Health Insurance Coverage by Type in Oregon's All Payer All Claims Database

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1 Covered Lives,000 1,800,000 1,600,000 Health Insurance Coverage by Type in Oregon's All Payer All Claims Database ,400,000 1,200,000 1,000, , , , ,000 0 Commercial Medicaid Medicare Advantage Extract Date: 4/29/2013 This report should be considered preliminary and subject to change based on updates to the underlying data, data mapping & categorization. Ongoing efforts are underway to identify and address deficiencies in data completeness and validity. Data do not include services covered under Medicare fee-for-service, Indian Health Service, TRICARE, or Federal Employee Health Benefits Plans. 5/3/13 Office of Health Analytics 1

2 Commercial vs. Medicare Advantage Paid Amounts by Health Care Cost Groups, % 30% Commercial Medicare Advantage 25% 20% 15% 10% 5% 0% Inpatient Outpatient Professional Pharmacy Ancillary Extract Date: 4/29/2013 This report should be considered preliminary and subject to change based on updates to the underlying data, data mapping & categorization. Ongoing efforts are underway to identify and address deficiencies in data completeness and validity. Data do not include services covered under Medicare fee-for-service, Indian Health Service, TRICARE, or Federal Employee Health Benefits Plans. 5/3/13 Office of Health Analytics 2

3 Baker Benton Clackamas Clatsop Columbia Coos Crook Curry Deschutes Douglas Gilliam Grant Harney Hood River Jackson Jefferson Josephine Klamath Lake Lane Lincoln Linn Malheur Marion Morrow Multnomah Polk Sherman Tillamook Umatilla Union Wallowa Wasco Washington Wheeler Yamhill All Payer Utilization Paid Amounts by County, 2011 Admits Per 1000 ED Visits Per 1000 Baker Benton Clackamas Clatsop Columbia Coos Crook Curry Deschutes Douglas Gilliam Grant Harney Hood River Jackson Jefferson Josephine Klamath Lake Lane Lincoln Linn Malheur Marion Morrow Multnomah Polk Sherman Tillamook Umatilla Union Wallowa Wasco Washington Wheeler Yamhill Baker Benton Clackamas Clatsop Columbia Coos Crook Curry Deschutes Douglas Gilliam Grant Harney Hood River Jackson Jefferson Josephine Klamath Lake Lane Lincoln Linn Malheur Marion Morrow Multnomah Polk Sherman Tillamook Umatilla Union Wallowa Wasco Washington Wheeler Yamhill Average PMPM statewide avg. statewide avg. statewide avg $0 $200 $400 $600 Source: All Payer All Claims Database, Milliman MedInsight Extract Date: 5/2/13 Data Submission Period: through calendar year 2012 This report should be considered preliminary and subject to change based on updates to the underlying data, data mapping & categorization. Ongoing efforts are underway to identify and address deficiencies in data completeness and validity. Data do not include services covered under Medicare fee-for-service, Indian Health Service, TRICARE, or Federal Employee Health Benefits Plans. Average PMPM (per member per month) amounts include insurance carriers' paid amounts only. 5/3/13 Office of Health Analytics 3

4 Top 20 Episode Treatment Groups by Paid Amount of All Payers Combined, 2011 Pregnancy, with delivery Routine Exam Psychoses and schizophrenia Malignant neoplasm of the breast Depression Asthma Joint degeneration, localized - knee & lower leg Stroke Septicemia Bacterial lung infections Chronic obstructive pulmonary disease Malignant neoplasm of the large intestine Other neuropsychological or behavioral disorders Leukemia Multiple myeloma 31,000 56, , ,000 94,000 20, , , , ,000 25,000 41,000 6,000 31,000 47,000 96,000 3,000 1,000 0% 1% 2% 3% 4% 5% 6% Extract Date: 5/2/2013 Both complete and incomplete episodes are included in this report. The All Payers category includes Medicaid, Medicare Advantage, and commercial payers. The All Payers category does not include services covered under Medicare fee-for-service, Indian Health Service, TRICARE, or Federal Employee Health Benefits Plans. Self-pay or uninsured services are also not included. In addition, substance abuse services are not included. This report should be considered preliminary and subject to change based on updates to the underlying data and application of episode treatment groups. Ongoing efforts are underway to identify and address deficiencies in data completeness and validity. Office of Health Analytics 4

5 Top 20 Commercial Episode Treatment Groups by Paid Amount, 2011 Pregnancy, with delivery Routine exam Malignant neoplasm of breast Joint degeneration, localized - knee & lower leg Malignant neoplasm of large intestine Non-malignant neoplasm of female genital tract Mood disorder, depressed Joint degeneration, localized - neck Asthma Joint derangement - knee & lower leg Cholelithiasis Isolated signs, symptoms & non-specific diagnoses or conditions Multiple myeloma Non-malignant neoplasm of intestines & abdomen Joint degeneration, localized - thigh, hip & pelvis 19, ,000 10,000 21, , , ,000 27,000 69,000 16,000 6,000 94, ,000 Extract Date: 5/2/13 0% 1% 2% 3% 4% 5% 6% Both complete and incomplete episodes are included in this report. Substance abuse services are not included. This report should be considered preliminary and subject to change based on updates to the underlying data and application of episode of treatment groups. Ongoing efforts are underway to identify and address deficiencies in data completeness and validity. Office of Health Analytics 5

6 Top 20 Medicaid Episode Treatment Groups by Paid Amount, 2011 Pregnancy, with delivery Psychoses and schizophrenia Depression Asthma Bipolar disorder Stroke Other neuropsychological or behavioral disorders Chronic obstructive pulmonary disease Routine exam Septicemia Attention deficit disorder Bacterial lung infections Dementia Congestive heart failure Multiple sclerosis 24,000 14, ,000 59,000 15,000 14,000 33,000 15,000 10, ,000 19,000 67,000 3,000 9,000 27,000 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% Extract Date: 4/24/2013 Both complete and incomplete episodes are included in this report. This report should be considered preliminary and subject to change based on updates to the underlying data and application of episode of treatment groups. Ongoing efforts are underway to identify and address deficiencies in data completeness and validity. Office of Health Analytics 6

7 Top 20 Medicare Advantage Episode Treatment Groups by Paid Amount, 2011 Cerebral vascular accident Joint degeneration, localized - knee & lower leg Cataract Congestive heart failure Septicemia Closed fracture or dislocation - thigh, hip & pelvis Chronic obstructive pulmonary disease Bacterial lung infections Malignant neoplasm of breast Malignant neoplasm of pulmonary system Joint degeneration, localized - thigh, hip & pelvis Malignant neoplasm of prostate Malignant neoplasm of skin, major Atrial fibrillation & flutter Routine exam 27,000 41,000 13,000 21, ,000 13,000 33,000 14,000 10,000 5,000 5,000 7,000 11,000 11,000 54,000 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% Extract Date: 5/2/2013 Both complete and incomplete episodes are included in this report. Substance abuse services are not included. This report should be considered preliminary and subject to change based on updates to the underlying data and application of episode of treatment groups. Ongoing efforts are underway to identify and address deficiencies in data completeness and validity. Office of Health Analytics 7

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