What Happens to High-Cost Patients? An Analysis of the Trajectories of Billed Charges over Time

Brady P. Horn, Cameron S. Crandall, Douglas S. Binder, David P. Sklar

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


A growing literature documents the substantial burden that a small proportion of high-cost, medically complex patients impose on health care systems. However, it is not clear whether high-cost patients remain costly over time. This study looks at the monthly distribution of billed charges for a cohort of high-cost, medically complex patients enrolled in an intensive care management program in a university health care system, and finds that the billing trajectory is heterogeneous and highly nonlinear, characterized by a substantial spike in billed charges prior to identification, followed by a considerable drop prior to enrollment and a sustained drop thereafter. The conclusion is that many high-cost patients experience costly events that resolve without intensive case management. These results also suggest that interventions should target only those high-cost patients with expected continued high cost and that pre-post study designs may overstate the impact of interventions for high-cost, medically complex patients.

Original languageEnglish (US)
Pages (from-to)362-367
Number of pages6
JournalPopulation Health Management
Issue number5
StatePublished - Oct 1 2017
Externally publishedYes


  • care management
  • cost of care
  • economic impact

ASJC Scopus subject areas

  • Leadership and Management
  • Health Policy
  • Public Health, Environmental and Occupational Health


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