MN report finds acute costs from chronic disease

Learning to use an inhaler
Asthma program director Alex Aldrete teaches 15-year-old Jesus Ayala the proper use of an albuterol sulphate inhaler at a clinic in Los Angeles.
David McNew | Getty Images file

New research from the state Health Department finds that chronic diseases are surprisingly expensive in Minnesota.

Few would be surprised to hear that chronic conditions account for a large share of health spending. But for the first time, the state has been able to place a dollar figure on the cost of long-running health problems: nearly $23 billion.

And that number probably understates the true cost, because certain demographic groups weren't included in the tally.

The people who study these trends for a living were caught off guard by the large tab for treating heart disease, high blood pressure, diabetes and dozens of other persistent health conditions. The state's analysis of a large repository of billing information shows that chronic conditions account for 83 percent of total medical and drug spending.

State Health Economist Stefan Gildemeister said the findings challenge Minnesota's reputation as a healthy, low-spending state.

About 35 percent of insured Minnesotans, or 1.6 million people, have at least one chronic condition. More than half have multiple chronic conditions.

"I think we would have expected Minnesota to be maybe in a little bit healthier place," Gildemeister said. "Turns out that's not entirely the case."

Gildemeister's team analyzed the medical claims of 4.5 million residents covered by private and public insurance programs in 2012. It found the amount spent treating one patient with one or more chronic conditions averaged $13,000 that year. That's more than eight times the average for patients who don't have a chronic disease.

The report highlights the burden associated with 10 chronic conditions that make up the bulk of chronic disease patients. Almost half of all medical spending for the insured in 2012 went to care for high blood pressure patients. High blood pressure affects 900,000 insured Minnesotans and accounted for nearly $13.5 billion in health care costs.

State Health Commissioner Ed Ehlinger said the findings call for a different approach to managing disease. "We cannot afford to try to treat our way out of this chronic disease crisis," he said.

"Chronic diseases are prevalent at a high level throughout the state, costs are being felt in every county throughout the state, and this is really a statewide issue that we have to address," Ehlinger said.

The state needs to do better at preventing persistent health problems from developing in the first place, he said. And it needs to understand why people in some counties — particularly northwestern Minnesota — are much more likely to develop a chronic condition than residents in other counties.

Costs for treating chronic illnesses also vary widely geographically.

For example, kidney failure patients in southeastern Minnesota's Houston County rack up just over $24,000 in costs a year — but it's double that amount for similar patients from Stevens County in west central Minnesota.

Ehlinger said the reasons remain a mystery. "We would like to dig down and learn more about why different counties face different amounts of chronic diseases and why treatment costs vary from one county to another," he said. "But we can't answer those questions quite yet."

The state's analysis doesn't track where patients received their care, which makes county-level comparisons and assumptions potentially inaccurate.

The data set also omits costs for treating the uninsured and doesn't include people in several specialized health programs, such as the VA Health Care System.

Despite the limitations, Ehlinger said the research has already provided enough information to spark conversations about best practices and how to allocate public health dollars.

The Health Department hopes to analyze insurance data collected from other years, but the agency will need reauthorization. Legislative approval to use the database expires in June.

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