Subgroups of High-Cost Medicare Advantage Patients: an Observational Study.

Abstract:

BACKGROUND:There is a growing focus on improving the quality and value of health care delivery for high-cost patients. Compared to fee-for-service Medicare, less is known about the clinical composition of high-cost Medicare Advantage populations. OBJECTIVE:To describe a high-cost Medicare Advantage population and identify clinically and operationally significant subgroups of patients. DESIGN:We used a density-based clustering algorithm to group high-cost patients (top 10% of spending) according to 161 distinct demographic, clinical, and claims-based variables. We then examined rates of utilization, spending, and mortality among subgroups. PARTICIPANTS:Sixty-one thousand five hundred forty-six Medicare Advantage beneficiaries. MAIN MEASURES:Spending, utilization, and mortality. KEY RESULTS:High-cost patients (n = 6154) accounted for 55% of total spending. High-cost patients were more likely to be younger, male, and have higher rates of comorbid illnesses. We identified ten subgroups of high-cost patients: acute exacerbations of chronic disease (mixed); end-stage renal disease (ESRD); recurrent gastrointestinal bleed (GIB); orthopedic trauma (trauma); vascular disease (vascular); surgical infections and other complications (complications); cirrhosis with hepatitis C (liver); ESRD with increased medical and behavioral comorbidity (ESRD+); cancer with high-cost imaging and radiation therapy (oncology); and neurologic disorders (neurologic). The average number of inpatient days ranged from 3.25 (oncology) to 26.09 (trauma). Preventable spending (as a percentage of total spending) ranged from 0.8% (oncology) to 9.5% (complications) and the percentage of spending attributable to prescription medications ranged from 7.9% (trauma and oncology) to 77.0% (liver). The percentage of patients who were persistently high-cost ranged from 11.8% (trauma) to 100.0% (ESRD+). One-year mortality ranged from 0.0% (liver) to 25.8% (ESRD+). CONCLUSIONS:We identified clinically distinct subgroups of patients within a heterogeneous high-cost Medicare Advantage population using cluster analysis. These subgroups, defined by condition-specific profiles and illness trajectories, had markedly different patterns of utilization, spending, and mortality, holding important implications for clinical strategy.

journal_name

J Gen Intern Med

authors

Powers BW,Yan J,Zhu J,Linn KA,Jain SH,Kowalski JL,Navathe AS

doi

10.1007/s11606-018-4759-1

subject

Has Abstract

pub_date

2019-02-01 00:00:00

pages

218-225

issue

2

eissn

0884-8734

issn

1525-1497

pii

10.1007/s11606-018-4759-1

journal_volume

34

pub_type

杂志文章
  • Pulmonary alveolar proteinosis in a 67-year-old woman with Wegener's granulomatosis.

    abstract::Mycophenolate mofetil (MM) is commonly used in patients with autoimmune diseases or who have undergone transplantation. Common side effects of MM include anemia, leukopenia, mucositis and opportunistic infections. We report an unusual case of pulmonary alveolar proteinosis (PAP) in a 67-year-old woman on MM for Wegene...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-010-1433-7

    authors: Shah SK,Phan NB,Goyal G,Sharma G

    更新日期:2010-10-01 00:00:00

  • Improving Outcomes After Hospitalization: A Prospective Observational Multicenter Evaluation of Care Coordination Strategies for Reducing 30-Day Readmissions to Maryland Hospitals.

    abstract:BACKGROUND:Patients frequently experience suboptimal transitions from the hospital to the community, which can increase the likelihood of readmission. It is not known which care coordination services can lead to improvements in readmission rates. OBJECTIVE:To evaluate the effects of two care coordination interventions...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/s11606-017-4218-4

    authors: Hoyer EH,Brotman DJ,Apfel A,Leung C,Boonyasai RT,Richardson M,Lepley D,Deutschendorf A

    更新日期:2018-05-01 00:00:00

  • Variation in primary care physicians' colorectal cancer screening recommendations by patient age and comorbidity.

