An examination of the health care claims of 8.6 million group plan enrollees in 2021 revealed that over 80 percent of top spenders had at least 1 of 5 chronic health conditions — heart disease, respiratory conditions, musculoskeletal conditions, skin disorders, and nervous system conditions. This Fast Fact reviews the spending of people with one or more of these chronic conditions.
Figure 1 Data and Methods Chronic Condition Comorbidities and Spending Among Top Spenders, 2021 ® We analyzed the Merative™ MarketScan Commercial Database, which contains pharmacy and medical claims Share With at Least 1 of 5 Average Spending per Panel A Percentage of Spending data o n a sample of 8.6 million enr ollees in a non-capitated employment-based health plan in 2021. The study June 1, 2023, #470 Conditions Person cohort included individuals under age 65, residing in all U.S. geographic regions, and enrolled in a variety of plan Top 1% 91% $199,866 91% types. Using relevant procedure codes from claims, we derived health condition indicators. Top 2–5% 89% $79,993 90% Top 6–10% 86% $51,355 89% A Thank You To Members: This study was conducted through the EBRI Center for Research on Health Benefits Top 11–20% 83% $31,143 87% Spending Among Group Plan Enrollees With Multiple Innovation (EBRI CRHBI), with the funding support of the following organizations: Aon, Blue Cross Blue Shield Association, ICUBA, JP Morgan Chase, Pfizer, and PhRMA. Health Conditions: A Look at High-Cost Claimants in 2021 Heart Disease and Average Spending per Panel B Percentage of Spending The Employee Benefit Research Institu Othe te is a p r 1 of 4 rivate, nonpartisan, a Pernd so n n onprofit research institute based in Washington, D.C., that focuses on health, savings, retirement, and economic security issues. EBRI does not lobby Top 1% 52% $209,159 55% Examining the health care claims of 8.6 million group plan enrollees in 2021, we show that over 80 percent of top and does not take policy positions. The work of EBRI is made possible by funding from its members and sponsors, Top 2–5% 43% $88,688 48% spenders in 2021 had at least 1 out of 5 chronic conditions: heart disease, respiratory conditions, musculoskeletal which include a broad range of public and private organizations. For more information, visit www.ebri.org. Top 6–10% 37% $60,410 45% conditions, skin disorders, and nervous system conditions. These conditions are not only the most prevalent Top 11–20% 31% $39,742 42% conditions among top spenders, but they are also generally the most prevalent comorbidities among those with 1 any of these five conditions. In particular: Respiratory Condition and Average Spending per Panel C Percentage of Spending • Among the top 1 percent of health care spenders, 91 percent had at least one of these five chronic Other 1 of 4 Person 1 Diabetes and mental disorders are the other most common comorbidities among enrollees with any of these five health conditions, and total spending among these enrollees represented 91 percent of all health care spending. Top 1% 46% $219,064 50% conditions. Over 20 percent of top spenders with at least 1 of these 5 conditions had diabetes, and over 25 percent had a Average spending per person in this group was nearly $200,000 (Panel A). Half had heart disease and at Top 2–5% 37% $91,755 43% mental disorder. least 1 out of the 4 other conditions (Panel B), while 46 percent had at least a respiratory condition (Panel Top 6–10% 32% $61,084 40% C), 39 percent had at least a musculoskeletal condition (Panel D), 32 percent had at least a skin disorder Top 11–20% 28% $39,248 37% (Panel E), and half had at least a nervous system condition and at least 1 out of the 4 other conditions (Panel F). Musculoskeletal Condition Average Spending per Panel D Percentage of Spending • Among the top 2–5 percent of health care spenders, 89 percent had at least 1 of these 5 chronic and Other 1 of 4 Person conditions, and total spending among these enrollees represented 90 percent of all health care spending. Top 1% 39% $195,911 39% Average spending per person in this group was nearly $80,000 (Panel A). Approximately 40 percent had heart d Topisea 2–5s% e at a minimum (Panel B). 39% $79,490 39% Top 6–10% 34% $53,679 37% • Among the top 6–10 percent of health care spenders, 86 percent had at least 1 of these 5 chronic Top 11–20% 30% $35,220 35% conditions, and total spending among these enrollees represented 89 percent of all health care spending. Average spending per person in this group was approximately $50,000 (Panel A). Thirty-five percent have Skin Disorder and Average Spending per a nerv Pan ou els system con E dition and at least 1 out of the 4 other conditions (Pan Perce el F). ntag e of Spending Other 1 of 4 Person Top 1% 32% $205,461 33% • Among the top 11–20 percent of health care spenders, 83 percent have at least 1 of these 5 chronic Top 2–5% 27% $87,953 30% conditions, and total spending among these enrollees represents 87 percent of all health care spending. Top 6–10% 23% $60,283 28% Average spending per person in this group was around $30,000 (Panel A). A third had heart disease and at leasT t o1 p ou 11t o –2f 0th %e 4 other conditions (Panel B). 20% Three in 10 hav $3e a musculo 9,153 skeletal conditio26% n at a minimum (Panel D). Nervous System Condition Average Spending per Panel F Percentage of Spending and Other 1 of 4 Person Top 1% 51% $209,330 53% Top 2–5% 41% $89,087 46% Top 6–10% 35% $60,717 43% Top 11–20% 28% $41,552 40% Note: "Any 1 of 5" means has heart disease, a respiratory condition, a musculoskeletal condition, a skin disorder, or a nervous system condition. EBRI on Twitter @EBRI or twitter.com/EBRI LinkedIn: linkedin.com/company/employee-benefit-research-institute E EBRI on BRI on T Tw wi it tt ter er: : @E @EBRI BRI o or r t tw wi it tt te er r.c .co om/ m/E EBRI BRI L Li in nk ked edIn In: : l li in nk ked edi in n.c .co om m/ /c co om mp pan any y/ /e emp mpl lo oy yee ee- -b be en nef efi it t- -re res se earch arch- -i in ns st ti it tu ut te e © 2023, Employee Benefit Research Institute, 901 D St. SW, Suite 802, Washington, DC 20024, 202/659-0670 | ebri.org 2 3