Medicaid beneficiaries with disabilities frequently have multiple chronic conditions, says study

Kaiser PermanenteOct 21 2009

Medicaid beneficiaries with disabilities frequently have multiple chronic conditions, and very high rates of psychiatric illness and cardiovascular disease, according to a study released today by the Center for Health Care Strategies. As national policymakers debate health reform, The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions provides insights for targeting efforts to improve care and control spending for Medicaid's highest-need, highest-cost beneficiaries. These insights are relevant and applicable to other populations and patients with multiple complex comorbidities. The study was funded through a grant from Kaiser Permanente.

Building on an earlier analysis that examined one year of national Medicaid diagnostic data, this new study adds two data sets -- pharmacy claims and five years of diagnostic data -- to further refine what is known about Medicaid beneficiaries with chronic needs. The study, conducted by Rick Kronick, Ph.D., and Todd Gilmer, Ph.D., both from the University of California, San Diego, sought to expand the knowledge base regarding the prevalence and patterns of chronic conditions among Medicaid beneficiaries.

"Analyzing prescription drug use in addition to diagnostic claims identifies considerably more beneficiaries with comorbidities, and notably, a significant increase in patients with behavioral health issues," said Dr. Kronick. "By expanding these insights into the population's complex needs, this work can help Medicaid stakeholders in designing tailored care management interventions for patients with multiple chronic conditions."

Compared to solely looking at diagnostic data, the addition of pharmacy data reveals higher rates of comorbidity among Medicaid beneficiaries with disabilities, including significantly higher prevalence of psychiatric illness and cardiovascular disease. Following are highlighted findings resulting from the addition of pharmacy data:

• The proportion of Medicaid beneficiaries with disabilities who are diagnosed with three or more chronic conditions increases from 35 percent to 45 percent.
• The frequency of psychiatric illness among Medicaid beneficiaries with disabilities increases from 29 percent to 49 percent. Similarly, the prevalence of cardiovascular disease increases from 32 percent to 44 percent.
• Costs for Medicaid-only beneficiaries with three or more chronic conditions increases from 66 percent to 75 percent of total spending for beneficiaries with disabilities.

Pharmacy data was particularly valuable in illustrating the prevalence of psychiatric illness in high-cost Medicaid beneficiaries. Examining diagnostic and pharmacy data together, psychiatric illness is represented in three of the top five most common pairs of diseases among the highest-cost 5 percent of Medicaid-only beneficiaries with disabilities. This was not apparent using diagnostic data alone.

"These patients account for much of the cost and use of services in Medicaid, and require special attention, considerable resources and an intensive approach to care management," said Raymond J. Baxter, PhD, senior vice president, Community Benefit, Research and Health Policy, Kaiser Permanente. "This report contributes significantly to the body of information about how to understand and improve the care of patients with complex, chronic conditions."