Temporal Variation in Patterns of Comorbidities in the Medicare Population

Sorace, James; Millman, Michael; Bounds, Mallory; Collier, Michael; Wong, Hui-Hsing; Worrall, Chris; Kelman, Jeffrey A.; MaCurdy, Thomas

doi:10.1089/pop.2012.0045

Cited by 5 publications

(2 citation statements)

References 7 publications

(8 reference statements)

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“…For example, Sorace et al noted that while many beneficiaries had multiple diagnoses making them more costly and riskier, these diagnoses’ combinations remained relatively stable between 2007 and 2009. 20 However, this aggregate stability in risk scores over time does not imply that individual conditions or condition categories do not vary. For example, Mu et al showed that among beneficiaries with end-stage renal disease (ESRD), the Western region of the US had the lowest score between 2006 and 2009, and the HCC score fell annually in every region.…”

Section: Introductionmentioning

confidence: 97%

Drivers of Individual and Regional Variation in CMS Hierarchical Condition Categories Among Florida Beneficiaries

Jacobs¹,

Morris²,

Haleem³

et al. 2023

RMHP

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Objective To explore hierarchical condition categories (HCC) risk score variation among Florida Fee for Service (FFS) Medicare beneficiaries between 2016 and 2018. Data Sources This study analyzed HCC risk score variation using Medicare claims data for Florida beneficiaries enrolled in Parts A & B between 2016 and 2018. Study Design The CMS methodology analyzed HCC risk score variation using annual mean county- and beneficiary-level risk score changes. The association between variation and beneficiary characteristics, diagnoses, and geographic location was characterized using mixed-effects negative binomial regression models. Data Collection Not applicable. Principal Findings Counties in the Northeast [marginal effect (ME)=−0.003], Central (ME=−0.021), and Southwest (ME=−0.009) Florida have relatively lower mean risk scores. A higher number of lifetime (ME=0.246) and treatable (ME=0.288) conditions were associated with higher county-level risk scores, while more preventable conditions (ME=−0.249) were associated with lower risk scores. Counties with older beneficiaries (ME=0.015) and more Blacks (ME=0.070) have higher risk scores, while having female beneficiaries reduced risk scores (ME=−0.005). Individual risk scores did not vary by age (ME=0.000), but Blacks (ME=0.001) had higher rates of variation relative to Whites, while other races had comparatively lower variation (ME=−0.003). In addition, individuals diagnosed with more lifetime (ME=0.129), treatable (ME=0.235), and preventable (ME=0.001) conditions had higher risk score variation. Most condition-specific indicators showed small associations with risk score changes; however, metastatic cancer/acute leukemia, respirator dependence/tracheostomy, and pressure ulcers of the skin were significantly associated with both types of HCC risk score variation. Conclusion Results showed demographics, HCC condition classifications (ie, lifetime, preventable, and treatable), and some specific conditions were associated with higher variation in mean county-level and individual risk scores. Results suggest consistent coding and reductions in the prevalence of certain treatable or preventable conditions could reduce the county and individual HCC risk score year-to-year change.

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Section: Introductionmentioning

confidence: 97%

Drivers of Individual and Regional Variation in CMS Hierarchical Condition Categories Among Florida Beneficiaries

Jacobs¹,

Morris²,

Haleem³

et al. 2023

RMHP

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“…First, it will be challenging to define complex patients in a way that enables the design of specific interventions: A recent study of chronic conditions among approximately 32 million Medicare beneficiaries found more than 2 million unique combinations of conditions, reflecting a very "long tail" that changes nationally over time. [7][8][9] This distribution suggests that developing interventions tailored to each combination of disease is infeasible.…”

Section: Introduction Backgroundmentioning

confidence: 99%

Identifying and Coordinating Care for Complex Patients: Findings from the Leading Edge of Analytics and Health Information Technology

Rudin¹,

Gidengil²,

Predmore³

et al. 2016

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This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.html. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.

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Prevalence and Associated Cost and Utilization of Multiple Chronic Conditions in the Outpatient Setting among Adult Members of an Employer-Based Health Plan

Rezaee

Pollock

2015

Population Health Management

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Patients with multiple chronic conditions (MCCs) are a significant concern for the US health care system. MCC patients represent an increasing proportion of the US population and are associated with increased health care cost and utilization, and poor quality of care. Research that has been conducted on MCC patients to date has been at the national level using large data sets, such as Medicare and Medicaid claims and the National Inpatient Sample. These studies have produced research evidence that may be of little utility to individual employer-based health plans given the inherent differences in the patient populations they serve. This study analyzed evaluation and management claims for patients ages 18 years and older (n=632,477) from the Beaumont Employee Health Plan (BEHP), a regional health insurance provider serving Beaumont Health System employees and their families across Southeastern Michigan. The study found that individuals with MCCs are associated with increased cost and visits, and decreased time between appointments in the outpatient setting. Despite decreasing prevalence of MCCs over the study period, substantial increases in cost and visits, and a decrease in time between appointments was observed for MCC patients. Asthma and chronic back pain were uniquely identified as additional primary targets for disease management programs for employer-based health plans. These findings speak to the value of studying MCCs at the employer-based health plan level, where population-specific MCCs can be identified for meaningful intervention and management. Significant opportunity exists for employer-based health plans to study, prevent, and manage MCCs among adult patients.

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Temporal Variation in Patterns of Comorbidities in the Medicare Population

Cited by 5 publications

References 7 publications

Drivers of Individual and Regional Variation in CMS Hierarchical Condition Categories Among Florida Beneficiaries

Drivers of Individual and Regional Variation in CMS Hierarchical Condition Categories Among Florida Beneficiaries

Identifying and Coordinating Care for Complex Patients: Findings from the Leading Edge of Analytics and Health Information Technology

Prevalence and Associated Cost and Utilization of Multiple Chronic Conditions in the Outpatient Setting among Adult Members of an Employer-Based Health Plan

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