The majority of individuals eligible for both Medicaid and Medicare who were identified as high-cost beneficiaries in a 1-year period remained high-cost beneficiaries over 3 years, according to a study published in the Annals of Internal Medicine.

Researchers collected data from 2008 to 2010 using the Medicare-Medicaid Linked Enrollee Analytic Data Source, and calculated annual payments to enrollees of Medicare and Medicaid. “High-cost” was defined as spending within the top decile of that particular year, while not high-cost was defined as 90% of spending and below. The study researchers compared spending among those who were high-cost for all 3 years with those who were high-cost for only 2008, and those who were not high-cost at all during the study period.

This study included 1,928,340 individuals, 192,835 of whom were high-cost in year 1. Of these, 54.8% stayed high-cost over the 3-year study period, compared with the 45.2% of beneficiaries whose high-cost was transient. Persistent high-cost patients were comparatively younger than their transient counterparts and were more likely to have cognitive disabilities and fewer comorbid medical conditions.

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This patient population constituted 34.0% of all spending, while comprising only 5.5% of the total dually eligible group, spending $161,224 annually vs $86,333 among those who were transiently high-cost and $22,352 among those who were not high-cost. Among high-cost patients, 68.8% of spending was for long-term care, while less than 1% was spent on ambulatory conditions that were potentially preventable.

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The study researchers concluded that “more than half of patients who were dually eligible for Medicare and Medicaid and were designated as high-cost in 1 year remained persistently high-cost across 3 years. These patients were younger and were much more likely to have intellectual and cognitive disabilities, although they had fewer chronic conditions. Spending in persistently high-cost patients was largely attributable to long-term care use. Strategies to control costs in dual-eligible beneficiaries may be more effective if they focus on reducing spending in long-term care rather than on reducing potentially preventable hospitalizations.”

Disclosures: Dr  Grabowski discloses affiliations with navi-Health, Vivacitas, and CareLinx. Please refer to reference for a complete list of authors’ disclosures.


Figueroa JF, Lyon Z, Zhou X, Grabowski DC, Jha AK. Persistence and drivers of high-cost status among dual-eligible medicare and medicaid beneficiaries: an observational study [published online October 16, 2018]. Ann Intern Med. doi: 10.7326/M18-0085.