Prevalence of multiple chronic conditions in the United States' Medicare population

Kathleen M Schneider, Brian E O'Donnell, Debbie Dean

In 2006, the Centers for Medicare & Medicaid Services, which administers the Medicare program in the United States, launched the Chronic Condition Data Warehouse (CCW). The CCW contains all Medicare fee-for-service (FFS) institutional and non-institutional claims, nursing home and home health assessment data, and enrollment/eligibility information from January 1, 1999 forward for a random 5% sample of Medicare beneficiaries (and 100% of the Medicare population from 2000 forward). Twenty-one predefined chronic condition indicator variables are coded within the CCW, to facilitate research on chronic conditions. The current article describes this new data source, and the authors demonstrate the utility of the CCW in describing the extent of chronic disease among Medicare beneficiaries. Medicare claims were analyzed to determine the prevalence, utilization, and Medicare program costs for some common and high cost chronic conditions in the Medicare FFS population in 2005. Chronic conditions explored include diabetes, chronic obstructive pulmonary disease (COPD), heart failure, cancer, chronic kidney disease (CKD), and depression. Fifty percent of Medicare FFS beneficiaries were receiving care for one or more of these chronic conditions. The highest prevalence is observed for diabetes, with nearly one-fourth of the Medicare FFS study cohort receiving treatment for this condition (24.3 percent). The annual number of inpatient days during 2005 is highest for CKD (9.51 days) and COPD (8.18 days). As the number of chronic conditions increases, the average per beneficiary Medicare payment amount increases dramatically. The annual Medicare payment amounts for a beneficiary with only one of the chronic conditions is $7,172. For those with two conditions, payment jumps to $14,931, and for those with three or more conditions, the annual Medicare payments per beneficiary is $32,498. The CCW data files have tremendous value for health services research. The longitudinal data and beneficiary linkage within the CCW are features of this data source which make it ideal for further studies regarding disease prevalence and progression over time. As additional years of administrative data are accumulated in the CCW, the expanded history of beneficiary services increases the value of this already rich data source.