    abstract:BACKGROUND:Screening patterns among primary care physicians (PCPs) may be influenced by patient age and comorbidity. Colorectal cancer (CRC) screening has little benefit among patients with limited life expectancy. OBJECTIVE:To characterize the extent to which PCPs modify their recommendations for CRC screening based ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-012-2093-6

    authors: Haggstrom DA,Klabunde CN,Smith JL,Yuan G

    更新日期:2013-01-01 00:00:00

  • Meeting requirements and changing culture. The development of a web-based clinical skills evaluation system.

    abstract::The Accreditation Council of Graduate Medical Education (ACGME) and the Residency Review Committee require a competency-based, accessible evaluation system. The paper system at our institution did not meet these demands and suffered from low compliance. A diverse committee of internal medicine faculty, program directo...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1111/j.1525-1497.2004.30065.x

    authors: Triola MM,Feldman HJ,Pearlman EB,Kalet AL

    更新日期:2004-05-01 00:00:00

  • Characteristics Associated with Patient-Centered Medical Home Capability in Health Centers: A Cross-Sectional Analysis.

    abstract:BACKGROUND:The patient-centered medical home (PCMH) model is being implemented in health centers (HCs) that provide comprehensive primary care to vulnerable populations. OBJECTIVE:To identify characteristics associated with HCs' PCMH capability. DESIGN:Cross-sectional analysis of a national dataset of Federally Quali...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-016-3729-8

    authors: Gao Y,Nocon RS,Gunter KE,Sharma R,Ngo-Metzger Q,Casalino LP,Chin MH

    更新日期:2016-09-01 00:00:00

  • Will commercial managed care patients accept residents as their primary care providers?

    abstract::We conducted a telephone survey of patients in a university-based medical practice to determine if there was a difference across payer class in patients' willingness to have supervised housestaff physicians function as their primary care providers. Overall, commercial managed care patients were more likely to object t...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.1998.00100.x

    authors: Gross C,Callahan M,Mele J

    更新日期:1998-05-01 00:00:00

  • Patient expectations and satisfaction with medical care for upper respiratory infections.

    abstract::To describe the determinants of patient satisfaction with medical care, self-administered questionnaires were given to a consecutive sample of 237 patients coming to an ambulatory care practice for the treatment of upper respiratory infections (URIs). Patients' most important goal was to obtain a diagnosis (57%). They...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02599162

    authors: Sanchez-Menegay C,Hudes ES,Cummings SR

    更新日期:1992-07-01 00:00:00

  • A patient-based system for describing ambulatory medicine practices using diagnosis clusters.

    abstract:OBJECTIVE:To develop a patient-based classification system to describe the clinical content of ambulatory medicine practices. DESIGN:A system of 100 diagnosis clusters was developed based on retrospective review of computerized problem lists of patients from a university practice, and then applied to the problem lists...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02599394

    authors: Williams BC,Philbrick JT,Becker DM,McDermott A,Davis RC,Buncher PC

    更新日期:1991-01-01 00:00:00

  • Breast Density Notification Legislation and Breast Cancer Stage at Diagnosis: Early Evidence from the SEER Registry.

    abstract:BACKGROUND:Twenty-eight states have passed breast density notification laws, which require physicians to inform women of a finding of dense breasts on mammography. OBJECTIVE:To evaluate changes in breast cancer stage at diagnosis after enactment of breast density notification legislation. DESIGN:Using a difference-in...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-016-3904-y

    authors: Richman I,Asch SM,Bendavid E,Bhattacharya J,Owens DK

    更新日期:2017-06-01 00:00:00

  • Using the Knowledge Base of Health Services Research to Redefine Health Care Systems.

    abstract::This Perspective discusses 12 key facts derived from 50 years of health services research and argues that this knowledge base can stimulate innovative thinking about how to make health care systems safer, more efficient, more cost effective, and more patient centered, even as they respond to the needs of diverse commu...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1007/s11606-015-3298-2

    authors: Brook RH,Vaiana ME

    更新日期:2015-10-01 00:00:00

  • Decreasing disparities in breast cancer screening in refugee women using culturally tailored patient navigation.

