Who are the highest healthcare spenders? Study examines trends

A new study dives into healthcare spending trends among the people who regularly incur the highest costs. 

Researchers at the Kaiser Family Foundation analyzed data on more than 12.6 million continuously enrolled people (meaning they were covered for three years without a break) in large employer plans and found that those with persistent high spending spent 44% on outpatient care compared to those with high spending in just the last year. 

On average, those with routinely high spending racked up $37,790 on outpatient services in 2017, compared to $26,230 for those with one year of high spending. By contrast, the average spending for all enrollees was just $3,350. 

People that accounted for persistently high costs were just 1.3% of the continuously enrolled population, but they encompassed 12.5% of spending in 2017, according to the study.  

Overall, plan members with routinely high spending averaged $87,870 in claims in 2017, which is 15 times the average spending overall among the study population, or $5,870. 

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“Their extensive healthcare needs and predictably high spending make them an important focus for any efforts to improve value and quality,” the researchers wrote. 

Meanwhile, the patients who had high spending within the prior year spent more than the other groups on inpatient care, the study found. This group spent an average of $24,270 on inpatient services in 2017, compared to $15,970 among people with persistently high spending. 

Among all continuously enrolled people, average spending in 2017 on inpatient care was $1,220, according to the study. 

The study also looks at how much these subgroups are spending in other categories, such as prescription drugs. People with consistently high spending spent an average of $34,120 on drugs in 2017, compared to $5,110 among people with high spending in the past year. 

The average spending on retail pharmacy drugs among the entire study population was $1,290, the researchers found. 

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These breakdowns can provide target conditions for the industry to monitor as it aims to control spending, the researchers said. 

People who had high spending in one year but were not flagged for continually high spending usually incurred such charges thanks to an acute care episode—which also ties into their high rates of inpatient spending, according to the study. 

Those with routinely high spending, however, were instead often people with a chronic illness. The study found that this subgroup had far higher rates of HIV infection, cystic fibrosis and multiple sclerosis, which are all diseases that can be costly to manage. 

“While not everyone with these conditions has persistently high spending, knowing that there are large shares with persistently high spending within these disease groups helps us better understand where some of the most significant health needs and costs are concentrated,” the researchers said.