Online Program

Trigger Events for High Spenders with Functional Limitations and Chronic Conditions
*Lisa Alecxih, The Lewin Group 
Iris Chan, The Lewin Group 
Sophie Shen, MPA, The Lewin Group 
mark zezza, the lewin group 

Keywords: longitudinal,settings research,healthcare reform,regression,chronic condition,functional limitation,medicare

Scope of the Problem: One of the primary goals of healthcare reform is to determine who drives high healthcare spending and to create specific, targeted models of high-value care for those groups. To determine drivers of high healthcare costs, most researchers have focused on chronic conditions. However, with half of the U.S. population categorized as having a chronic condition, the concept of the chronic disease has limited utility for parsing out who exactly drives costs. Our previous analysis indicates that the co-occurrence of chronic conditions and functional limitations may be a more precise predicator of high utilization and spending. Our recent publication of a chartbook for Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services revealed that 14 percent of community residents have both chronic conditions and functional limitations but disproportionately account for 46 percent of healthcare spending (using 2006 Medical Expenditures Panel Survey(MEPS)). People with functional limitations and chronic conditions are likely to be among the most extremely expensive patients in the county, as they are four times as likely to be in the nation’s top 5 percent of healthcare spenders as members of the general population. Objective: One challenge of controlling costs is to accurately target high spenders for delivery of effective treatment. Understanding triggering events for becoming high spenders and tracking the trajectories of functional limitations and chronic conditions provides insights relevant for designing preventive targeting strategies and high-value care models. Method/Results: Our analysis is based on 2003-2005 Medicare Current Beneficiary Survey (MCBS) and MEPS data. We map out healthcare events patterns for three different groups of Medicare beneficiaries with chronic conditions and functional limitations—those who are always in institutions, always in the community, or transition between the two. We examine the significant triggering events for high costs over 12 and 24 months. Multivariate regression models the association between newly reported chronic conditions and functional limitations with healthcare expenditures. Some key preliminary findings are that the triggering events of hospital or nursing home readmission, home health use, cerebrovascular disorders, or hip fractures are significant predictors for high expenditures and deteriorating health problems that require proper care coordination.