title: Relationship of diabetes complications severity to healthcare utilization and costs among Medicare Advantage beneficiaries.
abstract: OBJECTIVE
  This study evaluated the usefulness of the Diabetes Complications Severity Index (DCSI) in assessing healthcare resource utilization (HRU) and costs among Medicare Advantage plan members diagnosed with type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  A retrospective cohort study of medical and pharmacy claims of 333,576 Medicare members aged 18 to 89 years with ≥1 medical claim with primary diagnosis or ≥2 medical claims with secondary diagnosis, of T2DM (International Classification of Diseases, Ninth Revision, Clinical Modification code 250.x0 or 250.x2) during the period of January 1, 2010, to December 31, 2011.
  
  
  METHODS
  DCSI was assessed concurrently with HRU and healthcare costs (total, medical, and pharmacy). The cohort was subdivided into 6 DCSI groups: DCSI = 0 (no complications) through DCSI = 5+ (≥5). Associations of complication severity with HRU and costs of care were summarized using regression models.
  
  
  RESULTS
  A 1-point increase in DCSI was associated with a $2744 increase in total costs (a $2480 increase in medical costs plus a $264 increase in pharmacy costs). Increasing DCSI was associated with greater use of inpatient and emergency department (ED) services. Among the higher complications subgroups, there were greater representations of older patients, men, and cases of depressive disorders and hypoglycemia.
  
  
  CONCLUSIONS
  DCSI is useful for identifying Medicare plan members with T2DM who should be targeted for clinical programs. HRU and costs increased with DCSI severity. Increases in high-cost HRU, driven by inpatient and ED visits, suggest that preventing or delaying utilization of these services are essential to driving down costs in the T2DM population. Furthermore, high rates of depression and hypoglycemia warrant early screening and necessary treatment to improve patient outcomes.
authors.affiliation: Comprehensive Health Insights, Inc, 515 W Market St, 7th Fl, Louisville, KY 40202. E-mail: Lhazel-fernandez@humana.com.
authors.forename: Leslie
authors.initials: L
authors.lastname: Hazel-Fernandez
authors.forename: Yong
authors.initials: Y
authors.lastname: Li
authors.forename: Damion
authors.initials: D
authors.lastname: Nero
authors.forename: Chad
authors.initials: C
authors.lastname: Moretz
authors.forename: Lane
authors.initials: L
authors.lastname: Slabaugh
authors.forename: Yunus
authors.initials: Y
authors.lastname: Meah
authors.forename: Jean
authors.initials: J
authors.lastname: Baltz
authors.forename: Nick C
authors.initials: NC
authors.lastname: Patel
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Bouchard
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D048909:Diabetes Complications / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007345:Insurance Claim Review; D016014:Linear Models; D008297:Male; D020398:Medicare Part C / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States