ArticleJournal of general internal medicine2019
A Retrospective Study of Administrative Data to Identify High-Need Medicare Beneficiaries at Risk of Dying and Being Hospitalized.
Article in Journal of general internal medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Caring for high-need patients.BMC health services research · 2023Article
- Identifying common patterns of health services use: a longitudinal study of older Swiss adults' care trajectories.BMC health services research · 2022Article
- Leveraging survey and claims data to identify high-need Medicare beneficiaries in the National Health and Aging Trends Study.Journal of the American Geriatrics Society · 2022Article
- Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries.PloS one · 2022Article
- Higher hospital referral concentration associated with lower-risk patients in skilled nursing facilities.Health services research · 2021Article
- Persistence of High-Need Status Over Time Among Fee-for-Service Medicare Beneficiaries.Medical care research and review : MCRR · 2021Article
- Dying with dementia in Medicare Advantage, Accountable Care Organizations, or traditional Medicare.Journal of the American Geriatrics Society · 2021Article
- High-Need Phenotypes in Medicare Beneficiaries: Drivers of Variation in Utilization and Outcomes.Journal of the American Geriatrics Society · 2020Article
- Validity of Race and Ethnicity Codes in Medicare Administrative Data Compared With Gold-standard Self-reported Race Collected During Routine Home Health Care Visits.Medical care · 2020Article
- Potentially Preventable Intensive Care Unit Admissions in the United States, 2006-2015.Annals of the American Thoracic Society · 2020Article
- Limited Medigap Consumer Protections Are Associated With Higher Reenrollment In Medicare Advantage Plans.Health affairs (Project Hope) · 2019Article
- Analysis of Drivers of Disenrollment and Plan Switching Among Medicare Advantage Beneficiaries.JAMA internal medicine · 2019Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDeveloping a definition of what constitutes high need among Medicare beneficiaries using administrative data is an important prerequisite to evaluating value-based payment reforms. While various definitions of high need exist, their predictive validity for different patient outcomes in the following year has not been systematically assessed for both fee-for-service (FFS) and Medicare Advantage (MA) beneficiaries.
objectiveTo develop a definition of high need using administrative data in 2014 and to examine its predictive validity for patient outcomes in 2015 as compared to alternative definitions for both FFS and MA beneficiaries.
designRetrospective cohort study of national Medicare claims and post-acute assessment data.
participantsAll Medicare beneficiaries in 2014 who survived until the end of the year (n = 54,717,039). MAIN MEASURES: Two or more complex conditions, 6 or more chronic conditions, acute or post-acute health services utilization, indicators of frailty, complete dependency in mobility or in any activities of daily living in post-acute care assessments, hospitalization, mortality, days in community, Medicare expenditures. KEY
resultsBased on our definition of high-need patients, 13.17% of FFS and 8.85% of MA beneficiaries were identified as high need in 2014. High-need FFS patients had mortality rates 7.1 times higher (16.23% vs. 2.27%) and hospitalization rates 3.4 times higher (40.69 vs. 12.03) in 2015 compared to other beneficiaries. Competing high-need definitions all had good specificity (≥ 0.88). Having 3 or more Hierarchical Chronic Conditions yielded a good positive predictive value for hospitalization, at 0.50, but only identified 19.71% of FFS beneficiaries hospitalized and 28.46% of FFS decedents that year as high need, as opposed to 33.92% and 51.98% for the new definition. Results were similar for MA beneficiaries.
conclusionsThe proposed high-need definition has better sensitivity and yields a sample of almost 5 million FFS and 1.5 million MA beneficiaries, facilitating outcome performance comparisons across health systems.
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