• James M Naessens, Robert J Stroebel, Dawn M Finnie, Nilay D Shah, Amy E Wagie, William J Litchy, Patrick J F Killinger, Thomas J D O'Byrne, Douglas L Wood, and Robert E Nesse.
• Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
• Am J Manag Care. 2011 Feb 1; 17 (2): 118-22.

ObjectiveTo determine the longitudinal effect on healthcare costs of multiple chronic conditions among adults aged 18 to 64 years.Study DesignRetrospective cohort assessment of working-age employees and their dependents with continuous coverage in a self-funded health plan from January 1, 2004, to December 31, 2007. Data were obtained from health benefit enrollment files and from medical and pharmacy claims.MethodsIndividuals were defined as having chronic conditions based on modification of a published method. The mean annual healthcare costs were estimated for individuals with 0, 1, 2, 3, 4, or 5 or more chronic conditions. The probability of persistence in high-cost categories across years was estimated for individuals in each group.ResultsOverall, 75.3% of working-age adult enrollees had at least 1 chronic condition, 54.3% had multiple chronic conditions, and 16.5% had 5 or more chronic conditions. The cost of healthcare was higher among individuals with more chronic conditions for all ages. The mean medical cost per year for an individual with no chronic conditions was $2137, while that for an individual with 5 or more chronic conditions was $21,183. Enrollees with more chronic conditions had higher persistence in high-cost categories between years and persisted at these high costs for more years.ConclusionsWhile multiple chronic conditions are common in the population 65 years and older, they are also of great concern for the working-age population. Understanding how to effectively manage individuals with multiple chronic conditions is an important challenge. Effective care management focused on managing the patient as opposed to a condition has the potential to significantly affect healthcare costs.

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