Wesley, another item to throw the numbers into perspective: One group of patients that use a high number of services are those with multiple chronic conditions. CMS, NCQA, and others are developing monitoring and usage plans to help reduce costs and improve outcomes.
Twenty-five percent of the patients in the US have one or more of the 17 conditions being tracked by CMS:
Alzheimer’s Disease and Related
Dementia
Depression
Arthritis (Osteoarthritis and Rheumatoid)
Diabetes
Asthma
Heart Failure
Atrial Fibrillation
Hyperlipidemia
Autism Spectrum Disorders
Hypertension
Cancer (Breast, Colorectal, Lung, and Prostate)
Ischemic Heart Disease
Chronic Kidney Disease
Osteoporosis
Chronic Obstructive Pulmonary Disease
Schizophrenia and Other Psychotic Disorders
Stroke
25% sounds low, 70 million Americans alone have hypertension, another 70 million have hyperlipidemia. I’m sure there is overlap but I’m going to guess even with that there are at least 100 million people in the US who have one of those two conditions alone, not speaking of the other 15 conditions. CKD affects 26 million, depression affects 16 million, etc.
Also they don’t seem like they’d be the same. Anti-hypertensives run as little as $4/month ($2 if you split the pills). So the overall cost sounds like it wouldn’t be that high.
People who have been in car accidents, or have a serious auto-immune disorder, or recurrent cancer or something like that though I could see them running up 7 figures in medical bills over their lives.
My point is that there are over 100 million people in the US who have risk factors for disease, but are those people actually expensive? Hypertension is a risk factor for kidney failure or heart disease, but many people with hypertension either control it cheaply or will never get those two conditions.