ArticleJournal of the American Geriatrics Society2020
High-Need Phenotypes in Medicare Beneficiaries: Drivers of Variation in Utilization and Outcomes.
Article in Journal of the American Geriatrics Society, 2020. 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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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed.
- Trial
- End-of-Life Care and Health Care Spending for Medicare Beneficiaries With Dementia in Accountable Care Organizations.JAMA health forum · 2025Article
- Rectal spacer use and overall long-term healthcare costs: payer perspective.Frontiers in oncology · 2025Article
- Place of care in the last three years of life for Medicare beneficiaries.BMC geriatrics · 2024Article
- Identifying common patterns of health services use: a longitudinal study of older Swiss adults' care trajectories.BMC health services research · 2022Article
- Pain Impacting Quality of Life in Persons with Dementia Dying in the Nursing Home by Alternative Medicare Payment Model.Journal of palliative medicine · 2022Article
- The Humanistic and Economic Burden of Alzheimer's Disease.Neurology and therapy · 2022Review
- Eating disorders in the U.S. Medicare population.The International journal of eating disorders · 2022Article
- Empiric segmentation of high-risk patients: a structured literature review.The American journal of managed care · 2022Review
- Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries.PloS one · 2022Article
- Dying with dementia in Medicare Advantage, Accountable Care Organizations, or traditional Medicare.Journal of the American Geriatrics Society · 2021Article
- Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectivesHigh-need (HN) Medicare beneficiaries heavily use healthcare services at a high cost. This population is heterogeneous, composed of individuals with varying degrees of medical complexity and healthcare needs. To improve healthcare delivery and decrease costs, it is critical to identify the subpopulations present within this population. We aimed to (1) identify distinct clinical phenotypes present within HN Medicare beneficiaries, and (2) examine differences in outcomes between phenotypes.
designLatent class analysis was used to identify phenotypes within a sample of HN fee-for-service (FFS) Medicare beneficiaries aged 65 years and older using Medicare claims and post-acute assessment data.
settingNot applicable.
participantsTwo cross-sectional cohorts were used to identify phenotypes. Cohorts included FFS Medicare beneficiaries aged 65 and older who survived through 2014 (n = 415 659) and 2015 (n = 416 643). MEASUREMENTS: The following variables were used to identify phenotypes: acute and post-acute care use, functional dependency in one or more activities of daily living, presence of six or more chronic conditions, and complex chronic conditions. Mortality, hospitalizations, healthcare expenditures, and days in the community were compared between phenotypes.
resultsFive phenotypes were identified: (1) comorbid ischemic heart disease with hospitalization and skilled nursing facility use (22% of the HN sample), (2) comorbid ischemic heart disease with home care use (23%), (3) home care use (12%), (4) high comorbidity with hospitalization (32%), and (5) Alzheimer's disease/related dementias with functional dependency and nursing home use (11%). Mortality was highest in phenotypes 1 and 2; hospitalizations and expenditures were highest in phenotypes 1, 3, and 4.
conclusionsOur findings represent a first step toward classifying the heterogeneity among HN Medicare beneficiaries. Further work is needed to identify modifiable utilization patterns between phenotypes to improve the value of healthcare provided to these subpopulations. J Am Geriatr Soc 68:70-77, 2019.
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