At-Risk Patients Gain Attention of Health Insurers

One percent of patients account for more than 25 percent of health care spending among the privately insured, according to a new study. Their medical bills average nearly $100,000 a year for multiple hospital stays, doctors’ visits, trips to emergency rooms and prescription drugs.

And they are not always the end-of-lifers. They are people who suffer from chronic and increasingly common diseases like diabetes and high blood pressure.

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Health insurers are likely to have little choice other than to monitor these cases more closely, said Daniel Malloy, an executive at IMS Health. Under the federal health care law, which is expected to go into effect in 2014 if it is not struck down by the Supreme Court, insurers will no longer be able to deny coverage to anyone with a potentially expensive medical condition or put limits on how much they will pay in medical bills.

And avoiding these patients altogether will no longer be an option. Insurance companies will be required to enroll millions of new customers without the ability to turn them away or charge them higher premiums if they are sick. They will prosper only if they are able to coordinate care and prevent patients from reaching that top 1 percent, Mr. Malloy said. “The insurance model is fundamentally changing,” he said.

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