Identification Of Four Unique Spending Patterns Among Older Adults In The Last Year Of Life Challenges Standard Assumptions

Abstract

The underlying assumption that healthcare spending skyrockets at the end-of-life may suggest that policymakers should target the last few months of life to control costs. However, spending patterns leading up to death have not been fully examined. We applied a new methodology to administrative claims data for older Medicare beneficiaries who died in 2012 to characterize trajectories of healthcare spending in the last year of life. After adjustment, we identified four unique spending trajectories among decedents: 48.7 percent had High Persistent spending, 29.0 percent had Moderate Persistent spending, 10.2 percent had Progressive spending, and only 12.1 percent had Late Rise spending. High spending throughout the full year before death (approximately half of all decedents) was associated with having multiple chronic conditions but not any specific diseases. These findings suggest that spending at the end-of-life is a marker of general spending patterns often set in motion long before death.

The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization

“…Identifying patients likely to benefit from HBPC based on historical claims is challenging since spending patterns are variable and do not reliably predict palliative care needs. 28 Predictors of palliative care need may include prognosis of less than one year, frailty, functional decline, and social isolation, which are not readily available through claims. Our claim-based algorithm appears to correctly identify a cohort of beneficiaries with a 57% risk of death within six months; however, we were unable to serve them all due to staffing limitations.…”

Health care demand elasticities by type of service

“…To deal with this using annual data, the convention in the literature is to use the log of annual spending plus one (Aron-Dine et al 2013, Aron-Dine et al 2015, Einav et al 2013, Davis et al 2016). 4 Here we modified the convention of adding one to accommodate the fact that we are using monthly rather than annual spending.…”

High-Cost Dual Eligibles’ Service Use Demonstrates The Need For Supportive And Palliative Models Of Care

“…16,17,19,26–29 A parallel literature discusses the high concentration of spending among people who are dying. 30–32 Only a few studies have focused on identifying adults whose high service use spans both Medicare and Medicaid, 9,13 but they focus on a snapshot in either Medicare or Medicaid, not both. Furthermore, these studies do not show how subgroups differ over time—which is important for program design.…”