Report Looks at High Health Care Spenders; Provides Insight for Provider Initiatives > Hospital Association of Pennsylvania

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Report Looks at High Health Care Spenders; Provides Insight for Provider Initiatives

August 02, 2019

A Kaiser Family Foundation report recently looked at people with persistently high health care spending and determined that a small share of people account for a large share of expenditures during any year.

Kaiser followed a group of people with employer-based coverage who were continuously insured over a three-year period (2015–2017) and identified those with persistently high spending. Their health spending was in the top 5 percent in each of the three years. 

This group changes from year to year as some people deal with serious illness and recover, but a subset of the group continues to have high spending for longer periods.

Report Highlights:

  • Individuals with acute episodes of illness are more likely to have high hospital spending, while those with chronic illnesses spend more on outpatient services and prescriptions
  • Among those with persistently high health spending, 1.3 percent of all enrollees had average per person spending of almost $88,000, and accounted for 19.5 percent of total spending during 2017
  • People with persistently high spending on average spent about 40 percent more on outpatient services than people with high spending just in the last year
  • People with persistently high spending averaged over $34,000 in spending on retail prescription drugs (not reflecting any rebates), considerably more than the average for people with high spending just in the last year or continuously covered enrollees overall
  • People with persistently high spending were over a decade older, on average, than continuously covered enrollees overall, yet still under the age of 50. While people of all ages have chronic illnesses, they are more prevalent at older ages
  • A large share of people with persistently high spending fell into a narrow range of disease categories–– including HIV, multiple sclerosis, cystic fibrosis, rheumatoid arthritis, diabetes, as well as a number of cancers

Hospitals and health systems have been developing different care management plans to address the needs of high health care spenders. These approaches include:

  • Population health initiatives
  • More integrated care–accountable care organizations
  • Medical home models
  • Direct work with the employer community
  • Post-discharge follow-up and health coaching
  • Linking physical and behavioral health treatment

For more information about Pennsylvania hospital efforts, contact Robert Shipp, HAP’s vice president, quality and population health.

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