People with chronic diseases tend to have higher health care costs and people with multiple chronic diseases have even higher ones. That is true for Medicare beneficiaries as well. The Centers for Disease Control conducted an analysis to see how many Medicare beneficiaries there were that had at least six chronic conditions and what their geographic dispersal was. (CDC Brief) In 2014, of 28 million FFS beneficiaries over 65, 4.3 million or 15%, had 6 or more of 19 studied chronic diseases, which included hypertension, high cholesterol, arthritis, heart disease, heart failure, diabetes, depression, COPD, Alzheimer’s, asthma, stroke, cancer, hepatitis, schizophrenia and a couple of others. Medicare spending on this population was $126 billion or an astounding 51% of all Medicare spending. Average annual spending on these beneficiaries was about $29,000. Looked at by county across the country, counties with high numbers of these beneficiaries, and with high average spending on them, tended to cluster as did those with low spending. But the clustering of beneficiaries and average spending was not always identical. Northern Louisiana, west Alabama, northern Texas and central Wyoming had high geographic concentrations of this spending, while northeast Wisconsin, northwest Michigan, western Oregon and upstate New York had low spending clusters.
As the brief notes, the next step of analysis would be to identify factors that lead to larger numbers of beneficiaries with 6 or more chronic conditions living in an area and to identify patterns of care and other factors that lead to higher spending on such patients in some geographies. Areas with many of these beneficiaries could obviously benefit from targeted disease management efforts and perhaps greater public health efforts to try to reduce the incidence of chronic disease. Given the clear link between chronic disease and total spending, if there are effective interventions to limit incidence and to manage care and spending, there would be a significant payback for Medicare.