Transitions in Health Care Use and Expenditures Among Frail Older Adults by Payor/Provider Type

Abstract

This study illustrates the complexity of frail older people with respect to their health care expenditures and service use. Expanded efforts to control health care expenditures for frail older people should focus first on those who are dually-enrolled. In addition, because mean medical expenditures for high users enrolled in different payor/ provider groups were surprisingly similar, the data suggest that containing expenditures for individuals in the highest usage group ($20,000+) presents challenges for physicians practicing in an era of healthcare reform, regardless of payor/ provider setting.

The predictability of individual primary care costs and its impact on managed care plans

“…Added to the relatively low occurrence of high cost users, similar to what was found elsewhere [9,16], our study found that expenditure transitions were also characterized by a high proportion of consistently low users and a small proportion of consistently high users, as observed previously by Pearlman et al [17] among frail older adults.…”

Cost of Health Care for a Community of Older Adults in an Urban Academic Healthcare System

“…These programs include interventions and incentives to decrease hospital episodes and lengths of stay, efforts to move more health care to the outpatient setting, closer scrutiny of the medical necessity for services, decreasing reimbursement for professional fees, and increased oversight and attention to fraud and abuse 2–7 . The last decade has also seen larger numbers of older adults moving into managed healthcare plans, the growth of increasingly larger healthcare systems, and a renewed interest in the potential for decreasing or delaying costs through improvements in preventive health and lifestyle behaviors 8–15 …”

Clinical Pharmacology of Chemotherapy Agents in Older People with Cancer

“…Frailty reflects a common view of aging, indicating a critically exhausted functional reserve [54]. The recognition of frailty is particularly useful in planning cancer chemotherapy in older individuals.…”

“…The frail older cancer patient needs a different approach to chemotherapy prescription. Sarcopenia, inflammation, and poor nutritional status are associated with frailty in older people [52, 54, 55]. The factors have the potential to significantly affect the clinical pharmacology of cancer chemotherapy agents.…”