AHPI: Small percent of high-need policyholders drive healthcare costs

High-cost claimants who purchased health insurance through their employer were the No. 1 driver of healthcare costs, according to a new study by the American Health Policy Institute and Leavitt Partners.

The study compared high-cost claimants who purchased a health plan through an employer to high-cost claimants who had Medicare coverage. The study defined a high-cost claimant as a health plan or Medicare member who incurred more than $50,000 in medical claims annually. AHPI analyzed 2013 claims data from 26 large employers and Medicare.

Here are four findings from employer sponsored health plans: 

  • The average high-cost claimant cost $122,382 annually.
  • About 1.2 percent of employer-sponsored health plan members were high-cost claimants.
  • These claimants made up 31 percent of total spending.
  • High cost claimants are the No. 1 cost driver for 43 percent of large employers, according to the National Business Group on Health.

Here are four findings from Medicare fee-for-service plans:

  • The average high-cost claimant cost $105,004 annually.
  • About 3.4 percent of Medicare FFS beneficiaries were high-cost claimants.
  • These claimants made up 44 percent of total Medicare spending in 2013.
  • Costliest claims included end stage renal disease, acute respiratory failure and congestive heart failure.

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