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.
More articles on finance and payer issues:
23,000 to lose coverage as Oregon’s Health Co-op closes
Aetna meets with DOJ over acquisition of Humana
Insider: WellCare, Centene bid for Aetna’s $1B Medicare assets
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.