    abstract:BACKGROUND:Patient navigator (PN) programs can improve breast cancer screening in low income, ethnic/racial minorities. Refugee women have low breast cancer screening rates, but it has not been shown that PN is similarly effective. OBJECTIVE:Evaluate whether a PN program for refugee women decreases disparities in brea...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-013-2491-4

    authors: Percac-Lima S,Ashburner JM,Bond B,Oo SA,Atlas SJ

    更新日期:2013-11-01 00:00:00

  • Efficacy of a one-month training block in psychosocial medicine for residents: a controlled study.

    abstract:STUDY OBJECTIVE:To determine the efficacy of a comprehensive, one-month psychosocial training program for first-year medical residents. DESIGN:Nonrandomized, controlled study with immediate pre/post evaluation. Limited evaluation of some residents was also conducted an average of 15 months after teaching. SETTING:Com...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/BF02598223

    authors: Smith RC,Osborn G,Hoppe RB,Lyles JS,Van Egeren L,Henry R,Sego D,Alguire P,Stoffelmayr B

    更新日期:1991-11-01 00:00:00

  • Real-time EBM: from bed board to keyboard and back.

    abstract:BACKGROUND:To practice Evidence-Based Medicine (EBM), physicians must quickly retrieve evidence to inform medical decisions. Internal Medicine (IM) residents receive little formal education in electronic database searching, and have identified poor searching skills as a barrier to practicing EBM. OBJECTIVE:To design a...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1007/s11606-007-0387-x

    authors: Stark R,Helenius IM,Schimming LM,Takahara N,Kronish I,Korenstein D

    更新日期:2007-12-01 00:00:00

  • Comparing a self-administered measure of empathy with observed behavior among medical students.

    abstract:PURPOSE:Studies show that measures of physician and medical students' empathy decline with clinical training. Presently, there are limited data relating self-reported measures to observed behavior. This study explores a self-reported measure and observed empathy in medical students. METHOD:Students in the Class of 200...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-009-1193-4

    authors: Chen DC,Pahilan ME,Orlander JD

    更新日期:2010-03-01 00:00:00

  • Preventing diabetes in the clinical setting.

    abstract:OBJECTIVE:Translating lessons from clinical trials on the prevention or delay of type 2 diabetes to populations in nonstudy settings remains a challenge. The purpose of this paper is to review, from the perspective of practicing clinicians, available evidence on lifestyle interventions or medication to prevent or delay...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1111/j.1525-1497.2005.0277.x

    authors: Burnet DL,Elliott LD,Quinn MT,Plaut AJ,Schwartz MA,Chin MH

    更新日期:2006-01-01 00:00:00

  • A Summary Report from the Research Partnership on Women in Science Careers.

    abstract:BACKGROUND:In response to the landmark report "Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering," the NIH Office of Research on Women's Health issued a request for applications that funded 14 R01 grants to investigate causal factors to career success for women in STEM. Fol...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1007/s11606-018-4547-y

    authors: Carr PL,Helitzer D,Freund K,Westring A,McGee R,Campbell PB,Wood CV,Villablanca A

    更新日期:2019-03-01 00:00:00

  • Effects of an inpatient geriatrics rotation on internal medicine residents' knowledge and attitudes.

    abstract:OBJECTIVE:The purpose of this study is to assess the effect of a geriatrics-focused acute medicine inpatient rotation and the presence or absence of a geriatrician as attending physician on knowledge about and attitudes toward older patients and the field of geriatrics. DESIGN:Randomized trial. INTERVENTION:A 4-week ...

    journal_title:Journal of general internal medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1007/BF02600185

    authors: Lindberg MC,Sullivan GM

    更新日期:1996-07-01 00:00:00

  • Linking Physical and Mental Health Summary Scores from the Veterans RAND 12-Item Health Survey (VR-12) to the PROMIS(®) Global Health Scale.

