Health Care Spending and Utilization by Patients with Chronic Conditions

In 2014, 60 percent of Americans had at least one chronic condition, and 42 percent had multiple chronic conditions.1 Americans with chronic conditions endure social and physical limitations. In general, they are consume, and spend more on, health care services. For instance, Americans with five or more chronic conditions account for 12 percent of the national population, yet represent 41 percent of national health care spending. The Centers for Medicare & Medicaid Services (CMS) has developed an analytics tool to track the volume and frequency of health care service use and spending by Medicare beneficiaries with chronic conditions. Relying on 2015 date, the current version of the dashboard accounts for  19 chronic conditions that align with those suggested by the U.S. Department of Health and Human Services’ (HHS) Strategic Framework on Multiple Chronic Conditions. It demonstrates the overall challenges facing policy makers and providers in identifying high risk patients and allocating resources. Using this tool, the VHHA Analytics Team conducted an analysis to evaluate trends among Virginia Medicare patients with chronic conditions. Among the 19 chronic conditions listed in the dashboard, the prevalence in Virginia is lower than the national average in 15 of 19 categories (79 percent). Virginians have a higher prevalence of cancer, diabetes, hyperlipidemia, and hypertension. There are differences between genders in chronic condition prevalence. Men in Virginia have a lower prevalence in 14 of the 19 categories (74 percent) when compared to the national rate. Virginian men have a higher prevalence of atrial fibrillation, cancer, diabetes, hyperlipidemia, and hypertension. Among women in Virginia, there is lower prevalence in 16 of the 19 categories (84 percent), though women in the Commonwealth have a higher prevalence of cancer, hyperlipidemia, and hypertension. As the health care community continues to move toward population health management and preventative medicine, proactive strategies to prevent chronic condition and improve their management is critical. To assist hospital members in planning for local patients with chronic conditions, VHHA will add rates of chronic conditions among hospital patients to the state database starting with data from the first quarter of 2018. The database will be available June 2018. (5/18)

1 https://www.rand.org/content/dam/rand/pubs/tools/TL200/TL221/RAND_TL221.pdf