Two research studies, one in pharmacy and the other in medicine, address the challenge of managing care for the small number of patients who account for a disproportionate fraction of healthcare costs.
From the Journal of Managed Care and Specialty Pharmacy comes a study of the “drug super spender tsunami.” Among 100,000 beneficiaries in a large, commercially insured population, 32 people accounted for $1 of every $10 of total drug expenditures. The analysis included 4 years of data for 17.9 million members with at least 1 month of eligibility. “Health plans need to understand the drug super spender trend and develop strategies to maintain health care affordability,” the researchers conclude.
Characteristics of high-need, high-cost (HNHC) patients include presence of multiple comorbid conditions and their severity and chronicity, according to a review article in Annals of Internal Medicine. Heart disease, chronic kidney disease, chronic lung disease, diabetes, cancer, and hypertension were commonly associated with high costs, and “patients’ risk for being HNHC was often amplified by behavioral health conditions and social risk factors,” the authors report. Reviewers of 64 studies adapted a National Academy of Medicine taxonomy to organize their findings; they added “chronic pain and prior patterns of high health care use as characteristics associated with an increased risk for being HNHC.”