Private vs. public sector: 10 statistics on high cost claimant spending Featured

Written by  Mary Rechtoris | Monday, 11 July 2016 00:00
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By 2024, U.S. healthcare spending is expected to total nearly $5.4 trillion by 2019, with most of that spending devoted toward a small portion of high-need individuals, or "high cost claimants." Individuals who cost $50,000 or more in one year are considered high cost claimants.

American Health Policy Institute released a report titled, "High Cost Claimants: Private vs. Public Sector Approaches," which analyzed spending in the private sector and public sector. In the report, AHIP analyzed data from 26 large employers that collectively cover 817,479 workers. AHIP then compared these figures to Leavitt Partners' 2013 Medicare fee-for-service data.


Here are 10 statistics:


Private sector
1. For 43 percent of large employers, high cost claimants are their primary cost driver. Among the 26 companies, total health costs reached $7.4 billion, of which $2.3 billion large employers spent on high cost claimants.


2. High cost claimants cost large employers, on average, $122,382 each year.


3. Of larger employers' members, 1.2 percent are high cost claimants.


4. Health cost claimants account for 31 percent of large employer's total spending.


5. High cost claimants cost nearly 29 times as much as other members.


Public sector
6. On average, each high cost claimant costs $105,004 each year.


7. Of Medicare FFS beneficiaries, 3.4 percent are high cost claimants.


8. High cost claimants account for 44 percent of total spending.


9. On average, high cost claimants cost 12.8 times more than other members.


10. Of high cost claimants total cost, 53 percent is for chronic conditions and the remaining 46 percent is for acute conditions.


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Last modified on Monday, 11 July 2016 19:07
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