Statement of the Problem: Few studies have characterized who the high cost patients are in rural communities and what can be done to manage their spending patterns. It is important to understand the relationship between costs and service use to appropriately design and target financial incentives for providers to better coordinate care and reduce costs in a rural context.

Project goals: The purpose of this study is to: 1) assess the relationship between service utilization patterns and costs for rural Medicare beneficiaries across the rural continuum and 2) examine the relationships between rural beneficiaries' service utilization and market structure.

Methods: The Medicare Beneficiary Annual Summary File will be used to analyze service use and per capita expenditures for rural Medicare beneficiaries, to identify factors associated with high Medicare expenditures for rural beneficiaries, and to describe service use and costs throughout the rural continuum as reflected in Hospital Service Areas. Multivariate regression analysis will be used to examine the relationships between provider market structure, beneficiary demographics, beneficiary service use and expenditures.

Anticipated publications/products: A policy brief; a peer-reviewed journal manuscript; and presentations at conferences and to key policy audiences to such as MedPAC and CMS.

Publications

• Medicare Costs and Utilization Among Beneficiaries in Rural Areas
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 03/2016
  This study assesses the relationship between service utilization patterns and costs for rural Medicare beneficiaries across the rural continuum. It also examines the relationships between rural beneficiaries' service utilization and healthcare delivery market structure and evaluates strategies and policies to address high costs in rural areas.