Cardiovascular, Renal and Metabolic Conditions Increasingly Prevalent, Expensive in Medicare Fee-For-Service Population | AMCP Nexus 2025

Cardiovascular, renal and metabolic (CRM) conditions are increasing within the Medicare fee-for-service population, with claims averaging $1,364 per patient with CRM, compared with an average of $743 per patient overall, reflecting a disproportionate cost burden and growing need for population health development, according to an abstract presented this week at the 2025 Academy of Managed Care Pharmacy (AMCP) Nexus Conference.

The abstract, titled ‘Retrospective analysis of cardiovascular, renal, and metabolic conditions in the Medicare population using 100% FFS claims data,’ was published by a team of researchers including Benjamin Miao, Pharm.D., product director at Boehringer-Ingelheim.

Miao and his colleagues studied Medicare FFS data from 2016 to 2023 of more than 40 million beneficiaries. Patients were categorized by condition, including atherosclerotic cardiovascular disease or heart failure (C), chronic kidney disease (R) and type 2 diabetes (M).

The team also found that spending was highest in patients with at least two of the conditions, with an average spend of $5,572 for CRM, compared with all-cause annualized spending, which was $3,995 overall.

Costs were also calculated by setting, in which CRM patients had higher spending in each compared with overall cost.

Inpatient institutional costs were the highest for both groups - with C+R+M patients totaling $43,895, when compared to overall cost, which was $30,759.

Other settings where costs were calculated include skilled nursing facility care ($22,738 overall; $31,617 for C+R+M), outpatient care ($6,440; $10,823), home health ($7,221; $9,016) and hospice ($43,039; $32,804).

From 2016 to 2023, CRM-specific spending rose 18%, with the biggest increase seen in C+M patients at 27%.

“Prevalence of CRM conditions is increasing and associated with high utilization and spending across care settings in the Medicare FFS population,” Miao and the team write in the abstract. “These results also underscore the disproportionate cost burden associated with CRM multimorbidity and its importance when developing population health strategy, targeted interventions, and benefit design in Medicare.”

CRM conditions are some of the leading causes of mortality in the United States, with cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes accounting for approximately one in three deaths. This is because heart, kidney and metabolic function are interconnected. The American Heart Association has officially designated this group of conditions as cardiovascular-kidney-metabolic syndrome (CKM).

Increases in disease within the Medicare population may be attributed to an aging population. Additionally, individuals exposed to adverse social determinants of health are especially susceptible to CKM, because of a lack of access to care, financial instability or discrimination.

One targeted intervention is the Accountable Health Communities Health-Related Social Needs Screening Tool, created by CMS. The 10-question survey is used to gather information about a patient’s life, including their living situation, employment status and support systems.

AMCP Nexus 2025 is held from Oct. 27 to Oct. 30 in National Harbor, MD.