The Rise In Spending Among Medicare Beneficiaries: The Role Of Chronic Disease Prevalence And Changes In Treatment Intensity

TLDR

The study highlights concerns about Medicare payment models for complex medical management. The study investigates how increasing treated disease prevalence drives Medicare spending growth. Spending growth is largely driven by patients with five or more conditions, due to higher disease prevalence and lower treatment thresholds, exemplified by an 11.5‑point rise in medication use for metabolic syndrome in under ten years.

Abstract

We examine the impact of the rise in treated disease prevalence on the growth in Medicare beneficiaries' health care spending. Virtually all of this spending growth is associated with patients who are under medical management for five or more conditions. This is traced to both a rise in true disease prevalence and changes in clinical treatment thresholds. Using the metabolic syndrome as a case study, we find that the share of patients treated with medications has increased 11.5 percentage points in less than ten years. This raises important questions about the "fit" of how Medicare pays for services for complex medical management.