Research suggests that Medicare beneficiaries with chronic diseases who consume the least of their benefits and services (referred to as "low consumers") and potentially under manage their disease may experience an acute event that requires costly emergency room visits and hospitalizations.
Findings detailed in the analysis “Low Consumption and Higher Medicare Cost: Consumption Clusters in a Medicare Fee-for-Service Population,” examine how individuals use benefits and services under the Medicare program. The research, spearheaded by the National Minority Quality Forum, analyzed Medicare data over a six-year period.
The forum found that Medicare beneficiaries may be clustered into five consumption groups (crisis consumers, heavy consumers, moderate consumers, light consumers and low consumers) based on how much Medicare reimburses for services provided to beneficiaries in a given year. The two most-costly clusters are crisis consumers and heavy consumers – representing only 11 percent of Medicare beneficiaries, but 65 percent of all costs.
"If we can identify the patients, who are under-managing their chronic condition putting them at high-risk for disease complications, we can intervene to help these individuals manage their disease more effectively, and, ultimately, reduce overall healthcare costs," said Gary Puckrein, PhD., Founding Partner of the Diabetes Care Project (DCP) and President and CEO of the National Minority Quality Forum.
"We know that diabetes and other chronic conditions disproportionately affect the elderly, and with an aging population and a rapid influx of Baby Boomers entering the Medicare program, we need to better understand the barriers associated with managing their chronic diseases," said Dr. James R. Gavin III, CEO and chief medical officer of Healing Our Village and chairman emeritus of the National Diabetes Education Program.
In 2010, the DCP plans to undertake a series of projects that will seek better understanding of low-consuming diabetics, and their impact on the healthcare system. The purpose of these initiatives is to offer guidance as to how policies, regulations, targeted interventions, education, and personalized diabetes care management plans may help improve patient outcomes and lower costs for the entire health system.
Diabetes is a growing public health epidemic affecting over 23 million Americans, according to the Centers for Disease Control and Prevention. The U.S. spends approximately $174 billion in annual total costs for diagnosed diabetes with $166 billion in direct medical costs.