AcademyHealth Annual Research Meeting
Boston, MA
June 29 2010
June 29, 2010
Patrick Miller, MPH
Copyright 2008-2010, NAHDO, RAPHIC & UNH
1
Today’ss “Consumers”
Today
Consumers of APCD Information
of APCD Information
 Policy Makers
 Consumers
 Employers
 Insurance Departments
I
D
t
t
 Medicaid
TRANSPARENCY
 Payers
P
 Providers
 Public Health
bli
lh
 Researchers
Copyright 2008-2010, NAHDO, RAPHIC & UNH
2
Prevalence of Asthma by Age, NH Medicaid (non‐Dual) and NH y g ,
(
)
Commercial Members, 2005
18%
17%
17%
17%
16%
16%
15%
14%
13%
12%
11%
10%
10%
10%
9%
9%
8%
8%
7%
7%
7%
6%
6%
6%
5%
5%
4%
4%
19 20
19-20
21 24
21-24
5%
5%
5%
5%
5%
35 44
35-44
45 49
45-49
50 54
50-54
55 59
55-59
60 64
60-64
4%
2%
0%
All Ages
04
0-4
Source: NH DHHS
59
5-9
10 14
10-14
15 18
15-18
Medicaid-only
25 34
25-34
CHIS Commercial
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3
Source: NH DHHS
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4
Outpatient Emergency Department Visit Rates per 1,000 Members by Age, SFY2006
1,200
992
1,000
872
800
589
600
526
489
385
400
303
360
309
244
227
194
200
226
146
0
<1 (0-11 mos)
1-2 (12-35 mos)
M di id
Medicaid
3-6 (36 mos-6 yrs)
SCHIP
7-11
12-18
CHIS C
Commercial
i l
Source: NH DHHS
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5
y
g
Payment Rate Benchmarking
Average Payment Including Patient Share
Share, 2006
Procedure Code
99203 Office/Outpatient Visit New
Patient, 30min
99212 Office/Outpatient Visit
Established Patient, 10min
99391 P
Preventive
ti M
Medicine
di i Vi
Visit
it
Established Patient Age <1
Health Plan 1 Health Plan 2 Health Plan 3
NH Medicaid
$124
$115
$130
$42
$51
$48
$52
$30
$111
$102
$107
$61
Source: NH DHHS
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6
Copyright
APCD
2008-2010,
Meeting May
NAHDO,
6, 2009
RAPHIC & UNH
Source: www.nhhealthcost.org
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7
Pricing Difference by Carrier and Provider: Colonoscopy
FACILITY
Carrier A
Carrier B
Carrier C
Hospital A
2,091.22
1,552.98
1,757.94
Hospital B
1,243.94
1,169.12
1,192.33
Hospital C
2,325.32
2,148.21
2,065.92
H it l D
Hospital D
1,658.53
6 8
1,200.62
6
1,431.43
Hospital E
1,715.74
2,075.38
1,514.17
Hospital F
1,381.96
‐‐
1,087.22
Hospital G
1,906.15
1,942.21
1,949.79
Source: www.nhhealthcost.org
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8
Source: ME Health Data Organization
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9
Source: MA Health Care Quality and Cost Council
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10
NH Hospital Acute Care Pricing Comparison
Source NH Insurance Department, 2008
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11
Healthcare Review: New Hampshire Prevention Benchmarks
Percent of Members Receiving Preventive Services**: Trends 2005‐2007
100%
80%
66% 66% 66%
65% 66% 65%
60%
40%
52% 53% 51%
39% 39%
41%
33%
36% 36% 36%
34% 35%
30%
26% 23%
20%
0%
Preventive Visit
Male 40-64
Prostate Cancer
Screen 50-64
Colorectal Cancer
Screen 50-64
Preventive Visit
Female 40-64
** Measures are calculated for a one-year
y time period.
p
Results mayy not
correspond to HEDIS-related measures that cover multi-year time periods.
Source: NHPGH
GYN Exam 18-64 Mammography 50- Cervical Cancer
64
Screen 18-64
2005
2006
2007
APCD Meeting May 6, 2009
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12
12
Healthcare Review: Company XYZ
Healthcare Review: Company XYZ
HealthCare Costs ‐ Impact of High Cost Cases** on Overall Medical Costs
Trends 2005 2007
‐ Trends 2005‐2007
$37.4M
$30.9M
$30
9M
w/0 RX $
$35.5M
48 patients
$97K per case
0.5% members
15% payments
58 patients
$129K per case
0.7% members
18% payments
64 patients
$107K per case
0.7% members
18% payments
** High Cost Cases = Patients with greater than $50
$50,000
000 in claims for the year
year.
