

AGED; CHRONIC DISEASE; ETHNIC GROUPS; FEE-FOR-SERVICE PLANS; FEMALE; HEALTH EXPENDITURES; HOSPITALIZATION; HUMANS; MALE; MEDICARE; UNITED STATES;

EID: 85059689408     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2018.05160     Document Type: Article

References (27)

1. Long P, Abrams M, Milstein A, Anderson G, Apton KL, Dahlberg ML, et al., editors. Effective care for high-need patients: opportunities for improving outcomes, value, and health. Washington (DC): National Academy of Medicine; 2017.
2. Blumenthal D, Chernof B, Fulmer T, Lumpkin J, Selberg J. Caring for high-need, high-cost patients-an urgent priority. N Engl J Med. 2016;375(10):909-11.
3. Mitchell EM. Concentration of health expenditures in the U.S. civilian noninstitutionalized population, 2014 [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; 2016 Nov [cited 2018 Nov 16]. (MEPS Statistical Brief No. 497). Available from: https://meps.ahrq.gov/data_files/publications/st497/stat497.shtml
4. Johnson TL, Rinehart DJ, Durfee J, Brewer D, Batal H, Blum J, et al. For many patients who use large amounts of health care services, the need is intense yet temporary. Health Aff (Millwood). 2015;34(8): 1312-9.
5. Burwell SM. Setting value-based payment goals-HHS efforts to improve U.S. health care. N Engl J Med. 2015;372(10):897-9.
6. Fisher ES, McClellan MB, Bertko J, Lieberman SM, Lee JJ, Lewis JL, et al. Fostering accountable health care: moving forward in Medicare. Health Aff (Millwood). 2009;28(2): w219-31. DOI: 10.1377/hlthaff.28 .2.w219.
7. Joynt KE, Figueroa JF, Beaulieu N, Wild RC, Orav EJ, Jha AK. Segmenting high-cost Medicare patients into potentially actionable cohorts. Healthc (Amst). 2017;5(1-2):62-7.
8. Joynt KE, Gawande AA, Orav EJ, Jha AK. Contribution of preventable acute care spending to total spending for high-cost Medicare patients. JAMA. 2013;309(24):2572-8.
9. Landon BE, Gill JM, Antonelli RC, Rich EC. Prospects for rebuilding primary care using the patient-centered medical home. Health Aff (Millwood). 2010;29(5):827-34.
10. Holtrop JS, Fitzpatrick L, Jortberg BT, Staton EW, Clark R, Voss S, et al. Care management: an implementation guide for primary care practices [Internet]. Battle Creek (MI): Integrated Health Partners; [cited 2018 Nov 16]. Available from: http:// www.integratedhealthpartners .net/system/res/696/original/ Care%20Management%20 lmplementation%20Guide%20 for%20PCP.pdf
11. Braveman P, Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep. 2014; 129(Suppl 2):19-31.
12. O'Donnell BE, Schneider KM, Brooks JM, Lessman G, Wilwert J, Cook E, et al. Standardizing Medicare payment information to support examining geographic variation in costs. Medicare Medicaid Res Rev. 2013;3(3):mmrr.003.03.a06.
13. Figueroa JF, Jha AK. Approach for achieving effective care for high-need patients. JAMA Intern Med. 2018;178(6):845-6.
14. Agency for Healthcare Research and Quality. Chartbook on care coordination: potentially avoidable hospitalizations [Internet]. Rockville (MD): AHRQ; 2016 Jul [last reviewed 2018 Jun; cited 2018 Nov 16]. Available from: http://www.ahrq .gov/research/findings/nhqrdr/ chartbooks/carecoordination/ measure3.html
15. Agency for Healthcare Research and Quality. Prevention Quality Indicators overview [Internet]. Rockville (MD): AHRQ; [cited 2018 Nov 16]. Available from: https://www.qualityindicators.ahrq.gov/ modules/pqi_overview.aspx
16. To access the appendix, click on the Details tab of the article online.
17. Tsai TC, Greaves F, Zheng J, Orav EJ, Zinner MJ, Jha AK. Better patient care at high-quality hospitals may save Medicare money and bolster episode-based payment models. Health Aff (Millwood). 2016; 35(9):1681-9.
18. Jha AK, Orav EJ, Dobson A, Book RA, Epstein AM. Measuring efficiency: the association of hospital costs and quality of care. Health Aff (Millwood). 2009;28(3):897-906.
19. Schpero WL, Morden NE, Sequist TD, Rosenthal MB, Gottlieb DJ, Colla CH. For selected services, blacks and Hispanics more likely to receive low-value care than whites. Health Aff (Millwood). 2017;36(6): 1065-9.
20. Lanting LC, Joung IM, Mackenbach JP, Lamberts SW, Bootsma AH. Ethnic differences in mortality, end-stage complications, and quality of care among diabetic patients: a review. Diabetes Care. 2005;28(9): 2280-8.
21. Fiscella K, Franks P, Gold MR, Clancy CM. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000;283(19):2579-84.
22. Toomey SL, Chien AT, Elliott MN, Ratner J, Schuster MA. Disparities in unmet need for care coordination: the National Survey of Children's Health. Pediatrics. 2013;131(2): 217-24.
23. Krieger J, Higgins DL. Housing and health: time again for public health action. Am J Public Health. 2002; 92(5):758-68.
24. Gundersen C, Ziliak JP. Food insecurity and health outcomes. Health Aff (Millwood). 2015;34(11):1830-9.
25. Marmot MG, Bell R. Action on health disparities in the United States: Commission on Social Determinants of Health. JAMA. 2009; 301(11):1169-71.
26. Figueroa JF, Joynt Maddox KE, Beaulieu N, Wild RC, Jha AK. Concentration of potentially preventable spending among high-cost Medicare subpopulations: an observational study. Ann Intern Med. 2017; 167(10):706-13.
27. Hayes SL, Salzberg CA, McCarthy D, Radley DC, Abrams MK, Shah T, et al. High-need, high-cost patients: who are they and how do they use health care? [Internet]. New York (NY): Commonwealth Fund; 2016 Aug 29 [cited 2018 Nov 16]. Available from: https://www.commonwealthfund.org/publications/issue-briefs/2016/aug/high-need-high-cost-patients-who-are-they-and-how-do-they-use