title: Multiple chronic conditions among Medicare beneficiaries: state-level variations in prevalence, utilization, and cost, 2011.
abstract: OBJECTIVE
  Individuals with multiple (>2) chronic conditions (MCC) present many challenges to the health care system, such as effective coordination of care and cost containment. To assist health policy makers and to fill research gaps on MCC, we describe state-level variation of MCC among Medicare beneficiaries, with a focus on those with six or more conditions.
  
  
  METHODS
  Using Centers for Medicare & Medicaid Services administrative data for 2011, we characterized a beneficiary as having MCC by counting the number of conditions from a set of fifteen conditions, which were identified using diagnosis codes on the claims. The study population included fee-for-service beneficiaries residing in the 50 U.S. states and Washington, DC.
  
  
  RESULTS
  Among beneficiaries with six or more chronic conditions, prevalence rates were lowest in Alaska and Wyoming (7%) and highest in Florida and New Jersey (18%); readmission rates were lowest in Utah (19%) and highest in Washington, DC (31%); the number of emergency department visits per beneficiary were lowest in New York and Florida (1.6) and highest in Washington, DC (2.7); and Medicare spending per beneficiary was lowest in Hawaii ($24,086) and highest in Maryland, Washington, DC, and Louisiana (over $37,000).
  
  
  CONCLUSIONS
  These findings expand upon prior research on MCC among Medicare beneficiaries at the national level and demonstrate considerable state-level variation in the prevalence, health care utilization, and Medicare spending for beneficiaries with MCC. State-level data on MCC is important for decision making aimed at improved program planning, financing, and delivery of care for individuals with MCC.
authors.affiliation: Centers for Medicare & Medicaid Services.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Lochner
authors.affiliation: Centers for Disease Control and Prevention ; Emory University ; Department of Health and Human Services-Office of the Assistant Secretary for Health.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Goodman
authors.affiliation: Centers for Disease Control and Prevention.
authors.forename: Samual
authors.initials: S
authors.lastname: Posner
authors.affiliation: Department of Health and Human Services-Office of the Assistant Secretary for Health.
authors.forename: Anand
authors.initials: A
authors.lastname: Parekh
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D062306:Geography, Medical; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D015995:Prevalence; D014481:United States / Q000453:epidemiology
keywords: Administrative Data Uses; Chronic Disease; Geographic; Medicare; Small area variations; Spatial Factors
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