Format

Send to

Choose Destination
JAMA Pediatr. 2015 Oct;169(10):e152682. doi: 10.1001/jamapediatrics.2015.2682. Epub 2015 Oct 5.

Total Direct Medical Expenses and Characteristics of Privately Insured Adolescents Who Incur High Costs.

Author information

1
Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts2Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
2
The Pediatric Physicians' Organization at Children's, Boston Children's Hospital, Boston, Massachusetts.
3
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts4Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
4
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts3The Pediatric Physicians' Organization at Children's, Boston Children's Hospital, Boston, Massachusetts4Division of General Pediatrics, Boston Children's Hospital, Boston, Massachuset.

Abstract

IMPORTANCE:

Accountable care payment models aim to reduce total direct medical expenses for high-cost patients through improved quality of care and preventive health services. Little is known about health care expenditures of privately insured adolescents, especially those who incur high costs.

OBJECTIVES:

To assess health care expenditures for high-cost adolescents and to describe the patient characteristics associated with high medical costs.

DESIGN, SETTING, AND PARTICIPANTS:

A retrospective cohort analysis was conducted of data from January 1 to December 31, 2012, of 13,103 privately insured adolescents aged 13 to 21 years (mean [SD] age, 16.3 [2.4] years; 6764 [51.6%] males) at 82 independent pediatric primary care practices in Massachusetts. Analysis was conducted from April 1, 2014, to April 1, 2015.

MAIN OUTCOMES AND MEASURES:

We compared demographic (age, sex, median income by zip code) and clinical (obesity, behavioral health problem, complex chronic condition) characteristics between high-cost (top 1%) and non-high-cost adolescents. We assigned high-cost adolescents to clinical categories using software from the Agency for Healthcare Research and Quality to describe clinically relevant patterns of spending.

RESULTS:

Total direct medical expenses were $41.2 million for the entire cohort and a median $1167 per patient. A total of 132 (1.0%) patients with the highest costs accounted for 23.6% of expenses of the cohort, with a median $52,577 per patient. Mental health disorders were the most common diagnosis in high-cost patients; 78 (59.1%) of these patients had at least 1 behavioral health diagnosis. Pharmacy costs accounted for 28.4% of total direct medical expenses of high-cost patients; primary care accounted for 1.0%. Characteristics associated with being a high-cost patient included having 1 complex chronic condition (relative risk [RR], 6.5; 95% CI, 4.7-9.0), having 2 or more complex chronic conditions (RR, 23.5; 95% CI, 14.2-39.1), having any behavioral health diagnosis (RR, 3.6; 95% CI, 2.6-5.1), and obesity (RR, 2.0; 95% CI, 1.3-3.0).

CONCLUSIONS AND RELEVANCE:

Total direct medical expenses for privately insured high-cost adolescents are associated with medical complexity, mental health conditions, and obesity. Cost reduction strategies in similar populations should be tailored to these cost drivers.

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center