Developing Models to Predict Persistent High-Cost Cases in Florida Medicaid

Abstract This paper examined individual characteristics associated with being a high-cost case in multiple years for Medicaid-covered health care services. In addition, the accuracy of models that predict future persistent high-cost cases was examined. Florida Medicaid claims from 2005 to 2010 were used to examine characteristics, diagnoses, and services associated with individual costs being in the top 1% of recipients. Regression models were estimated with diagnoses and service use in a base year used to predict future high-cost cases. Several different perspectives were used that focus on predicting current year high-cost cases based on prior persistence, predicting future persistence of high costs, and a combination of using past persistence to predict future persistence. Average annual costs for persistent high-cost cases were more than $140,000. Overall, models were predictive of future high-cost cases. The receipt of intermediate case facility (mental retardation) services was the strongest predict...