To examine high‐cost patients in and factors associated with persistence in high costs over time.
Secondary data for 2008–2012.
We obtained and Medicare utilization and cost records for enrollees and drew a 20 percent random sample ( = 1,028,568).
We identified high‐cost patients, defined as those in the top 10 percent of combined and Medicare costs, and determined the number of years they remained high cost over 4 years. We compared sociodemographics, clinical characteristics, and baseline utilization by number of high‐cost years and conducted a discrete time survival analysis to predict high‐cost persistence.
Among 105,703 patients with the highest 10 percent of costs at baseline, 68 percent did not remain high cost in subsequent years, 32 percent had high costs after 1 year, and 7 percent had high costs in all four follow‐up years. Mortality, which was 47 percent by end of follow‐up, largely explained low persistence. The largest percentage of patients who persisted as high cost until end of follow‐up was for spinal cord injury (16 percent).
Most high‐cost patients did not remain high cost in subsequent years, which poses challenges to providers and payers to manage utilization of these patients.