4 indicators of future high-cost patients

Cost history is the most predictive indicator of future high-cost patients, according to an analysis from the Society of Actuaries.

For the analysis, researchers examined Health Care Cost Institute claims data for about 47 million Aetna, Humana and UnitedHealthcare members annually from 2009-15.

Five findings:

1. Member cost history is the largest predictor of a high-cost individual. Considering cost history, if the member was high cost the previous year — meaning the individual had at least $100,000 in total claims — they were more likely to be high cost again. Researchers said the effect on the likelihood of an individual being high cost climbs as the dollar amount of total claims increases.

2. Age was also an indicator of high-cost patients, with older members being more likely to be high cost.

3. Researchers said gender had a "relatively small" effect on the likelihood of a member being high cost. However, women are generally less likely than men to be high cost.

4. The effect of prescription drug coverage on the likelihood of a member being high cost is also described as "relatively small," but the analysis found members with this coverage are more likely to have higher claims.

5. Members with $1 million or more in annual claims are an exception to the trends around indicators of high-cost patients. Researchers said this is because "there tends to be more uncertainty with costs at this level."

Read more about the analysis here.


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