Predicting Patients with High Risk of Becoming High-Cost Healthcare Users in Ontario (Canada)

Literature and original analysis of healthcare costs have shown that a small proportion of patients consume the majority of healthcare resources. A proactive approach is to target interventions towards those patients who are at risk of becoming high-cost users (HCUs). This approach requires identifying high-risk patients accurately before substantial avoidable costs have been incurred and health status has deteriorated further. We developed a predictive model to identify patients at risk of becoming HCUs in Ontario. HCUs were defined as the top 5% of patients incurring the highest costs. Information was collected on various demographic and utilization characteristics. The modelling technique used was logistic regression. If the top 5% of patients at risk of becoming HCUs are followed, the sensitivity is 42.2% and specificity is 97%. Alternatives for implementation of the model include collaboration between different levels of healthcare services for personalized healthcare interventions and interventions addressing needs of patient cohorts with high-cost conditions.