Persistent high utilization in a privately insured population

Objectives: To describe individuals characterized as persistent high users - that is, individuals who are in the top 10% of users every year over the 3-year study period. Study Design: Retrospective cohort study of 4 groups in a privately insured population. Groups were defined by the number of years an enrollee was in the top 10% of the spending group (top decile) for the period from 2009 to 2011: persistent high-user group (3 out of 3 years in the top decile spending group); frequent high-user group (2 out of 3 years in top decile); incidental high-user group (1 out of 3 years in top decile); and never highuser group (0 out of 3 years in top decile). Methods: This study used insurance claims data to examine enrollees with persistently high health service utilization. Data for the year 2008 were utilized to assess baseline individual characteristics. Annual data for 2009 to 2011 were used to examine healthcare expenditures, utilization patterns, and specific clinical conditions among the 4 groups of the study sample. Results: Among 42,038 enrollees, 1216 (2.9%) met the criteria as persistent high users. Over a 3-year period, this group accounted for 21% of total healthcare expenditure. Compared with the other groups, persistent high users had higher overall disease burden due to multiple chronic conditions and incurred significantly higher expenses in medication and professional services (including primary and specialty care). Conclusions: This study highlights the need to proactively engage employees and their dependents for primary and secondary prevention of common chronic diseases before an individual's health status, healthcare utilization, and medical cost become difficult to manage.