Diagnosis isn't enough: Understanding the connections between high health care utilization, XXXX and disabilities among U.S. working age adults.

@entity1 @entity121
BACKGROUND: Under the ACA, new programs are being developed to enhance care coordination and reduce health care costs among @entity1 with @entity121 , disabilities, and high utilization of health care. However, the relationships between these groups are not well understood. OBJECTIVES: Our aims were to (1) identify high utilizers of health care in the U.S. working age (18-64) population, (2) examine the overlap between this group and @entity1 with @entity121 and/or disabilities, (3) identify predictors of high service use or cost among these subpopulations, and (4) recommend approaches for stratification of individuals with high health care utilization. METHODS: Using pooled national data from the Medical Expenditure Panel Survey (2006-2008), we created indices to identify elevated or high utilization and cost groups. We performed descriptive analyses, bivariate comparisons and multivariate analyses to examine the relations between these populations and individuals with @entity121 and/or disabilities. RESULTS: While the large majority of @entity1 with high use/cost had @entity121 , the minority of @entity1 with @entity121 had high health care utilization. However, among @entity1 with @entity121 , disability was a significant predictor of high utilization. Annual expenditures were significantly elevated among @entity1 with disabilities, particularly when activities of daily living were limited. CONCLUSIONS: We conclude that medical diagnosis alone is insufficient for the development of eligibility criteria for, or the evaluation of, programs intended to better the delivery or coordination of services for high utilizers of health care services. New approaches are needed to assess functional limitations and identify ongoing needs for services and supports.
