US Pharm. 2017;42(6):10.
Medicare beneficiaries (MB)—totaling 55.3 million people, including 46.3 million elderly and 9 million disabled—are the most vulnerable patient population. The Centers for Medicare & Medicaid Services has analyzed data on the most common chronic conditions in 31 million medication therapy management (MTM)–eligible MB with Medicare Parts A and B.
Characteristics of MB: Seventeen percent of MB eligible for disability or end-stage renal disease coverage were aged <65 years; 15% were aged >85 years. More than 50% of MB aged <65 years had two or more chronic conditions, versus 63%, 78%, and 83% of those aged 65-74, 75-84, and ≥85 years, respectively. Dual-eligible Medicare and Medicaid beneficiaries (DEMB; 22%) were more likely to have multiple chronic conditions. Seventy-two percent of DEMB had two or more conditions, versus 67% of non-duals. DEMB were 1.7 times more likely to have six or more chronic conditions.
Service Utilization: MB with multiple chronic conditions used healthcare services most frequently. As the number of chronic conditions increased, so did the use of healthcare services, hospitalizations, and healthcare costs. Four percent of MB with 0 or 1 chronic condition were hospitalized, and <1% were hospitalized at least three times during the year. Almost two-thirds of beneficiaries with at least six chronic conditions were hospitalized; 16% had at least three hospitalizations during the year. The most common chronic conditions were hypertension, hyperlipidemia, heart disease, arthritis, and diabetes. More than two-thirds (21.4 million) of MB had at least two chronic conditions; 14% had at least six.
Types of Visits: The use of postacute care (PAC) rose steadily as the number of chronic conditions increased. Fourteen percent of all MB had at least one PAC visit: 1% of MB with 0 or 1 chronic condition, 7% of those with two or three conditions, 19% of those with four or five conditions, and 49% of those with at least six chronic conditions. MB with multiple chronic conditions were frequent recipients of home health (HH) visits. In 2010, 10% of MB received at least one HH visit, 7% received ≥13 visits, and >25% of those with at least six chronic conditions received ≥13 visits during the year. Most MB (84%) visited their doctor at least once during the year, but beneficiaries with multiple chronic conditions had more visits. Sixty-six percent of beneficiaries with 0 or 1 chronic condition had a doctor’s visit during the year, but 4% had ≥13 visits; in contrast, 92% of MB with at least six chronic conditions had a doctor’s visit during the year and 46% had ≥13 visits.
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