Available online 17 September 2022

Insulin-dependent diabetes patients in the HIghER care group (Hospital Inpatient/Observation/ER) incurred higher costs in every category related to inpatient care and outpatient services for both diabetes-related and non-diabetes related costs.

Hospital and emergency room resource use for diabetes-related events should trigger aggressive intervention to reduce future hospitalization and ER visits.

Encouraging healthcare technology adoption among patients who incur the most cost expenditures, rather than only targeting those with the poorest baseline clinical measures, may help health care systems and payers to develop a more inclusive method of risk stratification.

Using claims data from an integrated payer-provider, we compared the costs incurred by insulin-dependent diabetes mellitus (IDDM) patients who received Hospital Inpatient/Observation/Emergency Department care (HIghER care) for diabetes-related events with those who did not receive such care to identify a target population for interventions in future studies.

A retrospective study pooled real-world claims data for IDDM with type 1 or type 2 DM between July 1, 2018 and June 30, 2019. Medical claims were used to calculate the total and diabetes-related allowed medical costs to the Enterprise and per-member per month (pmpm) costs.

A total of 19,378 members’ medical and prescription drug coverage were analyzed. Only 8.4% of the IDDM population received HIghER care but incurred 20% of medical expenses, and nearly 40% of diabetes-related medical costs. For HIghER care patients, medical spending was higher in every inpatient and outpatient category (Wilcoxon two sample tests, all p < 0.0001). Non-diabetes related prescription drug costs were greater in this group (Wilcoxon, Z = 2.2879, p = 0.0221), but diabetes-related prescription drug costs were higher for non-HIghER care (Wilcoxon, Z = -9.5918, p < 0.0001). In a longitudinal study of 29,602 patients over 24 months, prior-year receipt of HIghER care was a significant predictor of HIghER care the subsequent year (odds ratio 3.28)

Medical spending for HIghER care patients was disproportionately high and greater in every inpatient and outpatient category. Receipt of HIghER care in the previous year was highly predictive of HIghER care episodes the following year.

cost of diabetes

insulin-dependent diabetes

hospitalization

readmission

risk-stratification

© 2022 Published by Elsevier Inc. on behalf of the AACE.