Persistence and Drivers of High-Cost Status Among Dual-Eligible Medicare and Medicaid Beneficiaries

Jose F. Figueroa
Zoe Lyon
Xiner Zhou
David Grabowski
Ashish K. Jha
Peer-Reviewed Article
October 2018

This resource analyzes the drivers of cost for Medicare-Medicaid beneficiaries, particularly looking at the differences between persistent and transient high costs.

  • We know surprisingly little about the drivers of costs for dually eligible Medicare and Medicaid beneficiaries, and even less about the drivers over time—that is, how much spending is transient versus persistent.
  • This study used Medicare-Medicaid Linked Enrollee Analytic Data Source from 2008-2010 to account for the full cost incurred by these patients.
  • More than half of patients (54.8 percent) remained high-cost over all three years. These patients were younger than transiently high-cost patients, with fewer medical co-morbidities and greater intellectual impairment.
  • Most spending for persistently high-cost patients was related to long-term care, and very little was for potentially preventable hospitalizations.
  • Strategies to control costs may be more effective if they target long-term care spending, rather than potentially preventable hospitalizations.
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Key Questions Answered
  • What are the drivers of costs for Medicare-Medicaid beneficiaries?
  • What are the differences between patients who incur persistently high costs and those for whom high costs are transient?
  • What is a promising strategy to control costs for this population?
Level of Evidence
What does this mean?