Multiple Chronic Conditions Common and Costly

A new report examining the prevalence and cost implications of chronic conditions among Medicare beneficiaries found that beneficiaries with multiple chronic conditions (MCCs) were more likely to be hospitalized, receive post-acute care services, and account for a larger share of Medicare spending compared with those without MCCs. The findings of the report from the Center for Strategic Planning were recently released by the Centers for Medicare & Medicaid Services. The prevalence of chronic conditions in Medicare beneficiaries can have significant cost and care implications. According to the report’s authors, the Chronic Conditions among Medicare Beneficiaries chart book was developed to provide health policymakers and those in the public health research community with more information about the cost burden and possible prevention strategies for chronic conditions among the Medicare fee-for-service (FFS) population. The report included information on nearly 31 million Medicare beneficiaries who were enrolled in the FFS program in 2008. Researchers assessed the population for 15 common chronic conditions using administrative claims data and evaluated prevalence, demographics, Medicare service utilization, and Medicare spending. They found that two-thirds of those in the study population had MCCs and 12% had ≥6 chronic conditions. The percentage of people with MCCs increased with patient age, and women were more likely than men to have ≥2 chronic conditions (70% vs 63%, respectively). The most common chronic condition was hypertension, which was found in 56% of the study population. Other common conditions were high cholesterol (43%), heart disease (32%), diabetes (27%), and arthritis (21%). When the data were analyzed by sex, the researchers found that men were 1.3 times more likely to have ischemic heart disease; however, women were 1.7 times more likely to have arthritis or depression. They also discovered that most chronic conditions were more prevalent in those people who were dual-eligible for both Medicaid and Medicare services than those who were not. Dual-eligible beneficiaries were also more likely to have MCCs (72%) compared with those who were not dual-eligible (66%). When the report’s authors reviewed the data for Medicare service utilization, they found that about 1 in 5 Medicare beneficiaries were admitted to the hospital in 2008. Those with more chronic conditions were more likely to be hospitalized more often, with almost two-thirds of beneficiaries with ≥6 chronic conditions making a hospital visit in 2008. In addition, those with more chronic conditions were also more likely to need post-acute care services, emergency department visits, and hospital readmissions. The number of visits to a physician was also >3 times higher for those with 2 or 3 chronic conditions compared with those with none or 1 chronic condition. Patients with MCCs also carry significant cost implications for Medicare. For the total study population, Medicare spending was >$280 billion in 2008; however, those beneficiaries with MCCs contributed to a larger share of Medicare spending. For instance, those with ≥6 chronic conditions accounted for about $120 billion that year, and those with 2 or 3 chronic conditions had Medicare spending that was 3 times greater than those with none or 1 condition. Even across all sociodemographic groups, the average Medicare spending per beneficiary increased as the number of chronic conditions increased. A higher number of chronic conditions per person was also associated with higher Part D drug costs, which put patients at risk for exceeding their initial coverage limits. Those beneficiaries with 2 or 3 chronic conditions had drug costs that were 1.4 times higher than those with 1 or none. In addition, those beneficiaries who were eligible for low-income-level subsidies had average drug costs that were about twice that of those without the subsidy.