At a Glance | November 14, 2019 Areas of Health Care Spending Concentrations Based on claims by 5.8 million policyholders and dependents with employment-based health benefits between 2013 and 2017. SPENDING DISTRIBUTION In 2017, 20 Percent of the Population Accounted for 84 Percent of Health Spending Employers offer health plans Average Minimum that in large part look and Spending Spending 10 0% per Person per Person feel the same to plan enrollees Health Spending whether they are high, 84% of Health Spending $24,900 $5,400 moderate, or low users of health 70% $41,300 $12,000 care. High users are a 56% $65,315 $23,000 challenging population. Enrollees Just one percent of enrollees 20% accounted for 28 percent of of Claimants 28% $168,500 $80,000 total spending on health care 10% 5% services in 2017. In contrast, 80 1% percent of the population accounted for only 16 percent of spending in 2017. DIABETES FOCUS One-Third of Individuals in the Top 10 There Is a Strong Correlation Between Percent of Claimants Had Diabetes Diabetes and Other Health Conditions One finding that stands out is the large percentage of Top 5 Health Conditions With High-Cost Claims Other Health Conditions Among Diabetics claimants each year with diabetes. The results suggest 33% 51% Diabetes Hypertension a strong correlation between 18% 27% diabetes and other health Chronic Obstructive Pulmonary Disease Respiratory Disease/Infection conditions. 10% 26% Rheumatoid Disease Spondylosis, Back Disorders Among individuals in the top 10% 24% Cancer Connective Tissue Disease 10 percent of claimants for five years (2013–2017), half 8% 18% Mild Liver Disease Chronic Obstructive Pulmonary Disease of those with diabetes also 17% had hypertension, and about Schizophrenia/Bipolar, Mood Disorders one-quarter of those with 16% diabetes also had respiratory Non-Traumatic Joint Disorders disease, back problems, 14% Nervous System Disorders and/or connective tissue disease, among other less prevalent 13% Renal Disease conditions. 10% Cancer 10% Osteoarthritis 10% Mild Liver Disease SOURCE: Paul Fronstin and M. Christopher Roebuck, “Persistency in High-Cost Health Care Claims: ‘It’s Where the Spending Is, Stupid,’” EBRI Issue Brief, no. 493 (Employee Benefit Research Institute, October 24, 2019). © 2019 EBRI This report is copyrighted by the Employee Benefit Research Institute (EBRI). You may copy, print, or download this report solely for personal and noncommercial use, provided that all hard copies retain any and all copyright and other applicable notices contained therein, and you may cite or quote small portions of the report provided that you do so verbatim and with proper citation. Any use beyond the scope of the foregoing requires EBRI’s prior express permission. For permissions, please contact EBRI at permissions@ebri.org.