D Cer atta and ain chr M oni etc hod cond s itions like heart disease, mental disorders, connective tissue disease, and nervous system disorders have become more prevalent among the top spenders over time. On the other hand, respiratory ® conditions, hypertension, diabetes, and musculoskeletal conditions, among others, have become less common We analyzed the Merative™ MarketScan Commercial Database, which contains pharmacy and medical among the top spenders. claims data on a sample of 8 to 16 million enrollees in a non-capitated employment-based health plan from March 30, 2023, #461 2013 to 2021. The study cohort included individuals under age 65, residing in all U.S. geographic regions, Among Enrollees Who Spend $100,000 or More in 2013 Relative to 2021 and enrolled in a variety of plan types. Using relevant procedure codes and financial fields from claims, we derived health condition prevalence indicators, as well as spending categories. Chronic Conditions That Were Less Common High-Cost Health Care Claimants: Health Care Spending A Thank You To Members: This study was conducted through the EBRI Center for Research on Health Benefits Ian nnovat •d Chro iFrom on (EB 2013 RI C nic tR o 202 HBIConditio 1, t ), w hie s th h the are of fund peop ing s n Pre luppo e witr h tva o ce fr t th ale ien c fnce oh llrow oniic c ng o A on rm di gatni iong on zat s s io aw ns:To a de Aon, B cr p Spende ealse ue C . The c rossh B ron lue S ir c s hi eld Associatcondi ion, ItC ions UBA for , JP M which organ Ch this was as te, P rue fw ize erre , and P respirh at R or MA y con . ditions (71 percent in 2013 to 51 percent in 2021), 1 hypertension (44 percent to 31 percent), musculoskeletal conditions (54 percent to 41 percent), Examining the health care claims of 8.6 to 16.3 million enrollees in a group policy from 2013 to 2021, our The Emp ce loy rebr eeov Bas encu efilta R r d eisse eaas rce h I (12 nst per itutc e ent is a pr to 1i0 va pe te, rce nonpar nt), pne tisa um n, on and n ia (13 onpr peo rf cient t res to 11 earch pier ns ce tint tu) te ba , cance sed r i(n 51 research shows that the share of top health care spenders has increased over time. Washing per ton, D cent.C to 44 ., tha per t fo ce cuse nt),s o end n he ocr ailne d th, sa ise vias ng e s, r (31 et p irer em ce ent nt , and to 29 ec pe ono rcen m t) ic s , and ecu ir nf itec y itss iou ue s di s. EB seaR se I does s (31 n pe ot rc lent obby to and does no 29 per t take cen po t) (lFig icy po ure si 2t). ion s. The work of EBRI is made possible by funding from its members and • The share of enrollees spending $100,000 or more per year on health care rose 50 percent from 0.60 sponsors, which include a broad range of public and private organizations. For more information, visit percent in 2013 to 0.90 percent in 2021. w Chroni ww.ebr c Con i.orgd . itions That Have Been Constant • The share of enrollees spending $250,000 or more per year on health care rose from 0.12 percent in 2013 • For some chronic conditions, the share of individuals who had them remained constant from 2013 to to 0.2 percent in 2021. ### 2021. These conditions were diabetes (32–33 percent), kidney disease (21 percent), and skin disorders (35 percent) (Figure 2). • The share spending $500,000 or more per year on health care rose from 0.03 percent in 2013 to 0.04 percent in 2021. Chronic Conditions That Were More Common • The share spending $1,000,000 or more doubled, increasing from 0.005 percent in 2013 to 0.01 percent in • The chronic conditions with an increase in the share of individuals who had them were some “other” 2021. conditions (e.g., liver disease, hemiplegia/paraplegia, AIDS, regional enteritis, ulcerative colitis, and dementia) (20 percent to 23 percent), heart disease (43 percent to 56 percent), mental disorders (19 • The share spending $2,000,000 or more was 2.5 times larger in 2021 relative to 2013, increasing from percent to 28 percent), connective tissue disease (2 percent to 3 percent), and nervous system disorders 0.0004 percent in 2013 to 0.001 percent in 2021. (36 percent to 56 percent) (Figure 2). Figure 1 Figure 2 Share of Top Spenders From 2013–2021 Changes in Chronic Condition Prevalence Among Enrollees Spending $100,000+ Share With Health Spending $100,000+ $250,000+ $500,000+ $1,000,000+ $2,000,000+ Prevalence in 2021 Prevalence in 2013 In 2013 0.60% 0.12% 0.03% 0.005% 0.0004% 56% In 2014 0.50% 0.11% 0.03% 0.004% 0.0003% Nervous System Disorders 36% In 2015 0.70% 0.14% 0.03% 0.00 56% 6% 0.0006% Heart Disease 43% 51% In 2016 0.80% 0.16% 0.04% 0.007% 0.0007% Respiratory Conditions 71% 44% In 2017 0.80% 0.16% 0.04% 0.008% 0.0009% Cancer 51% In 2018 0.90% 0.17% 41% 0.04% 0.008% 0.0009% Muskulosketal Conditions 54% In 2019 0.80% 0.16% 0.04% 0.007% 0.0008% 35% Skin Disorders In 2020 0.70% 0.1635% % 0.04% 0.007% 0.001% 32% Diabetes In 2021 0.90% 0.33% 20% 0.04% 0.01% 0.001% 31% ® Hypertension Source: EBRI estimates using 2021 Merative™ MarketScan Comme 44% rcial Database. 29% Infectious Disease Note: Dollar amounts are in real 2021 dollars. 31% 29% Endocrine Disease 31% We also show that the top five most prevalent conditions a 28% mong the top spenders in 2021 were nervous system Mental Disorders 19% disorders, heart disease, respiratory conditions, canc 23% er, and musculoskeletal conditions. Four of these five Other 20% 21% conditions were a Kidn lso ey Di in seas the e top five most prevalent conditions among top spenders in 2013. These were 21% 11% respiratory conditiP ons, neumo m nius a culoskeletal conditions, cancer, and heart disease. 13% 10% Cerebrovascular Disease 12% 3% Connective Tissue Disease 2% 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 16.3 million enrollees in 2013, 14.8 million enrollees in 2014, 13.8 million enrollees in 2015, 14.6 million enrollees in ® Source: EBRI estimates using 2021 Merative MarketScan Commercial Database. 2016, 14.4 million enrollees in 2017, 13.4 million enrollees in 2018, 10.2 million enrollees in 2019, 12.3 million enrollees in “Other” category includes liver disease, hemiplegia/paraplegia, AIDS, regional enteritis, ulcerative colitis, and dementia. 2020, and 8.6 million enrollees in 2021. Chronic Condition Prevalence Indicator Definition: In a given year, enrollee received inpatient treatment for the chronic condition at least once or received outpatient treatment for the condition on two separate dates. EBRI on Twitter @EBRI or twitter.com/EBRI LinkedIn: linkedin.com/company/employee-benefit-research-institute E EB BR RI I on on T Twitt witte er r: : @ @E EB BR RI I o or r twit twitte ter r..c com/ om/E EB BR RI I L LinkedI inkedIn: n: li linke nkedin. din.c com om/compa /company ny/e /empl mploye oyee e- -be bene nef fit it- -r re es se ea ar rc ch h- -ins insti titu tute te © 2023, Employee Benefit Research Institute, 901 D St. SW, Suite 802, Washington, DC 20024, 202/659-0670 | ebri.org 3 2