Medical Care Utilization and Costs Among Transition-Age Young Adult Medicare Beneficiaries with Autism Spectrum Disorder

Background: Autism spectrum disorder (ASD) is a lifelong condition which globally impacts functioning (APA, 2013). Emerging research suggests increases in restrictive medical care for adolescents with ASD (e.g. Cidav et al., 2013) corresponding studies finding higher rates of psychiatric illness among adults with ASD compared to non-ASD adults (e.g. Croen et al., 2015). Additionally, comorbid intellectual disability (ID) contributes to greater healthcare needs. It is imperative to identify healthcare needs of young adults with ASD.

Objectives: We aimed to 1) describe utilization and cost of services (hospital-based services, ambulatory services, therapy services) among young adults in Medicare fee-for-service claims data (years 2008-2010), and 2) examine differences in utilization and costs between young adults with ASD without intellectual disability (ASD-ID) and with ID (ASD+ID).

Methods: We used CMS national Limited Data Files to identify persons with ASD and ID aged 18-25 years in the 5% physician visit (Carrier) claims files for 2008, 2009 and 2010. Individuals were included if they had a minimum of 1 claim of ASD (299.xx) in at least 1 file type; individuals with ID alone were identified as having a minimum of 1 claim of either 317.xx, 318.xx or 319.xx in 1 or more file types. Those with ASD+ID were identified as having a minimum of one claim with both an ASD and ID diagnosis code types in any claim file. Carrier claims records were linked to the other five claims types: inpatient hospitalization, home health, hospice, outpatient facility, and skilled nursing facility to create a dataset of identified claims based on diagnosis type. Weighted frequency counts of overall utilization and for each service type (hospitalizations, ambulatory services, therapy service), and bivariate comparisons were used to identify differences in utilization and costs between individuals with ASD+ID, ASD-ID, and ID only (no ASD). A total of 1,537 unique individuals with ASD+ID were available for analysis in 2008, 1,911 in 2009 and 2,090 in 2010. For individuals with ASD-ID, 2,073 unique individuals were available for analysis in 2008, 2,838 in 2009, and 3,603 in 2010.

Results: The number of unique individuals with an ASD-related claim increased in Medicare files 2008-2010, consistent with observed prevalence increases. Total payment costs almost doubled (44.87%) for all individuals with ASD with a Medicare claim from 2008 compared with 2010 claim year. We found that overall utilization and costs were higher among those with ASD+ ID compared with ASD-ID. Young adults with ASD+ID had significantly greater overall utilization (mean number of annual claims= 8.48) compared to those with ASD-ID (mean number of annual claims= 6.06). Average claim payment was higher among those with ASD+ID ($717.38) compared with those with ASD-ID ($547.99). Additional findings on specific healthcare services will be presented, as well as comparisons with an ID-only comparison group.

Conclusions:  Similar to pediatric literature, individuals with ASD+ID utilize more healthcare and therefore costs are higher among this population. Across the three claim years, adjusted utilization and costs increased for both groups. Implications for care providers, policymakers, and researchers will be discussed.