    abstract:BACKGROUND:Global health measures represent an attractive option for researchers and clinicians seeking a brief snapshot of a patient's overall perspective on his or her health. Because scores on different global health measures are not comparable, comparative effectiveness research (CER) is challenging. OBJECTIVE:To ...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-015-3453-9

    authors: Schalet BD,Rothrock NE,Hays RD,Kazis LE,Cook KF,Rutsohn JP,Cella D

    更新日期:2015-10-01 00:00:00

  • Incident Type 2 Diabetes Risk is Influenced by Obesity and Diabetes in Social Contacts: a Social Network Analysis.

    abstract:BACKGROUND:Obesity and diabetes family history are the two strongest risk factors for type 2 diabetes (T2D). Prior work shows that an individual's obesity risk is associated with obesity in social contacts, but whether T2D risk follows similar patterns is unknown. OBJECTIVE:We aimed to estimate the relationship betwee...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-016-3723-1

    authors: Raghavan S,Pachucki MC,Chang Y,Porneala B,Fox CS,Dupuis J,Meigs JB

    更新日期:2016-10-01 00:00:00

  • "Stealth" alerts to improve warfarin monitoring when initiating interacting medications.

    abstract:BACKGROUND:As electronic health records (EHRs) become widely adopted, alerts and reminders can improve medication safety, but excessive alerts may irritate or overwhelm clinicians, thereby reducing their effectiveness. We developed a novel "stealth" alert in an EHR to improve anticoagulation monitoring for patients pre...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-012-2137-y

    authors: Koplan KE,Brush AD,Packer MS,Zhang F,Senese MD,Simon SR

    更新日期:2012-12-01 00:00:00

  • Cue-dose training with monetary reinforcement: pilot study of an antiretroviral adherence intervention.

    abstract:OBJECTIVE:To assess the feasibility and efficacy of two interventions for improving adherence to antiretroviral therapy regimens in HIV-infected subjects compared with a control intervention. DESIGN:Randomized, controlled, pilot study. SETTING:Department of Veterans Affairs HIV clinic and community-based HIV clinical...

    journal_title:Journal of general internal medicine

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1046/j.1525-1497.2000.00127.x

    authors: Rigsby MO,Rosen MI,Beauvais JE,Cramer JA,Rainey PM,O'Malley SS,Dieckhaus KD,Rounsaville BJ

    更新日期:2000-12-01 00:00:00

  • Can a web-based curriculum improve students' knowledge of, and attitudes about, the interpreted medical interview?

    abstract:OBJECTIVES:To develop and evaluate a web-based curriculum to introduce first year medical students to the knowledge and attitudes necessary for working with limited English proficient (LEP) patients through interpreters. METHOD:Six hundred and forty first year medical students over 4 consecutive years took this curric...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1111/j.1525-1497.2005.0193.x

    authors: Kalet AL,Mukherjee D,Felix K,Steinberg SE,Nachbar M,Lee A,Changrani J,Gany F

    更新日期:2005-10-01 00:00:00

  • Association Between Patients' Self-Reported Gaps in Care Coordination and Preventable Adverse Outcomes: a Cross-Sectional Survey.

    abstract:BACKGROUND:Whether patients' reports of gaps in care coordination reflect clinically significant problems is unclear. OBJECTIVE:To determine any association between patient-reported gaps in care coordination and patient-reported preventable adverse outcomes. DESIGN AND PARTICIPANTS:We administered a cross-sectional s...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-06047-y

    authors: Kern LM,Reshetnyak E,Colantonio LD,Muntner PM,Rhodes JD,Casalino LP,Rajan M,Pesko M,Pinheiro LC,Safford MM

    更新日期:2020-12-01 00:00:00

  • Middle-aged Women's Experiences of Intimate Partner Violence Screening and Disclosure: "It's a private matter. It's an embarrassing situation".