13
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13
Source: NH Purchasers Group on Health
Copyright 2008-2010, NAHDO, RAPHIC & UNH
14
Source: NH IHPP
Copyright
2008-2010,
NAHDO,
RAPHIC
& UNH
Copyright
APCD
2008-2010,
Meeting May
NAHDO,
6, 2009
RAPHIC
& UNH
15
Total IP ADE Discharge, Rate, Total Paid, and Average Paid, 2006
2007 for Maine and New Hampshire
Paid, 2006‐2007
for Maine and New Hampshire
Maine
M
i
2006
2007
Total
% Increase
Rate / 1,000 IP Discharges
IP
Di h
Di h
Discharges
TTotal Paid
t l P id
Average Paid
A
P id
747
26.7
$ 11,864,264 $ 15,883 770
34.5
$ 13,705,995 $ 17,800 1 517
1,517
30 1
30.1
$ 25 570 259
$ 25,570,259 $
$ 16,856 16 856
3%
29%
16%
12%
New New
Hampshire
2006
2007
Total
% Increase
Rate / 1,000 Rate
/ 1 000
IP Discharges Discharges
Total Paid
Average Paid
459
22.3
$ 5,712,414 $ 12,445 504
25 1
25.1
$ 6 719 104
$ 6,719,104 $
$ 13,332 13 332
963
23.7
$ 12,431,518 $ 12,909 10%
12%
18%
7%
Source: NH IHPP
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16
ETGs for Benign Conditions of the Uterus
g
Maine Commercial Claims (2006–2007); Full Episodes Outliers Removed
Preference Sensitive Care
BENIGN CONDITIONS OF
THE UTERUS
HYSTERECTOMY
OTHER SURGICAL
PROCEDURES
WITHOUT
SURGERY
ETG-Subclass
646
646
647
Number of Episodes
938
2,183
7,369
% with CT-Scan
11%
15%
9%
% with
ith Ultrasound
Ult
d
57%
67%
45%
% with Hysteroscopy
7%
48%
9%
% with
ith C
Colposcopy
l
1%
2%
17%
20%
13%
9%
$11 074
$11,074
$7 994
$7,994
$1 273
$1,273
% with Endometrial biopsy
Average Payment per Episode
The average episode payment for members with abdominal hysterectomy was $11,221, and the average payment for members with vaginal
hysterectomy was $10,990. Of members with a hysterectomy, 66% had abdominal and 34% had vaginal hysterectomy. Other surgical procedures
included hysteroscopy ablation, laparoscopic removal of lesions, myomectomy, and removal of ovarian cysts.
Source: ONPOINT Health Data
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17
Top 10 Diseases Driving Costs in Utah (sorted by cost)
Disease
No. Of
Members *
Percent of
Total
Total Cost
Percent of
Total Cost
1
Diabetes
31,213
3.31 %
$168,707,906
11.07 %
2
Hypertension
39,767
4.22 %
$90,511,253
5.94 %
3
Asthma
23,606
2.50 %
$70,423,249
4.62 %
4
CAD
5,680
0.60 %
$49,889,119
3.27 %
5
Breast Cancer
2,007
0.21 %
$28,764,116
1.89 %
6
Depression
ep ess o
23,382
3,38
2.48
8%
$25,798,326
$
5, 98,3 6
1.69
69 %
7
ESRD
1,237
0.13 %
$25,738,250
1.69 %
8
CVA
1,377
0.15 %
$23,064,392
1.51 %
9
CHF
1,106
0.12 %
$14,821,737
0.97 %
10
COPD
1,116
0.12 %
$10,946,039
0.72 %
* Unique
q members with the disease
Source: Utah Department of Health
Tri‐State Variation in Health Services Utilization & Expenditures in Northern New England, June 2010
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18
A L k t Ph
ti l U I Ut h
A Look at Pharmaceutical Use In Utah
Top 10 Therapeutic Classes by Number of Prescriptions
2009
Cost Per
Member
Number of
Scripts
Average
Cost Per
Script
Percent
Generic
Therapeutic Class
Total Cost
Utilizing
Members
1
ANTIDEPRESSANTS
$18,338,790
94,876
$531
526,540
$35
80 %
2
ANALGESICS - OPIOID
$11,508,735
129,968
$469
444,927
$26
96 %
3
ANTIHYPERLIPIDEMICS
$15,201,559
62,289
$658
325,794
$47
63 %
4
ANTIHYPERTENSIVES
$9,771,828
58,762
$418
320,653
$30
67 %
5
ULCER DRUGS
$22,198,987
71,613
$1,136
279,649
$79
76 %
6
CONTRACEPTIVES
$5,943,860
48,213
$373
230,791
$26
57 %
7
THYROID AGENTS
$1,878,011
45,379
$116
221,639
$8
89 %
8
ANTIDIABETICS
$19,249,166
33,623
$1,445
220,602
$87
53 %
9
PENICILLINS
$1,660,924
134,258
$110
195,531
$8
99 %
10
DERMATOLOGICALS
$10,904,253
99,052
$864
190,709
$57
69 %
Source: Utah Department of Health
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19
T i St t V i ti i H lth S i
Tri‐State Variation in Health Services Advanced Imaging – MRIs
Keene
(90.8)
Greenville
(46 2)
(46.2)
Middlebury
(53.3)
Rutland
(73 8)
(73.8)
Source: ONPOINT Health Data
Tri‐State Variation in Health Services Utilization & Expenditures in Northern New England, June 2010
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20
B kS
R t b A
dG d
Back Surgery Rates by Age and Gender
National Rates Acquired from NCQA HEDIS by ONPOINT
AGE & TRI‐STATE VT NATIONAL NATIONAL Based on annualized counts adjusting for the varying months in preferred
GENDER
RATE
RATE
HMO
PPO
and non-preferred periods
20 44 F
20–44, Female
l
22
2.2
16
1.6
22
2.2
23
2.3
20–44, Male
2.9
2.6
2.3
2.5
45–64 Female
45–64, Female
41
4.1
32
3.2
45
4.5
51
5.1
45–64, Male
5.1
4.6
4.9
5.3
Source: ONPOINT Health Data
Tri‐State Variation in Health Services Utilization & Expenditures in Northern New England, June 2010
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21
Concord NH PMPM Analysis to
Concord, NH PMPM Analysis to pp
j
p
Support ACO Project Development
$350 $300 $250 $200 $150 5
2005 Total Payments PMPM $100 2008 Total Payments PMPM $50 $0 Carrier A Carrier B Carrier C Other
Totals
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23
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Contact Information
Patrick Miller MPH
Patrick Miller, MPH
Research Associate Professor
NH Institute for Health Policy and Practice
University of New Hampshire
patrick.miller@unh.edu
603.536.4265
www.raphic.org for more resources in assisting states to move forward
for more resources in assisting states to move forward
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