A health plan's investigation of Healthy Days and chronic conditions

To investigate whether self-reported unhealthy days are related to 6 chronic conditions and other health indicators by using administrative claims.

Cross-sectional study using Healthy Days survey data linked to administrative claims.

Survey respondents 65 years or older with Medicare Advantage coverage in November or December 2014 and 12 months continuous presurvey enrollment were identified. Mean physically and mentally unhealthy days were reported by chronic condition subgroups. Mean incremental unhealthy days were calculated for individuals in chronic condition subgroups and those exhibiting noncompliance with 2014 quality measures after adjusting for age, gender, provider/insurer contractual relationship, dual Medicaid/Medicare eligibility, and sum of chronic conditions. The relationship between the unhealthy days category and adjusted mean resource utilization (inpatient and outpatient visits) and total healthcare costs for the year prior to the survey was also described.

The population averages for physically and mentally unhealthy days were 7.24 and 4.05, respectively. After adjustment, all 6 chronic conditions were associated with significantly more physically unhealthy days, and chronic obstructive pulmonary disease, depression, and diabetes were associated with significantly more mentally unhealthy days (P <.001 vs not having the condition). After adjustment, quality measure noncompliance was generally associated with incremental increases in unhealthy days. Utilization and cost generally increased with increasing unhealthy days.

This is the first study to use administrative claims to demonstrate a relationship between Healthy Days and chronic conditions, related healthcare quality measures, utilization, and costs. Our findings underscore the validity of using Healthy Days to supplement traditional health measures in assessing health status in this population.