    abstract:BACKGROUND:National guidelines indicate that healthcare providers should routinely screen women of reproductive age for experience of intimate partner violence. We know little about intimate partner violence (IPV) screening and disclosure experience among women older than reproductive age. OBJECTIVE:To examine the per...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-020-05947-3

    authors: Dichter ME,Makaroun L,Tuepker A,True G,Montgomery AE,Iverson K

    更新日期:2020-09-01 00:00:00

  • The impact of an ambulatory rotation on medical student interest in internal medicine. The Society of General Internal Medicine Task Force on Career Choice in Internal Medicine.

    abstract:OBJECTIVE:To determine whether students who take ambulatory rotations in internal medicine are more likely to choose internal medicine careers. DESIGN:National survey. SETTING AND PARTICIPANTS:The intended sample was 1,650 senior U.S. medical students from 16 medical schools, of whom 1,244 (76%) responded. Representa...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1007/BF02640362

    authors: Schwartz MD,Linzer M,Babbott D,Divine GW,Broadhead WE

    更新日期:1995-10-01 00:00:00

  • Association Between Patient-Centered Medical Home Capabilities and Outcomes for Medicare Beneficiaries Seeking Care from Federally Qualified Health Centers.

    abstract:BACKGROUND:Patient-centered medical home (PCMH) models of primary care have the potential to expand access, improve population health, and lower costs. Federally qualified health centers (FQHCs) were early adopters of PCMH models. OBJECTIVE:We measured PCMH capabilities in a diverse nationwide sample of FQHCs and asse...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-017-4078-y

    authors: Timbie JW,Hussey PS,Setodji CM,Kress A,Malsberger R,Lavelle TA,Friedberg MW,Wensky SG,Giuriceo KD,Kahn KL

    更新日期:2017-09-01 00:00:00

  • What drives referral from primary care physicians to mental health specialists? A randomized trial using actors portraying depressive symptoms.

    abstract:BACKGROUND:Referral from primary care to the mental health specialty sector is important but poorly understood. OBJECTIVE:Identify physician characteristics influencing mental health referral. DESIGN:Randomized controlled trial using Standardized Patients (SPs). SETTING:Offices of primary care physicians in 3 cities...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/j.1525-1497.2006.00411.x

    authors: Kravitz RL,Franks P,Feldman M,Meredith LS,Hinton L,Franz C,Duberstein P,Epstein RM

    更新日期:2006-06-01 00:00:00

  • Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study.

    abstract:BACKGROUND:Recent studies that compared patient spending in hospital-owned physician practices versus physician-owned groups did not compare quality of care. Past studies had incomplete measures of physician-hospital integration, or lacked patient-level data. OBJECTIVE:To measure the association between physician-hosp...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1007/s11606-019-05312-z

    authors: Ho V,Metcalfe L,Vu L,Short M,Morrow R

    更新日期:2020-03-01 00:00:00

  • A comparison of physicians' and patients' attitudes toward pharmaceutical industry gifts.

    abstract:OBJECTIVE:To compare physicians' and their patients' attitudes toward pharmaceutical gifts. DESIGN:Survey of physicians and their patients. SETTING:Two tertiary-care medical centers, one military and one civilian. PARTICIPANTS:Two hundred sixty-eight of 392 consecutively surveyed physicians, 100 of 103 randomly sele...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章

    doi:10.1046/j.1525-1497.1998.00048.x

    authors: Gibbons RV,Landry FJ,Blouch DL,Jones DL,Williams FK,Lucey CR,Kroenke K

    更新日期:1998-03-01 00:00:00

  • Optimal management strategies for HIV-infected patients who present with cough or dyspnea: a cost-effective analysis.

    abstract:OBJECTIVE:To determine the effectiveness and costs of alternative management strategies for patients infected with the human immunodeficiency virus (HIV) who present with pulmonary symptoms. DESIGN:Decision analysis comparing initial testing (arterial blood gas analysis, induced sputum analysis, or bronchoscopy with b...

    journal_title:Journal of general internal medicine

    pub_type: 杂志文章,评审

    doi:10.1007/BF02598081

    authors: Freedberg KA,Tosteson AN,Cotton DJ,Goldman L

    更新日期:1992-05-01 00:00:00