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Member Research & Reports

Member Research & Reports

Saint Louis: The Role of Social, Cognitive, And Functional Risk Factors in Medicare Spending for Dual And Nondual Enrollees

A recent study led by Dr. Kenton Johnston from Saint Louis University College for Public Health and Social Justice and Dr. Karen Joynt Maddox, from the Washington University School of Medicine in St. Louis, found that beneficiaries enrolled in both Medicare and Medicaid had strikingly higher levels of medical, functional, and cognitive comorbidities, as well as social needs, compared to their non–dually enrolled counterparts. Dual enrollees also had significantly higher annual costs of care.

The authors conducted a retrospective observational study using cohort data from the Medicare Current Beneficiary Survey (MCBS) linked to respondents’ fee-for-service Medicare claims and administrative data for the years 2006–13. They limited the study population to beneficiaries who had at least two years of continuous enrollment in fee-for-service Medicare Parts A and B that overlapped with two years of enrollment in the survey and at least one physician or clinic visit in the baseline year. Their study population consisted of 168,860,511 patient-years. Of these, 18.4 percent were for dually enrolled beneficiaries and 81.6 percent were for non–dually enrolled beneficiaries.

In this nationally representative study, which was published in HealthAffairs, the authors found that dual enrollees had significantly higher annual costs of care than their nondual enrollee counterparts. Their findings suggest that cognitive and functional factors, which differed markedly between the two groups, may be important areas for further research into targeted interventions to improve health outcomes and reduce disparities.

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