Background Healthcare fragmentation among adults with multiple chronic conditions (MCC) may drive inefficient care and increased costs, yet little is known about this relationship at the national level.

Objective To examine the association between healthcare utilization fragmentation and total healthcare costs among US adults with multiple chronic conditions, and assess how this relationship varies by insurance type.

Methods Cross-sectional analysis of 21,876 adults from the 2020 Medical Expenditure Panel Survey (MEPS). I measured healthcare fragmentation using a composite score based on utilization across multiple provider types and settings. Multiple chronic conditions were defined as ≥3 diagnosed conditions. I used surveyweighted regression models to examine associations between fragmentation, MCC status, and total healthcare expenditures, controlling for demographics, socioeconomic status, and insurance type.

Results The sample represented 256 million US adults, with 44.7% (SE: 0.6%) having multiple chronic conditions. Adults with MCC had significantly higher healthcare costs than those without MCC (mean: $13,847 vs. $2,145, respectively). Healthcare fragmentation was associated with dramatic cost increases: expenditures ranged from $909 for no fragmentation to $34,956 for high fragmentation. In adjusted models, MCC was associated with a 167% increase in healthcare costs, while each unit increase in fragmentation score was associated with a 784% cost increase. High fragmentation affected 57.9% of the adult population.

Conclusions Healthcare fragmentation is strongly associated with substantially higher costs, particularly among adults with multiple chronic conditions. These findings suggest that care coordination interventions could yield significant cost savings while potentially improving quality of care.

The authors have declared no competing interest.

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study used only openly available human data originally located at the Medical Expenditure Panel Survey (MEPS) public-use data files, produced by the Agency for Healthcare Research and Quality (AHRQ). Source: https://meps.ahrq.gov/data_stats/download_data_files.jsp These datasets were publicly available prior to initiation of the study and are fully de-identified. No new human subjects were recruited, and the study was determined to be exempt from institutional review board review.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Email: ab4646mynsu.nova.edu

Conflicts of Interest: The author declares no conflicts of interest.

Data Availability: MEPS public-use files; details in Methods.

All data produced in the present study are available upon reasonable request to the author