Knowledge of Medicare beneficiaries with high medical expenditures can help identify target populations for intervention and strategies to reduce overall Medicare expenditures. Using 100% Medicare fee-for-service claims, we examined characteristics and spending patterns of high spenders among Medicare beneficiaries with diabetes (DM) . We defined high spenders as those whose expenditures in a year were in the top 10% of beneficiaries with DM. We identified 7,321,228 high spenders in 2015 and followed them through 2017. We grouped high spenders in 2015 into three groups: those who died during 2015-2017 (group 1) , were alive and a high spender in all 3 years (group 2) , and alive but a high spender for 1/2 years (group 3) . We used regression models to identify factors associated with each group. In 2015 high spenders accounted for 48% of all medical expenditures in Medicare beneficiaries with DM. Of the high spenders, 34% were in group 1, 20% in group 2, and 46% in group 3. High spenders in group 1 had a mean annual expenditure of $110,429 and were more likely to be male, be older, have dual eligibility for Medicaid, and have a higher number of comorbid conditions compared with groups 2 and 3. Over 60% of the expenditures in group 1 were spent on either acute inpatient care (39%) or on skilled nursing facility (23%) . Groups 2 and 3 had mean annual expenditures of $83,2 and $42,527, respectively. High spenders in group 2 were more likely to be male, be older, have dual eligibility for Medicaid, and have a higher number of comorbid conditions compared with group 3. Compared to those in group 3, high spenders in group 2 spent a higher proportion on hospice (13.3% vs. 7.9%) and inpatient care (16.7% vs. 9.9%) , but less on acute inpatient care (19.5% vs. 31.3%) . High-spender Medicare beneficiaries with DM had different characteristics and spending patterns. Future studies could identify modifiable factors and develop strategies to lower Medicare expenditures among high spenders with DM.
Y.Wang: None. P.Zhang: None.