OBJECTIVES: The research aims to identify the population of HiCCs within a multi-employer database, and to describe demographic and clinical characteristics and cost patterns for this population.

METHODS: The study utilizes a random sample of individuals from a large multi-employer claims database from Gallagher benefits consulting. HiCCs are identified as individuals with medical and pharmacy claims in one year exceeding $250,000. Demographic and clinical characteristics for the HiCC population, and proportion of medical vs. pharmacy claims are described.

RESULTS: From a random sample of 65,535 employees with claims, 0.25% (167 individuals) exceeded the $250,000 annual claims threshold. Gender differences were not noted but we observed that the number of high-cost claimants increased with age. Despite the fact that the oldest age group (over 60 years old) had the highest number of claims, the 40-49 age group had the highest overall cost of claims, with 78.8% of the total cost coming from medical claims. Conversely, the 15-29 age group had the highest cost of pharmacy claims at 35.9%, while the oldest age group had the lowest cost of pharmacy claims at 7.63%.

CONCLUSIONS: This study may provide insights that can be used to develop more effective interventions for early identification and management of the HiCC population. This could help improve the overall effectiveness of healthcare delivery and potentially lead to more efficient allocation of healthcare resources.