Exhibit 1.
Characteristics of high-cost adult patients dually eligible for Medicare and Medicaid in 2010, by age and residence
| Age-residence group | |||||
|---|---|---|---|---|---|
| Community | Nursing home | ||||
| All | Age <65 | Age ≥65 | Age <65 | Age ≥65 | |
| Number | 386,886 | 135,509 | 86,389 | 30,091 | 134,897 |
| Percentage of total | 100% | 35% | 22% | 8% | 35% |
| Patient characteristics | |||||
| Age range (years) | |||||
| 21–54 | 27.0% | 67.6% | —a | 42.9% | —a |
| 55–64 | 15.8 | 32.3 | —a | 57.1 | —a |
| 65–74 | 20.0 | —a | 47.8% | —a | 26.8% |
| 75–84 | 21.0 | —a | 34.4 | —a | 38.1 |
| 85 or more | 16.2 | —a | 17.7 | —a | 35.1 |
| Male | 42.5% | 54.4% | 36.4% | 53.6% | 32.0% |
| Race/ethnicity | |||||
| Whiteb | 71.8% | 72.8% | 66.3% | 68.7% | 74.8% |
| Black | 20.1 | 20.7 | 20.2 | 25.0 | 18.4 |
| Hispanic | 8.1 | 6.4 | 13.5 | 6.3 | 6.8 |
| Chronic conditions | |||||
| Renal disease | 41.1% | 29.3% | 53.8% | 43.3% | 44.4% |
| Congestive heart failure | 36.6 | 19.5 | 51.8 | 32.3 | 44.9 |
| Diabetes mellitus | 41.2 | 27.7 | 51.1 | 50.4 | 46.2 |
| Chronic obstructive lung disease | 28.5 | 15.7 | 37.7 | 31.2 | 34.7 |
| Peripheral vascular disease | 16.5 | 9.5 | 23.4 | 17.8 | 18.7 |
| Coronary artery disease | 13.3 | 8.1 | 22.7 | 10.4 | 13.1 |
| Cancer | 6.7 | 4.7 | 13.1 | 4.5 | 5.2 |
| Depression | 20.3 | 15.2 | 14.7 | 32.8 | 26.3 |
| Cerebrovascular disease and stroke | 13.1 | 5.2 | 14.6 | 18.3 | 19.0 |
| Dementia | 38.4 | 8.8 | 35.6 | 35.1 | 70.6 |
| Parkinson’s or Huntington’s disease | 4.4 | 1.1 | 4.6 | 4.4 | 7.8 |
| Severe mental illness | 21.7 | 23.3 | 12.3 | 41.4 | 21.8 |
| Paralysis | 6.1 | 8.2 | 3.8 | 16.4 | 3.2 |
| Liver disease | 4.4 | 1.1 | 4.6 | 4.4 | 7.8 |
| Hematologic or thrombotic disease | 11.8 | 9.3 | 15.5 | 13.7 | 11.5 |
| Cerebral vascular disease or stroke | 14.2 | 5.7 | 16.3 | 19.7 | 20.3 |
| Number of chronic conditions | |||||
| 0 | 13.8 | 31.5 | 6.6 | 5.1 | 2.5 |
| 1–2 | 28.1 | 35.3 | 22.4 | 25.8 | 24.9 |
| 3–4 | 31.8 | 20.7 | 36.6 | 36.5 | 38.9 |
| 5 or more | 26.4 | 12.6 | 34.3 | 32.7 | 33.8 |
| Number of hospitalizations | 1.76 | 1.65 | 1.98 | 2.23 | 1.63 |
| Spending | |||||
| Payer | |||||
| Medicare and Medicaid | $135,343 | $151,851 | $133,304 | $143,497 | $118,248 |
| Medicare only | 71,803 | 55,591 | 90,900 | 89,168 | 71,986 |
| Medicaid only | 63,540 | 96,320 | 42,523 | 54,404 | 46,373 |
| Ratio of Medicare to Medicaid | 1.13 | 0.58 | 2.14 | 1.64 | 1.55 |
| Medicare spending per capita | |||||
| Inpatientc | $48,164 | $34,472 | $61,825 | $61,899 | $50,107 |
| Professional services | 17,043 | 16,748 | 20,263 | 22,565 | 14,046 |
| Hospice | 2,651 | 293 | 1,519 | 1,881 | 5,915 |
| Home health | 2,388 | 2,016 | 5,616 | 1,100 | 982 |
| Medicaid LTSS spending per capita | |||||
| Inpatient nursing facility | $17,789 | $ 1,620 | $ 2,363 | $44,023 | $38,057 |
| Other facilities | 4,967 | 35,410 | 9,175 | 613 | 206 |
| HCBS adult day care | 2,460 | 5,862 | 1,754 | 74 | 27 |
| Home health and personal care | 4,055 | 4,150 | 10,681 | 531 | 501 |
| Residential care | 12,076 | 28,831 | 7,621 | 593 | 659 |
SOURCE Authors’ analysis of linked Medicare and Medicaid data for 2010. NOTES High-cost patients are those in the top decile of spending in their state. All tests for independence across the four age-residence groups (proportions), and comparisons of each group to the “Age ≥65 community dwelling group” (continuous variables) are significant (p < 0.001). Home and community-based services (HCBS) waivers allow states to provide funding for long-term services and supports (LTSS) in the home or community, instead of in an institutional setting.
Not applicable.
Non-Hispanic whites and other races not listed.
Includes at a skilled nursing facility.