Characteristics And Spending Patterns Of Persistently High-Cost Medicare Patients
Abstract
One strategy for reducing health care spending is to target the Medicare beneficiaries who remain persistently high cost over time. Using a 20 percent sample of Medicare fee-for-service beneficiaries in the period 2012-14, we sought to identify the proportion of patients who remained persistently high cost (that is, in the top 10 percent of spending each year) and determine the characteristics and spending patterns that differentiated them from other patients. We found that 28.1 percent of patients who were high cost in 2012 remained persistently high cost over the subsequent two years. On average, persistently high-cost patients were younger, more likely to be members of racial/ethnic minority groups, eligible for Medicare based on having end-stage renal disease, and dually eligible for Medicaid, compared to transiently and never high-cost patients. Persistently high-cost patients had greater relative spending on outpatient care and medications, while very little of their spending was related to preventable hospitalizations. Health care systems and policy makers can use this information to better target spending reductions and care improvements over time.
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Canagliflozin was included on <75% of Part D plan formularies in 2019 and 2020, but coverage without prior authorization and without step therapy requirements was only 53.2% in 2019 Part D plans.
“Canagliflozin was included on <75% of Part D plan formularies in 2019 and 2020,32,33 but coverage without prior authorization and without step therapy requirements was only 53.2% (95% CI, 49.1%-57.4%) in 2019 Part D plans.32”
From Disparities in SGLT2 Inhibitor or Glucagon-Like Peptide 1 Receptor Agonist Initiation Among Medicare-Insured Adults With CKD in the United States (2023) · cites this paper as [32]
The median retail prices for a 30-day supply ranged from $300 for ertugliflozin to $942 for liraglutide for Medicare beneficiaries in 2019 Part D plans.
“The median retail prices for a 30-day supply ranged from $300 (interquartile range, $285-$303) for ertugliflozin to $942 (interquartile range, $931-$969) for liraglutide for Medicare beneficiaries in 2019 Part D plans.”
From Disparities in SGLT2 Inhibitor or Glucagon-Like Peptide 1 Receptor Agonist Initiation Among Medicare-Insured Adults With CKD in the United States (2023) · cites this paper as [32]
Medicare claims data sources of race/ethnicity information are commonly used in reports and studies of health disparities.
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From Disparities in SGLT2 Inhibitor or Glucagon-Like Peptide 1 Receptor Agonist Initiation Among Medicare-Insured Adults With CKD in the United States (2023) · cites this paper as [35]
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- Authors
- Figueroa, J. F., Zhou, X., & Jha, A. K.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2019-01
- Volume
- 38
- Issue
- 1
- Pages
- 107-114
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- OpenAlex
- W2907064478
- Cited by
- 67
- References
- 21
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 5 · 2023: 12 · 2022: 12 · 2021: 11 · 2020: 12 · 2019: 6
- FWCI
- 12.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- Medicare spending, high-cost patients, fee-for-service Medicare, end-stage renal disease, Medicaid dual eligibility, racial and ethnic minorities, outpatient care, prescription drugs, avoidable hospitalizations
- MeSH terms
- Aged, Chronic Disease, Ethnicity, Health Expenditures, Female, Medicare, Hospitalization, Humans, Male, United States, Fee-for-Service Plans
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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