Characteristics and spending patterns of high cost, non-elderly adults in Massachusetts

Given that health care costs in Massachusetts continue to grow despite great efforts to contain them, we seek to understand characteristics and spending patterns of the costliest non-elderly adults in Massachusetts based on type of insurance.

We used the Massachusetts All-Payer Claims Database (APCD) from 2012 and analyzed demographics, utilization patterns and spending patterns across payers (Medicaid, Medicaid managed care, and private insurers) for high cost patients (those in the top 10% of spending) and non-high cost patients (the remaining 90%).

We identified 3,712,045 patients between the ages of 18-64 years in Massachusetts in 2012 who met our inclusion criteria. Of this group, 8.5% had Medicaid fee-for-service, 11.1% had Medicaid managed care, and 80.3% had private insurance. High cost patients accounted for 65% of total spending in our sample. We found that high cost patients were more likely to be older (median age 48 vs 40, p<0.001), female (60.2% vs. 51.2%, p<0.001), and have multiple chronic conditions (4.4 vs. 1.3, p<0.001) compared to non-high cost patient patients. Medicaid patients were the most likely to be designated high cost (18.1%) followed by Medicaid managed care (MCO) (13.9%) and private insurance (8.6%). High cost Medicaid patients also had the highest mean annual spending and incurred the most preventable spending compared to high cost MCO and high cost private insurance patients.

We used 2012 claims data from Massachusetts to examine characteristics and spending patterns of the state's costliest patients based on type of insurance. Providers and policymakers seeking to reduce costs and increase value under delivery system reform may wish to target the Medicaid population.