Subgroups of High-Cost Medicare Advantage Patients: an Observational Study.

ABSTRACT:

Background

There is a growing focus on improving the quality and value of health care delivery for high-cost patients. Compared to fee-for-service Medicare, less is known about the clinical composition of high-cost Medicare Advantage populations.

Objective

To describe a high-cost Medicare Advantage population and identify clinically and operationally significant subgroups of patients.

Design

We used a density-based clustering algorithm to group high-cost patients (top 10% of spending) according to 161 distinct demographic, clinical, and claims-based variables. We then examined rates of utilization, spending, and mortality among subgroups.

Participants

Sixty-one thousand five hundred forty-six Medicare Advantage beneficiaries.

Main measures

Spending, util

SUBMITTER: Powers BW 

PROVIDER: S-EPMC6374249 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature