Drivers of High-cost Medical Complexity in a Medicaid Population. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Labby, David; Wright, Bill; Broffman, Lauren; Holtorf, Megan
• Is Part Of: Medical care. Volume 58:Issue 3(2020)
• Publication Date: 2020-03
• Subjects: life adversity -- medical complexity -- health care cost/utilization; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001261
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Efforts to improve outcomes for the 10% of patients using two thirds of health care expenditures increasingly include addressing social determinants. Empiric evidence is needed to identify the highest impact nonmedical drivers of medical complexity and cost. Objectives: This study examines whether complex, highest cost patients have different patterns of critical life adversity than those with better health and lower utilization. Research Design: Using a validated algorithm we constructed a complexity/cost risk patient profile. We developed and fielded a life experience survey (Supplemental Digital Content 1, http://links.lww.com/MLR/B920 ) to a representative sample, then examined how the prevalence of specific adversities varied between complex, high-cost individuals, and others. Subjects: Surveys were sent to 9176 adult Medicaid members in Portland, Oregon. Measures: Our primary variable was high medical complexity health cost risk; an alternative specification combined health cost risk and actual utilization/cost. Our survey instrument measured exposure to early and later-life adversities. Results: Compared with healthy individuals in our population, medically complex individuals had significantly higher rates of adversity. The greatest risk of medical complexity and cost was associated with substance use [odds ratio (OR), 4.1], homelessness (OR, 3.0), childhood maltreatment (OR, 2.8), and incarceration (OR 2.4). Those with the highest prior year acute care utilization and cost had the highest rates of these same factors: substance use (62.5%), homelessness (61.7%), childhood maltreatment (55.5%), and incarceration (52.1%). Conclusion: Clinical and policy strategies that mitigate high-impact social drivers of poor outcomes are likely critical for improving both health and costs for complex, high-needs patients. Abstract : Supplemental Digital Content is available in the text.