Researchers at Weill Cornell’s Department of Healthcare Policy and Research and the University of Florida’s Department of Health Outcomes & Biomedical Informatics developed a new patient taxonomy with clinically meaningful categories for high-cost Medicare patients.
The full study, published in Healthcare presents a novel patient taxonomy that developed 10 clinically meaningful categories to describe and identify high-cost patients which could help health systems tailor interventions to individuals who account for a disproportionate share of healthcare spending and utilization.
There is a great deal of interest in understanding high-cost patients given the resources needed to care for them. Our current understanding of this group is that they are not homogenous; rather, they have diverse healthcare needs and current approaches to categorizing these patients have several limitations. Foremost is the fact that existing categories or taxonomies seek to map patients to one segment, which does not account for the complex interplay between varying health needs (e.g. someone presenting with opioid misuse may also have mental illness). Second, most studies focus exclusively on medical conditions and do not account for mental health conditions. Third, they primarily rely on administrative data such as claims and do not incorporate patients’ social needs.
With these limitations in mind, researchers from Weill Cornell Medical College and the University of Florida developed a new taxonomy with 10 overlapping patient categories to understand the medical, behavioral, and social complexity of high-cost Medicare patients. The categories were developed through a literature review, focus groups, and interviews with patients, physicians, health systems leaders, and health policy experts. Preliminary categories were analyzed against 428,024 of 2013 Medicare beneficiaries in the New York metropolitan area. The 10 categories were: (1) multiple chronic conditions; (2) seriously ill; (3) frail; (4) serious mental illness; (5) single condition with high pharmacy cost; (6) chronic pain; (7) end-stage renal disease; (8) single high-cost chronic condition; (9) opioid use disorder; and (10) socially vulnerable.
Initial findings confirmed current thinking around the demographics of high-cost patients. Compared to non-high-cost patients, high-cost patients tended to be older, male, African American, and have more chronic conditions. From a medical standpoint, 97.4% of all high-cost patients had multiple chronic conditions, 53.7% were seriously ill, and 48.9% were frail. In terms of quantifiable cost, high-cost patients accounted for Medicare spending per beneficiary 8 times higher than non-high-cost patients. The authors also found that 72.7% of high-cost patients could be mapped into multiple categories, with the highest concentration being patients who were both frail and seriously ill.
Source: MedCity News