February 2020 – Onpoint’s analytics team, on behalf of California’s Integrated Healthcare Association (IHA), recently concluded an in-depth evaluation of healthcare trends in California’s seriously ill population. The investigation was a collaboration between Onpoint Health Data, IHA, and the Duke-Margolis Center for Health Policy (Duke-Margolis) at Duke University, with funding from the Gordon and Betty Moore Foundation.

In this study, the seriously ill were defined through a combination of their diagnoses, their healthcare utilization (such as a recent hospitalization), and the presence of functional limitations. While research into the seriously ill is typically limited to members covered by Medicare fee-for-service plans, this study allowed for a more comprehensive analysis by including data from commercial and Medicare Advantage health plans.

Together with the Duke-Margolis and IHA teams, Onpoint’s senior analysts developed and finalized study methodologies and then produced reporting to compare the seriously ill population with the non-seriously ill across age groups, California regions, and insurance types. The results provide a detailed view into the use of healthcare services, including usage and cost of prescription drugs, visits to the emergency room, and hospital readmissions among the seriously ill.

The study identified trends consistent with many other reports: that the seriously ill are concentrated in the older population (i.e., those 65 years of age and older), tend to have more and higher-cost prescriptions, and are more likely to utilize the emergency room compared to the non-seriously ill. The granularity of the data, however, will allow analysts to move beyond those findings to stratify the data in myriad ways so they can examine trends, identify anomalies, and explore discrepancies in detail across geographical regions, age bands, and payer types.

Figure 1. Severe Illness A by CBSA, All Insurance Product Types & 65+ Years Age Group

An evaluation of the seriously ill population provides important evidence that can have real-world implications, including helping researchers and policymakers identify opportunities to improve the services and programs offered to this population. Programs can be tailored to regions where the seriously ill population is most dense or is deemed to be at greater risk. As the aging U.S. population continues to expand, such analyses will continue to grow in importance. Onpoint welcomed the opportunity to play a key role in this innovative and crucial analysis, again demonstrating the value of using claims data to expand knowledge and impact policy.

Figure 2. Serious Illness Category Distribution by Age Group