Change in Self-Reported Health: A Signal for Early Intervention in a Medicare Population

Dana Drzayich Antol
Angela Hagan
Hannah Nguyen
Yong Li
Gilbert S. Haugh
Michael Radmacher
Kurt J. Greenlund
Craig W. Thomas
Andrew Renda
Karen Hacker
William H. Shrank
Peer-Reviewed Article
December 2021


A health-related quality of life (HRQOL) measure can be a leading indicator for future adverse health outcomes for older adults.


Self-reported HRQOL is a measure that reflects both disease and social contexts, and therefore could potentially be used to more effectively reach individuals to mitigate poor health outcomes. This study examines how changes in the self-reported measure of HRQOL among Medicare Advantage enrollees are related to health care utilization and costs. HRQOL can be quantified as the number of self-reported “unhealthy days,” which can be tracked in a four-item survey that can be completed digitally by the enrollee.


This retrospective analysis of claims data found that individuals with worsening HRQOL had a substantial increase of costs, while those with improved HRQOL had either reduced or slightly increased costs. Measuring unhealthy days reflects both clinical conditions as well as social context that is not captured in claims.  


HRQOL can be a leading indicator for future changes in health care utilization for older adults, and health plans can use this measure to create a more comprehensive risk stratification approach.

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