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Longitudinal Changes in Risk Stratification for a Managed Population
Lincoln Sheets1, Mihail Popescu1, Kayson Lyttle2
1Informatics Institute, University of Missouri, Columbia, Missouri, USA.
Studies in Health Technology and Informatics
|January 4, 2018
Summary
Healthcare utilization for Medicare and Medicaid patients showed a surprising trend. Patients initially in lower risk tiers remained healthy, while those in higher risk tiers improved, indicating a return to stability over three years.
Area of Science:
- Health Services Research
- Gerontology
- Health Economics
Background:
- The LIGHT² project monitored ~10,000 Medicare and Medicaid patients from 2013-2015.
- Risk stratification models typically predict increasing healthcare utilization with age and chronic conditions.
Purpose of the Study:
- To analyze healthcare utilization patterns in a large cohort of elderly and low-income patients.
- To identify factors influencing healthcare utilization over a three-year period.
Main Methods:
- Retrospective cohort analysis of Medicare and Medicaid claims data.
- Risk tier assessment based on chronic diseases and recent healthcare use.
- Data visualization to identify trends in healthcare utilization.
Main Results:
- Initial risk tiers were predictive of healthcare utilization.
- Patients in lower risk tiers tended to remain healthy.
- Patients in higher risk tiers demonstrated improvement in health status.
- A return to stability significantly influenced healthcare utilization over three years.
Conclusions:
- Patient risk stratification alone may not fully capture future healthcare utilization.
- The tendency for patients to return to a stable health state is a critical factor in healthcare management.
- Findings challenge assumptions about aging populations and increasing healthcare demand.
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