225197 Health Trajectories and Expenditures Patterns for Medicare Beneficiaries with Accelerated Expenditures

Sunday, November 7, 2010

Sophie Shen , Center on Long Term Care, The Lewin Group, Falls Church, VA
Iris Chan , The Lewin Group, Falls Church, VA
Lisa Maria B. Alecxih, MPA , Center on Long Term Care, The Lewin Group, Falls Church, VA
In 2006, a quarter of Medicare beneficiaries over the age 65 saw their health care expenditures at least double in a year. Our analysis found that their health trajectories drive spending patterns. Using three years (2004-2006) of the Medicare Current Beneficiary Survey, we found that people in the top quartile for expenditures increases shared a similar socio-demographic profile with the lower quartiles but had different trajectories for developing chronic conditions, limitations with activities of daily living (ADLs), and inpatient visits. In general, beneficiaries with jumps in spending between 2005 and 2006 were healthier at baseline with fewer chronic conditions, ADLs, and inpatient claims than the lower quartiles with steadier spending. However, the odds of a person in the top quartile of skyrocketing expenditures developing two or more new ADLs in a year were twice that of a person in the lower quartiles. The odds of a person in the top quartile developing two or more new chronic conditions in a year was almost two times (1.7) the odds for a person in the lower quartiles.

This population deserves a closer look. The top quartile for expenditures increase accounted for only 10-20 percent of all Medicare spending in 2004-2005, but disproportionately represented 40 percent in 2006.

The analysis demonstrates that the scope of cost-containment strategies should expand beyond the sickest of beneficiaries to invest in prevention and care coordination for the relatively healthy. Even older adults who appear healthy should be monitored for rapid accrual of chronic conditions and functional limitations.

Learning Areas:
Biostatistics, economics
Chronic disease management and prevention

Learning Objectives:
Describe how health trajectories drive spending patterns among Medicare beneficiaries with rapid expenditures increases; Identify determinants for accelerated expenditures; Discuss potential targeting strategies to control the cost and prevent further deterioration of health status

Keywords: Chronic Diseases, Medicare

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I work on aging, long term care, and health care expenditures research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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