Identifying Patients at Risk for High Medical Costs and Good Candidates for Obesity Intervention

Abstract

Purpose. To develop a risk-scoring tool to identify in a base year patients likely to have high medical spending in the subsequent year and to understand the role obesity and obesity reduction may play in mitigating this risk. Design. Cross-sectional analysis, using commercial claims and health risk assessment data. Setting. United States, 2004–2009. Subjects. Panel of 192,750 person-year observations from 116,868 unique working-age employees of large companies. Measures. Probability of high medical expenses (80th percentile or above) in the following year; adjusted body mass index (BMI). Analysis. Generate risk scores by modeling the likelihood of high next-year expenses as a function of base-year age, sex, medical utilization, comorbidities, and BMI. Estimate the effect of simulated bariatric intervention on patient risk scores. Results. Individuals with higher BMI were more likely to be categorized in the very high risk group, in which the average annual medical expense was $8621. A weight-loss intervention transitioning a patient to the next lower obesity class was predicted to reduce this risk by 1.5% to 27.4%—comparable to hypothetically curing a patient of depression or type 2 diabetes. Conclusion. A logistic model was used to capture the effect of BMI on the risk of high future medical spending. Weight-loss interventions for obese patients may generate significant savings by reducing this risk.