County-Level Concentration of Selected Chronic Conditions Among Medicare Fee-for-Service Beneficiaries and Its Association with Medicare Spending in the United States, 2017

Abstract

Multiple chronic conditions (MCC) reduce quality of life and are associated with high per capita health care spending. One potential way to reduce Medicare spending for MCC is to identify counties whose populations have high levels of spending compared to level of disease burden. Using a nationally representative sample of Medicare Fee-for-Service beneficiaries, this paper presents a method to measure the collective burden of several chronic conditions in a population, which the authors have termed the concentration of chronic conditions (CCC). The authors observed a significantly positive linear relationship between the CCC measure and county-level per capita Medicare spending. This area-level measure can be operationalized to identify counties that might benefit from targeted efforts designed to optimally manage and prevent chronic illness.

Keywords: GIS; health care spending; multimorbidity; multiple chronic conditions.

FIG. 1.

Concentration of chronic conditions in US counties among Medicare fee-for-service beneficiaries, 2017. The concentration of chronic conditions measure in a given county is the sum of the prevalence score for the following 16 conditions: hypertension, hyperlipidemia, arthritis, diabetes, ischemic heart disease, chronic kidney disease, depression, heart failure, chronic obstructive pulmonary disease, Alzheimer’s disease and related dementia, asthma, atrial fibrillation, cancer, osteoporosis, schizophrenia, and stroke. For the given county, each chronic condition received a prevalence score of 1, 0, or −1 depending on the prevalence of each condition among all of the counties. A value of 1 indicates that the prevalence was in the upper decile among all counties and a value of −1 indicates that the prevalence was in the lower decile; a value of 0 indicates the prevalence in neither the upper nor lower decile.

FIG. 2.

Per capita Medicare spending. (A) Per capita Medicare spending ($) among fee-for-service beneficiaries and (B) deviation of per capita spending ($) from expected given the concentration of chronic condition burden of disease measure, 2017.