print share
Version HistoryVersion History


Segmentation of High-Cost Adults in an Integrated Healthcare System Based on Empirical Clustering of Acute and Chronic Conditions (Journal of General Internal Medicine)

Publication Topics

Access to Health Care; Barriers to/Disparities in Health Care; Use of Health Services; Health Care Economics; Health Promotion/Disease Prevention Issues; Health Status and Conditions; Chronic Condition Prevalence; Diabetes

Publication Type

Journal Article

Publication Date


Author 1

<a onclick="OpenPopUpPage('{7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=609&RootFolder=*', RefreshPage); return false;" href="{7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=609&RootFolder=*">Anna C. Davis</a>

Author 2

<a onclick="OpenPopUpPage('{7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=1409&RootFolder=*', RefreshPage); return false;" href="{7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=1409&RootFolder=*">Beth Glenn, PhD</a>

Author 3

<a onclick="OpenPopUpPage('{7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=243&RootFolder=*', RefreshPage); return false;" href="{7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=243&RootFolder=*">Ninez A. Ponce, PhD, MPP</a>

Author 4

<a onclick="OpenPopUpPage('{7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=627&RootFolder=*', RefreshPage); return false;" href="{7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=627&RootFolder=*">Jack Needleman, PhD</a>

Author 5

<a onclick="OpenPopUpPage('{7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=151&RootFolder=*', RefreshPage); return false;" href="{7AAD61FA-4BCB-48C0-B0B7-87AFDC3673EF}&ID=151&RootFolder=*">et al</a>

Author 6

Author 7

Author 8

Author 9

Author 10

Author 11

Author 12

Author 13

Author 14


​High-cost patients are a frequent focus of improvement projects based on primary care and other settings. Efforts to characterize high-cost, high-need patients are needed to inform care planning, but such efforts often rely on a priori assumptions, masking underlying complexities of a heterogenous population.

In this study, authors define recognizable subgroups of patients among high-cost adults based on clinical conditions, and describe their survival and future spending. Within a large integrated delivery system with 2.7 million adult members, the authors selected the top 1 percent of continuously enrolled adults with respect to total health care expenditures during 2010.
Among 21,183 high-cost adults, seven clinically distinctive subgroups of patients emerged. Classes included end-stage renal disease (12 percent of high-cost population), cardiopulmonary conditions (17 percent), diabetes with multiple comorbidities (8 percent), acute illness superimposed on chronic conditions (11 percent), conditions requiring highly specialized care (14 percent), neurologic and catastrophic conditions (5 percent), and patients with few comorbidities (the largest class, 33 percent). Over 4 years of follow-up, 6566 (31 percent) patients died, and survival in the classes ranged from 43 to 88 percent. Spending regressed to the mean in all classes except the ESRD and diabetes with multiple comorbidities groups.
Data-driven characterization of high-cost adults yielded clinically intuitive classes that were associated with survival and reflected markedly different health care needs. Relatively few high-cost patients remain persistently high cost over four years. Our results suggest that high-cost patients, while not a monolithic group, can be segmented into few subgroups. These subgroups may be the focus of future work to understand appropriateness of care and design interventions accordingly.


Article 1

Journal Article: Segmentation of High-Cost Adults in an Integrated Healthcare System Based on Empirical Clustering of Acute and Chronic Conditions

Article 2

Article 3

Article 4

Article 5

Article 6

Article 7

Article 8

Article 9

Article 10

Article 11

Article 12

Press Release

Related Link 1

Related Link 2

Related Link 3

Related Link 4

Related Link 5

Related Link 6

Related Link 7

Related Link 8

Related Link 9

Related Link 10

Related Link 11

Related Link 12

Related Link 13

Related Link 14

Related Link 15

Related Link 16

Version: 3.0
Created at 9/6/2018 1:54 PM by i:0#.f|uclachissqlmembershipprovider|celeste
Last modified at 9/6/2018 1:59 PM by i:0#.f|uclachissqlmembershipprovider|celeste