Identifying the Most Prevalent and Costly Chronic Conditions in Medicaid

High prevalence of chronic conditions has been a key driver of healthcare costs in the United States, and Medicaid beneficiaries tend to have higher rates of chronic diseases than people not on Medicaid.

A new review published in American Journal of Preventive Medicine examined studies published between 2000 and 2016 to estimate the prevalence and cost of noncommunicable chronic diseases in Medicaid.

“As the Medicaid population continues to change, it is increasingly important to understand the major health burdens this population faces and the associated medical costs, which is important for informing future program design and developing health promotion programs to contain or reduce the public health burden and healthcare costs,” the authors explained.

The review looked at adults between the ages of 18 and 64 years and, based on the 29 studies selected, reported the following prevalence estimates:

• 8.8% to 11.8% for heart disease
• 17.2% to 27.4% for hypertension
• 16.8% to 23.2% for hyperlipidemia
• 7.5% to 12.7% for diabetes
• 9.5% for cancer
• 7.8% to 19.3% for asthma
• 5% to 22.3% for depression
• 55.7% to 62.1% for 1 or more chronic conditions

The review presented the total cost per patient with disease and the disease-related cost per patient with disease separately. For total cost per patient, heart failure/congestive heart failure ($29,271 to $51,937) and cancer ($29,384 to $46,194) were the most expensive. However, in the disease-related cost category, congenital heart disease ($5835), heart failure/congestive heart failure ($7031), and chronic obstructive pulmonary disease (COPD) ($3968 to $6491) were the most expensive based on the studies reviewed.

In general, Medicaid beneficiaries have a high prevalence of heart diseases. Hypertension, hyperlipidemia, heart disease, and diabetes were common comorbidities. The review also found that patients with COPD had high rates of hypertension and diabetes.

The authors did acknowledge some limitations, such as many studies using state-level data, which is important since states’ Medicaid populations can vary. In addition, the use of claims data in many of the studies in the review might undercount the number of patients with certain chronic conditions. Despite the limitations, the review confirms the high prevalence of noncommunicable chronic diseases among Medicaid beneficiaries.

“The specific prevalence and cost estimates highlighted here could be used to inform the evaluation of interventions for effectively managing chronic diseases and controlling costs in this vulnerable population and for informing future designs of the Medicaid program,” the authors concluded.