Temporal Patterns of High-Spend Subgroups Can Inform Service Strategy for Medicare Advantage Enrollees.

ABSTRACT:

Background

Most healthcare costs are concentrated in a small proportion of individuals with complex social, medical, behavioral, and clinical needs that are poorly met by a fee-for-service healthcare system. Efforts to reduce cost in the top decile have shown limited effectiveness. Understanding patient subgroups within the top decile is a first step toward designing more effective and targeted interventions.

Objective

Segment the top decile based on spending and clinical characteristics and examine the temporal movement of individuals in and out of the top decile.

Design

Retrospective claims data analysis.

Participants

UnitedHealthcare Medicare Advantage (MA) enrollees (N = 1,504,091) continuously enrolled from 2016 to 2019.

Main measures

Medical (physi

SUBMITTER: Amodeo SJ 

PROVIDER: S-EPMC9198168 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature