Healthcare Spending Among Privately Insured Individuals Under Age 65
|
|
- Moris Griffith
- 8 years ago
- Views:
Transcription
1 Healthcare Spending Among Privately Insured Individuals Under Age 65 February 2012
2 Healthcare Spending Among Privately Insured Individuals Under Age 65 February 2012
3 Introduction Healthcare spending and utilization patterns among the privately insured population are not widely understood, or widely available. With limited access to private sector data, health services researchers have relied on the analyses of publicly available data (predominately Medicare) to advance public policy recommendations. 1 To effectively advance healthcare reform, IMS believes a deeper understanding of the privately insured population is critical to successfully address cost growth trends, and ensure appropriate planning for this evolving population. Using comprehensive, proprietary data consisting of more than 10 million privately insured members under age 65, we were able to examine the distinctions between IMS aggregated healthcare use and spending patterns and those commonly cited among health services researchers, including the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare and Medicaid Services (CMS). In this report, we highlight the differences, examine healthcare spending patterns among the privately insured under age 65 by considering spending on outpatient, inpatient and pharmacy, and discuss the potential implications. Murray L. Aitken Executive Director IMS Institute for Healthcare Informatics IMS Institute for Healthcare Informatics 11 Waterview Boulevard Parsippany, NJ USA info@theimsinstitute.org Analysis and support from IMS Payer Solutions gratefully acknowledged in the development of this report IMS Health Incorporated and its affiliates. All reproduction rights, quotations, broadcasting, publications reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without express written consent of IMS Health and the IMS Institute for Healthcare Informatics. FIND OUT MORE If you want to receive more reports from the IMS Institute, or be on our mailing list, please click here.
4 Contents Executive Summary... 1 Total Healthcare Spending All Payers - Privately Insured Outpatient Spending Privately Insured Inpatient Spending Privately Insured Pharmacy Spending Privately Insured Top 1% Member Spending Cohort Profiles Total Healthcare Spending - Spending Profile - RA and MS Spending Profiles Potential Implications End Notes Notes on Sources Appendix About the IMS Institute APPROACH AND METHODOLOGY The LifeLink Health Plan Claims Database, which comprises 6.7 billion medical and pharmacy claims, 79 health plans, and 79.4 million members from 2001 to the present, was used to conduct this study. A more detailed description can be found in the Appendix. These analyses were derived from an analytic subset of the database, covering the time period from January 1, 2009 through December 31, 2010 for only privately insured health plan members under age 65 with continuous enrollment and medical and pharmacy benefit coverage. Cost and use patterns in the overall study population, including 17 chronic conditions, 12 cancers, and 10 auto-immune and other specialty conditions were studied. Costs reported reflect the plan allowed amount (i.e., plan paid amount plus member contribution) for a given service. Members were identified by condition based on Year 1 experience, and their cost and utilization is reported based on Year 2 experience. A more detailed description of conditions studied can be found in the Appendix. Findings in this report may differ from prior analyses of US and Medicare spending due to inherent differences in the health status and age distribution of the privately insured and differences in analytic methods, such as requiring continuous member enrollment and medical and pharmacy benefit coverage during the study time period. Unless otherwise noted in this study, all reference to the privately insured population throughout this report refer to the IMS study population.
5 Executive summary In 2010, 184 million Americans were enrolled in a private health insurance plan and collectively were responsible for $822 billion in healthcare expenditures. By 2020, enrollment is expected to be 198 million and expenditures will reach $1.4 trillion. This commercially insured segment of the healthcare system and in particular the under 65 year segment will remain the dominant part of the payment system even as the impact of implementation of the Affordable Care Act transforms the healthcare landscape. A deep understanding of the characteristics, dynamics and drivers of utilization and cost within the commercially insured under 65 segment is particularly important as we stand on the threshold of substantial increases in spending and dependence by enrollees in such programs. TOTAL HEALTHCARE SPENDING LEVELS For the total sample of more than 10.6 million privately insured health plan members analyzed in this report, average healthcare spending in 2010 was $3,840, or $320 per member per month. However the 5% highest cost members accounted for 50.6% of the total cost, and over 25% of the total cost was for just 1% of the members. Conversely, just 3% of total cost was incurred by the 50% of members with the least annual spending. This reinforces the importance of understanding the profile, behavior and interventions that can be optimally applied to the relatively small number of members who have a substantial impact on overall healthcare costs. Overall spending levels of the privately insured under 65 population are mostly focused on outpatient and pharmacy services, representing 59% and 21% of total spending, respectively. Inpatient services represent the remaining 20% of spending. This distribution of costs differs significantly from that reported by the Medical Expenditure Panel Survey (MEPS) for all payers and for the Medicare 65 and over population. In particular, Medicare 65 and over population spending on inpatient services represents 43% of total spending, while outpatient and pharmacy services represent 39% and 18%, respectively. The differences in spending distribution between the privately insured under 65 population and the Medicare 65 and over population are substantial and highlight the need for correspondingly differentiated analysis, understanding, and actions aimed at bending the overall US healthcare cost curve. Among health plan members, spending is highly disproportionate to prevalence rates. Over one-third of members have one or more chronic conditions and account for over two-thirds of total spending for all members. Members with cancer amount to only 1.5% of all health plan members and account for almost 8% of total spending. Other members with auto-immune or other specialty conditions represent 1.7% of all members, and consume 7% of total spending. OUTPATIENT SPENDING Outpatient services represent the largest share of total spending, averaging $2,251 per member per year, or $188 per member per month. Professional and facility visits account for 74% of overall spending, with emergency room visits a further 10%. Outpatient medical drug therapy, including office, facility and home-based injections and infusions, were 5% of all outpatient spending, or $9 per member per month on average. However, outpatient drug therapy for oncology, auto-immune and other specialty condition populations studied were significantly higher, and amount to 19% and 18%, respectively. continued on next page... 1
6 Executive summary INPATIENT SPENDING Spending per inpatient admission was $14,248 on average, and accounts for 20% of overall spending per member. Facility costs account for 84% of the total inpatient spending, with the balance being professional costs. Members with chronic conditions had 63% of all hospital admissions, and averaged $15,566 per admit. These costs include average 4.5 days of stay, and 219 professional visits per 1,000 members. Oncology patients had the highest average cost per admission, at $20,074 but admissions only totaled 2.8 admissions per 1,000 members compared to 29.3 admissions per 1,000 members for chronic conditions. PHARMACY SPENDING Average pharmacy spending including outpatient drug claims for both specialty and non-specialty medicines amounts to 21% of total healthcare spending for the privately insured under age 65 population. For every 1,000 members, 11,950 prescriptions were filled in 2010, of which 78% were for those members with chronic illnesses. Members with oncology and those with auto-immune or other specialty conditions filled only 4% and 5% of the total number of prescriptions. Specialty drugs represent about 1% of the total of pharmacy prescriptions but 17% of total pharmacy spending. Relative to total healthcare spending including inpatient costs, outpatient medical costs and non-specialty pharmacy costs specialty drug therapy and outpatient medical drug therapy are particularly high for members with auto-immune or other specialty conditions and represent 33% of their total healthcare spending. By comparison, these drugs represent 17% of spending for oncology patients, and just 6% for those members with chronic conditions. TOP 1% SPENDING COHORT Consistent with patterns across the healthcare system, privately insured under 65 health plan members who are among the top 1% in annual spending are vastly disproportionate users of healthcare resources. They average almost $100,000 in annual spending per member. Within the top 1% cohort, our analysis shows that 77% of the members had at least one chronic condition, 16% had one or more cancers, and 13% suffered from auto-immune or other specialty conditions (some members had more than one of these condition groupings). The oncology patients had the highest average spending, of $118,000 per year....continued from previous page The distribution of spending among the 1% cohort is similar to that of the Medicare 65 and over population, with 45% of spending being for inpatient services, 45% for outpatient services, and 10% for pharmacy benefits. Average spending for the top 1% of members with specific chronic conditions is between five- and tenfold the average spending for all members with the same conditions. For example, members with diabetes average $11,858 in annual spending, while those suffering from diabetes who are in the top 1% cohort average $102,465 in annual spending. Similarly, those with chronic renal failure on average spend $33,801 per year, but those within the top 1% cohort spend over $150,000 annually. Efforts to address healthcare spending levels and ensure optimal care for patients require detailed understanding from timely and robust information. This analysis is intended to focus attention on the patient segments, care settings, and treatment options that can best bring improved health outcomes at lowest cost to those in need. Understanding the privately insured under 65 populations and addressing their health needs efficiently will bring significant benefits to the entire healthcare system. 2
7 Total Healthcare Spending All Payers HIGHLIGHTS Private insurance will remain the largest segment (57%) of the covered population through Insurance exchanges are projected to include 12.5% of the privately insured by Private insurance expenditures will remain the largest share of insurance spending (41%) through
8 TOTAL HEALTHCARE SPENDING ALL PAYERS Enrollment in private insurance will reach 197.8Mn by 2020 Insurance Enrollment in the US(Mn) Mn individuals, 63% of insured population Mn individuals, 58% of insured population Mn individuals, 57% of insured population In 2010, 63.4%, million, of insured individuals in the US were enrolled in private health insurance, while 16.1%, 46.8 million, and 18.5%, 53.7 million, of insured individuals were enrolled in Medicare and Medicaid, respectively. By 2016, private insurance enrollment is projected to increase by 6%, from million to 195 million people. Health insurance exchange plans will represent 18.8 million people, 9.6%, of all private enrollment. By 2020, private health insurance enrollees are projected to remain the largest proportion of the overall insured population, at 57.3%, with Medicare and Medicaid accounting for 18.1%, 62.3 million, and 24.2%, 83.5 million individuals, respectively Uninsured Exchanges Other Private Employer CHIP Medicaid Medicare Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group 4 Dec 2010 Chart notes Medicare volume includes individuals under age 65. Medicare enrollees who purchase supplemental private insurance are represented in both Medicare and private insurance categories. 11 4
9 TOTAL HEALTHCARE SPENDING ALL PAYERS Spending on private insurance will exceed $1.4 trillion in 2020 Healthcare Expenditures in the US($Bn) $822Bn, 44.5% of insurance expenditures , $1,141Bn, 42.6% of insurance expenditures , $1,402Bn, 41.1% of insurance expenditures Private health insurance spending in 2010 was $822.3Bn, or 44.5% of total insurance expenditures. Medicare and Medicaid expenditures were 28.4%, $525Bn, and 21.7%, $400.7Bn, respectively. By 2016, private health insurance expenditures are projected to exceed $1 trillion, increasing by 38.8%, to $1,141Bn. In 2020, private health insurance expenditures will reach nearly $1.5 trillion and represent 41.1%, the largest proportion of insurance spending for healthcare in the US. Medicare and Medicaid will represent 27.7%, $922Bn, and 26.7%, $908.1Bn, respectively, of total healthcare spending on insurance Exchanges Other Private Employer CHIP Medicaid Medicare Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group 4, Dec 2010 Chart notes Medicare volume includes individuals under age 65. Medicare enrollees who purchase supplemental private insurance are represented in both Medicare and private insurance categories. 11 5
10 Total Healthcare Spending Privately Insured HIGHLIGHTS Healthcare spending was highly concentrated, with 1% of the population driving over 25% of all spending. Spending among the privately insured under age 65 population was outpatient driven, in contrast to Medicare. Treatment pattern differences across conditions were noteworthy, in that they were: Outpatient driven among members with chronic conditions or cancers. Pharmacy driven for members with auto-immune or other specialty conditions. Members with chronic conditions, cancers or conditions treated with specialty medicines represented a disproportionate share of spending. 6
11 TOTAL HEALTHCARE SPENDING PRIVATELY INSURED Spending was highly concentrated Distribution of Spending in the Privately Insured 96.9% 85.4% 80.7% 74.3% 65.2% 50.6% 25.6% 3.1% A sample of more than 10 million privately insured health plan members, from the IMS LifeLink database, showed that over 25% of all spending was for just 1% of the total number of health plan members. More than 50% of the total spending was for only 5% of all health plan members. Slightly more than 3% of expenditures went to treat the bottom 50% of all members, who had average annual spending of less than $874 per member. Spending distribution nearly mirrored the overall US population, where AHRQ also reports that 3% of spending was driven by the bottom 50%, while 22% of spending was driven by the top 1%. 3 Top 1% Top 5% Top 10% Top 15% Top 20% Top 25% Top 50% Bottom 50% (>=$44,957) (>=$14,947) (>=$8,582) (>=$5,773) (>=$4,169) (>=$3,130) (>=$874) (<$874) PERCENT OF HEALTH PLAN MEMBERS, RANKED BY HEALTHCARE SPENDING ($) Source: IMS LifeLink Health Plan Claims Database, Dec 2010 Chart notes Spending distribution reflects spending for all health plan members, including members with no service use and no spending in the analysis year. 7
12 TOTAL HEALTHCARE SPENDING PRIVATELY INSURED Spending increased with age in the under 65 population Average Annual Spending Per Member By Age and Gender ($) $3,893 $6,297 $5,601 Health plan members between the ages of 45 and 64 expended, on average, $5,900 annually on healthcare services, or nearly twice that of their counterparts between the ages of 20 and 44, and four times that of members in the youngest age group - 0 to 9 years of age. Average annual spending for women less than 65 years of age was higher, at $4,278 per year, versus $3,373 for men under 65, predominately due to higher rates of healthcare utilization overall. This was especially true for women aged 20 to 44. $1,308 $1,580 $1,784 $1,779 $2,188 F M F M F M F M Source: IMS LifeLink Health Plan Claims Database, Dec 2010 Chart notes Estimates of annual spending are averages based on spending of all health plan members, including members with no service use and no spending in the analysis year. 8
13 TOTAL HEALTHCARE SPENDING PRIVATELY INSURED Spending continued to increase in the Medicare population Annual Program Payments Per Member ($) $14,527 $10,953 $6,550 As with privately insured under age 65 individuals, spending for Medicare enrollees increased with age, with average annual spending per enrollee higher than for the IMS privately insured population. On average, Medicare spending was $10,109 per member across the age 65 and older age groups. For low-cost Medicare members, the prevalence of minor age-related illnesses, such as cataracts was higher. High-cost Medicare beneficiaries had higher prevalence of chronic conditions, including hypertension, chest pain and coronary artery disease years years 85 years or over Source: Centers for Medicare & Medicaid Services, Office of Information Services, 2010 Chart notes Graph represents data from See Appendix for the definition of Medicare program payments. 9
14 TOTAL HEALTHCARE SPENDING PRIVATELY INSURED Spending increases differed as males and females aged Average Annual Spending Per Member ($) F M F M F M F M Pharmacy $172 $242 $331 $415 $670 $454 $1,400 $1,267 Outpatient $941 $1,117 $1,166 $1,086 $2,311 $1,345 $3,725 $3,003 Inpatient $195 $221 $287 $278 $912 $389 $1,173 $1,330 Source: IMS LifeLink Health Plan Claims Database, Dec 2010 Males, from birth to age nine, had higher annual healthcare spending, on average, at $1,580, than females, at $1,308. The average annual per member spending for females, ages 20 to 44 was $3,893, 78% higher than same-aged males at $2,188. This difference might, in part, be due to maternity and other reproductive healthcare services. Higher per member spending by gender, in the study population, reflected increased utilization of services. 7 Similarly, the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) also reported higher use of health services among females than males in the US population. 8 Chart notes See Appendix: Cost and Use by Age and Gender for detailed age-gender spending profiles. 10
15 TOTAL HEALTHCARE SPENDING PRIVATELY INSURED Spending was outpatient driven, in contrast to Medicare Distribution of Spending by Payer Type 21% 22% 18% 39% 47% 59% Among the IMS privately insured study population, the proportion of spending for inpatient and pharmacy services was about the same, at 20.4% and 20.9%, respectively. The proportion of Medicare age 65+ spending on inpatient care was 43%, more than double the IMS population, while spending for outpatient services, 39%, and pharmacy, 18%, were much lower than the IMS population. Inpatient spending remained a higher proportion of overall spend. 43% 20% 31% IMS Privately Insured Under Age 65 Inpatient MEPS All Payers Outpatient MEPS Medicare 65 and Over Pharmacy Source: IMS LifeLink Health Plan Claims Database, Dec 2010; Medical Expenditure Panel Survey 2, 2009 Chart notes MEPS represents data from See Notes on Sources for details. IMS place of service definitions differ slightly from MEPS definitions. See Appendix for detail. 11
16 TOTAL HEALTHCARE SPENDING PRIVATELY INSURED Share of spending was disproportionate for certain conditions Proportion of Spending by Health Services Channel Condition Set All Members Chronic Conditions Oncology Auto-Immune/Other Specialty 10,657,042 3,862, , ,393 Members (N) 100.0% 36.2% 1.5% 1.7% $PMPM $320 $216 $25 $22 $PMPM (%) 100.0% 67.5% 7.9% 7.0% Spending was highly disproportionate to prevalence rates among health plan members with chronic conditions, cancer, auto-immune or other specialty diseases. When the prevalence of these various conditions was compared to total spending for members affected by these specific diseases, their impact was immediately evident and dramatic. More than one-third of all members, 36%, were shown to have at least one chronic condition, and comprised approximately two-thirds, 67.5%, of spending for all members. Source: IMS LifeLink Health Plan Claims Database, Dec 2010 Chart notes $PMPM is a population-based measure that reflects the proportion of all plan spending attributable to overall members or member sub-populations. Estimates for subgroups will be relatively low, even when spending for each member in the subgroup is high, because the denominator is the overall population. 12
17 TOTAL HEALTHCARE SPENDING PRIVATELY INSURED Treatment pattern differences across conditions were noteworthy Distribution of Spending by Treatment Setting ($) 21% 24% 3% 3% 12% 56% 52% 53% 20% 21% 21% All Members ($320 PMPM N=10,657,042) Chronic Conditions ($216 PMPM N=3,862,984) 14% Oncology ($25 PMPM N=162,767) 39% 8% 37% 16% Auto-Immune / Other Specialty ($22 PMPM N=183,393) Inpatient Outpatient Medical Outpatient Medical Rx Pharmacy Source: IMS LifeLink Health Plan Claims Database, Dec 2010 Treatment patterns were outpatient driven among members with chronic or oncology conditions, and pharmacy driven for members with auto-immune and other specialty conditions. For members with chronic conditions, 55% of all spending was for outpatient services, of which 3% was for medical drug therapy. Outpatient services comprised 65% of all spending for members being treated for cancer, with 12% of all spending for medical drug therapy. Inpatient spending represented a smaller share of all spending for members with auto-immune and other specialty conditions, while outpatient spending was 45% and medical drug therapy 8% of all spending. Pharmacy spending was 39% of all spending for members with autoimmune and other specialty conditions. Chart notes Outpatient Medical Rx includes injected or infused drug therapy administered in a facility, office, or home health setting. $PMPM is spending per member per month. 13
18 Outpatient Spending Professional and facility visits accounted for 74% of outpatient spending overall. Emergency room visits were 10% of outpatient spending overall. Medical drug therapy provided in the office, facility or home was 5% of outpatient spending overall, but represented 18-19% of spending for members with specialty conditions. 14
19 OUTPATIENT SPENDING PRIVATELY INSURED Most outpatient spending was on professional and facility services Distribution of Outpatient Spending $PMPM Home Health Medical, $5, 3% Professional Medical, $74, 39% Laboratory/Pathology, $7, 4% Radiology, $8, 4% Medical Rx, $9, 5% Emergency Room, $18, 10% Home Health $1 Facility $2 Emergency room visits, at $18 per member per month, was 10% of all outpatient spending. Home health medical services represented 3% of all outpatient spending, followed by radiology and laboratory/ pathology at 4% each. Outpatient medical drug therapy, including office, facility and home-based injections and infusions, were 5% of all outpatient spending, or $9 per member per month. Facility Medical, $65, 35% Professional $6 Source: IMS LifeLink Health Plan Claims Database, Dec 2010 Chart notes Medical Rx includes drugs administered in an outpatient facility, office or home health setting, under the medical benefit, identified by HCPCS or revenue codes. Spending may be understated for this category since not all health plans capture outpatient service usage at this level of detail. $PMPM is spending per member per month. 15
20 OUTPATIENT SPENDING PRIVATELY INSURED Medical drug therapy use resulted in different spending profiles Distribution of Outpatient Spending $PMPM 1% 3% 39% 35% 5% 4% 4% 10% All Members ($188 Outpatient PMPM N=10,657,042) 1% 3% 38% 36% 5% 4% 5% 8% Chronic Conditions ($120 Outpatient PMPM N=3,862,984) 1% 2% 23% 44% 19% 2% 6% 3% Oncology ($16 Outpatient PMPM N=162,767) 1% 4% 30% 34% 18% 3% 4% 6% Auto-Immune / Other Specialty ($10 Outpatient PMPM N=183,393) Emergency Room Radiology Laboratory/Pathology Medical Rx Facility Medical Professional Medical Home Health Medical Other Source: IMS LifeLink Health Plan Claims Database, Dec 2010 In oncology, auto-immune and other specialty condition populations studied, higher use of medical drug therapy resulted in outpatient spending profiles that differed from the overall or chronic patient populations. Medical drug therapy represented 19% of all outpatient spending for members with various types of cancer, and 18% for members with auto-immune and other specialty conditions, compared to all members and members with chronic conditions at 5% each. Professional and facility spending represented the largest share of outpatient spending for members overall, and for members with chronic conditions. Gary Gatyas 11/15/2011 Should we add a - Y axis on the right to show dollars? Chart notes $PMPM is spending per member per month. 16
21 Inpatient Spending Facility-based services were 84% of inpatient spending, while professional services were 16%. Members with chronic conditions had 63% of all inpatient admissions. Inpatient services spending among members with chronic conditions or cancers was about 20% of their total spending, similar to that of the overall membership. Inpatient services were only 16% of all spending among members with auto-immune or other specialty conditions. Members with cancer had the highest spending per admission, at $20,074, which was nearly $6,000 higher than the average spending per admission across all members. 17
22 INPATIENT SPENDING PRIVATELY INSURED 84% of inpatient spending was for facility-based care Inpatient Spending Distribution and Service Use Professional 16% Measure Inpatient $PMPM Allowed Amount ($) Per Admit Average Length of Stay (ALOS) Cost Per Admit ($)/Rate $65 $14, Spending per inpatient admission was, on average, $14,248. Each inpatient admission lasted 4.2 days, on average, with 46.4 admissions per 1,000 members per year. Inpatient spending included professional visits, with 310 visits per 1,000 members per year. Admits Per 1,000 Days Per 1,000 Professional Visits Per 1, Facility 84% Source: IMS LifeLink Health Plan Claims Database, Dec 2010 Chart notes $PMPM is spending per member per month. 18
23 INPATIENT SPENDING PRIVATELY INSURED Inpatient was a lower share of spending for specialty conditions Distribution of Total Spending $PMPM All Members $65 $254 All Chronic Conditions $44 $171 Inpatient spending was 16%, or $4 per member per month, of all spending for members with auto-immune and other specialty conditions. Spending on inpatient services, for members with chronic conditions and members with cancers, more closely resembled the proportion spent for inpatient services in the overall population. All Oncology $5 $20 All Auto- Immune/Other Specialty $4 $19 0% 20% 40% 60% 80% 100% Inpatient Outpatient & Pharmacy Source: IMS LifeLink Health Plan Claims Database, Dec 2010 Chart notes $PMPM is spending per member per month. 19
24 INPATIENT SPENDING PRIVATELY INSURED Members with chronic conditions had 63% of all inpatient admissions Description Inpatient $PMPM Cost Per Admit($) Admits Per 1,000 Average Length of Stay (ALOS) Days Per 1,000 Professional Visits Per 1,000 All Members $65.33 $14, Chronic Conditions $44.49 $15, Oncology $5.33 $20, Auto-Immune /Other Specialty $3.59 $16, Members with chronic conditions had the largest share of inpatient facility admits at 29 admissions per thousand; they also had the largest share of professional visits, logging 219 visits per 1,000 members. Oncology patients had the highest average spending per admission, at $20,074, which was nearly $6,000 higher than the average spending per admission across all members. Oncology patients also had a longer average length of stay compared to the overall member population and members with a chronic condition, making cancer admissions the most expensive. Source: IMS LifeLink Health Plan Claims Database, Dec 2010 Chart notes $PMPM is spending per member per month. 20
25 Pharmacy Spending Members with chronic conditions filled more than 75% of all prescriptions. Specialty medicines provided by a pharmacy were a very small share of all prescriptions, but 17% of all pharmacy spending. Spending on specialty medicines provided by a pharmacy, or administered in the facility, office, or home, when combined, accounted for: 6% of all spending across all members. 33% of all spending for members with auto-immune or other specialty conditions. 17% of all spending for members with cancer. 21
26 PHARMACY SPENDING PRIVATELY INSURED Specialty pharmacy was 1% of utilization, yet 17% of spending Specialty vs. Non-Specialty Rx Spend and Usage $ ,950 1% 17% Overall, 11,950 prescriptions per 1,000 members were filled annually, with 174 prescriptions per 1,000 members for specialty medications, the majority of which were branded. At $11.31 per member per month, specialty prescriptions were 17% of pharmacy spending. 99% 83% $PMPM Non -Specialty Source: IMS LifeLink Health Plan Claims Database, Dec 2010 Specialty Scripts/1,000 Chart notes Figures reflect outpatient drug claims typically processed by a pharmacy benefit manager utilizing NDC codes. See Appendix for detail. $PMPM is spending per member per month. 22
PRESCRIPTION MEDICINES: COSTS IN CONTEXT
PRESCRIPTION MEDICINES: COSTS IN CONTEXT 2015 Since 2000, biopharmaceutical companies have brought MORE THAN 500 NEW TREATMENTS AND CURES to U.S. patients In the last 100 years, medicines have helped raise
More informationPhysical and Mental Health Condition Prevalence and Comorbidity among Fee-for-Service Medicare- Medicaid Enrollees
Physical and Mental Health Condition Prevalence and Comorbidity among Fee-for-Service Medicare- Medicaid Enrollees Centers for Medicare & Medicaid Services September, 2014 i Executive Summary Introduction
More informationWhite Paper. Medicare Part D Improves the Economic Well-Being of Low Income Seniors
White Paper Medicare Part D Improves the Economic Well-Being of Low Income Seniors Kathleen Foley, PhD Barbara H. Johnson, MA February 2012 Table of Contents Executive Summary....................... 1
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Montana Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6
More informationINSIGHT on the Issues
INSIGHT on the Issues AARP Public Policy Institute Medicare Beneficiaries Out-of-Pocket for Health Care Claire Noel-Miller, PhD AARP Public Policy Institute Medicare beneficiaries spent a median of $3,138
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile North Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...
More informationThe Evolving Landscape of Payment Care Delivery and Manufacturer Implications of Coverage Expansion
November 2013 Edition Vol. 7, Issue 10 The Evolving Landscape of Payment Care Delivery and Manufacturer Implications of Coverage Expansion By Gordon Gochenauer, Director, Oncology Commercial Strategies,
More informationSTATISTICAL BRIEF #93
Agency for Healthcare Medical Expenditure Panel Survey Research and Quality STATISTICAL BRIEF #93 August 2005 Health Care Expenditures for Injury- Related Conditions, 2002 Steven R. Machlin, MS Introduction
More informationSTATISTICAL BRIEF #73
Agency for Healthcare Medical Expenditure Panel Survey Research and Quality STATISTICAL BRIEF #7 March Characteristics of Persons with High Medical Expenditures in the U.S. Civilian Noninstitutionalized
More informationPROPOSED US MEDICARE RULING FOR USE OF DRUG CLAIMS INFORMATION FOR OUTCOMES RESEARCH, PROGRAM ANALYSIS & REPORTING AND PUBLIC FUNCTIONS
PROPOSED US MEDICARE RULING FOR USE OF DRUG CLAIMS INFORMATION FOR OUTCOMES RESEARCH, PROGRAM ANALYSIS & REPORTING AND PUBLIC FUNCTIONS The information listed below is Sections B of the proposed ruling
More informationMedicare Beneficiaries Out-of-Pocket Spending for Health Care
Insight on the Issues OCTOBER 2015 Beneficiaries Out-of-Pocket Spending for Health Care Claire Noel-Miller, MPA, PhD AARP Public Policy Institute Half of all beneficiaries in the fee-for-service program
More informationDrug Adherence in the Coverage Gap Rebecca DeCastro, RPh., MHCA
Drug Adherence in the Coverage Gap Rebecca DeCastro, RPh., MHCA Good morning. The title of my presentation today is Prescription Drug Adherence in the Coverage Gap Discount Program. Okay, to get started,
More informationHealth Care Spending. July 2012
The Concentration of Health Care Spending NIHCM Foundation Data Brief July 2012 KEY POINTS FROM THIS BRIEF: n Spending for health care services is highly concentrated among a small proportion of people
More informationTurning Health Care Insights into Action. Impacting the Cost of Government through your Employee Health Benefits Strategy
Turning Health Care Insights into Action Impacting the Cost of Government through your Employee Health Benefits Strategy Reaching your Health Care Goals: Changing the Conversation There is a significant
More informationRESEARCH IN ACTION. The High Concentration of U.S. Health Care Expenditures. Introduction. Background. Issue #19 June 2006
RESEARCH IN ACTION Issue #19 June 2006 The High Concentration of U.S. Health Care Expenditures Introduction As policymakers consider various ways to contain the rising costs of health care, it is useful
More informationHospitals and Health Systems:
Hospitals and Health Systems: An Inside Look at Employee Health Plan Strategies To Control Costs and Provide Access to Healthcare August 2010 Highlights Because of their dual role as benefit plan sponsor
More informationMedical Dental Integration Study. March 2013
Medical Dental Integration Study March 2013 Executive summary The study, which was a performed by Optum, the nation s leading health services company, on behalf of UnitedHealthcare evaluates the impact
More informationBENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Appendix A. Prepared Exclusively for The Dow Chemical Company
Appendix A BENEFIT PLAN Prepared Exclusively for The Dow Chemical Company What Your Plan Covers and How Benefits are Paid Choice POS II (MAP Plus Option 2 - High Deductible Health Plan (HDHP) with Prescription
More informationMedicare Supplement plan application
Medicare Supplement plan application SECTION 1 Personal information Last name First name Middle initial Social Security number - - Primary Street address City State ZIP code Mailing Street address (if
More informationTotal Cost of Cancer Care by Site of Service: Physician Office vs Outpatient Hospital
Total Cost of Cancer Care by Site of Service: Physician Office vs Outpatient Hospital Prepared by Avalere Health, LLC Page 2 Executive Summary Avalere Health analyzed three years of commercial health plan
More informationNew Hampshire Accountable Care Project: Analytic Report User Guide
New Hampshire Accountable Care Project: Analytic Report User Guide November 2015 Contents OVERVIEW... 2 Introduction... 2 User Guide Purpose... 2 USING THE ANALYTIC REPORT... 3 Report Access... 3 Report
More informationNear-Elderly Adults, Ages 55-64: Health Insurance Coverage, Cost, and Access
Near-Elderly Adults, Ages 55-64: Health Insurance Coverage, Cost, and Access Estimates From the Medical Expenditure Panel Survey, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research
More informationUse and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup
Use and Integration of Freely Available U.S. Public Use Files to Answer Pharmacoeconomic Questions: Deciphering the Alphabet Soup Prepared by Ovation Research Group for the National Library of Medicine
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Kentucky Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization...
More informationDepression treatment: The impact of treatment persistence on total healthcare costs
Prepared by: Steve Melek, FSA, MAAA Michael Halford, ASA, MAAA Daniel Perlman, ASA, MAAA Depression treatment: The impact of treatment persistence on total healthcare costs is among the world's largest
More informationPrescription drugs are a critical component of health care. Because of the role of drugs in treating conditions, it is important that Medicare ensures that its beneficiaries have access to appropriate
More informationMedInsight Healthcare Analytics Brief: Population Health Management Concepts
Milliman Brief MedInsight Healthcare Analytics Brief: Population Health Management Concepts WHAT IS POPULATION HEALTH MANAGEMENT? Population health management has been an industry concept for decades,
More informationJon S. Howell, LNHA President & CEO Georgia Health Care Association November 18, 2013
Jon S. Howell, LNHA President & CEO Georgia Health Care Association November 18, 2013 GEORGIA HEALTH CARE ASSOCIATION Represents 336 skilled nursing facilities 13 SOURCE agencies 15 assisted living communities
More informationN Basic, including 100% Part B coinsurance. Basic including 100% Part B coinsurance* Basic including 100% Part B coinsurance
HEARTLAND NATIONAL LIFE INSURANCE COMPANY Outline of Medicare Supplement Coverage Benefit Plans A, D, F, G, M and N Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or After Jun 1,
More informationThe State Health Benefits Program Plan
State of New Jersey Department of the Treasury Division of Pensions and Benefits STATE HEALTH BENEFITS PROGRAM PLAN COMPARISON SUMMARY FOR STATE EMPLOYEES EFFECTIVE APRIL 1, 2008 (March 29, 2008 for State
More informationEconomic Impact of Integrated Medical-Behavioral Healthcare
Economic Impact of Integrated Medical-Behavioral Healthcare Implications for Psychiatry Prepared for: American Psychiatric Association Prepared by: Milliman, Inc. Stephen P. Melek, FSA, MAAA Douglas T.
More informationInfogix Healthcare e book
CHAPTER FIVE Infogix Healthcare e book PREDICTIVE ANALYTICS IMPROVES Payer s Guide to Turning Reform into Revenue 30 MILLION REASONS DATA INTEGRITY MATTERS It is a well-documented fact that when it comes
More informationImpact Intelligence. Flexibility. Security. Ease of use. White Paper
Impact Intelligence Health care organizations continue to seek ways to improve the value they deliver to their customers and pinpoint opportunities to enhance performance. Accurately identifying trends
More informationMedicare Advantage Plans: An Overview
Medicare Advantage Plans: An Overview June 2014 Prepared by: Penny Finch, Benefits Consultant Copyright 2014 by The Segal Group, Inc. All rights reserved. 5432273.1 CONTENTS Medicare 101 Understanding
More informationNational Findings on Access to Health Care and Service Use for Non-elderly Adults Enrolled in Medicaid
National Findings on Access to Health Care and Service Use for Non-elderly Adults Enrolled in Medicaid By Sharon K. Long Karen Stockley Elaine Grimm Christine Coyer Urban Institute MACPAC Contractor Report
More information5/5/2015 PHARMACY WHAT S AN EMPLOYER TO DO? Current Structure Misaligned
PHARMACY WHAT S AN EMPLOYER TO DO? MAY 15, 2015 Debbie Doolittle Nashville, TN Pharmaceutical Spending Per Capita, 2013 vs. 2018 The US vs. the Rest of the World 1 Current Pharmacy Landscape How Did We
More informationChart 11-1. Number of dialysis facilities is growing, and share of for-profit and freestanding dialysis providers is increasing
11 0 Chart 11-1. Number of dialysis facilities is growing, and share of for-profit and freestanding dialysis providers is increasing Average annual percent change 2014 2009 2014 2013 2014 Total number
More informationTHE A,B,C,D S OF MEDICARE
THE A,B,C,D S OF MEDICARE An important resource for understanding your healthcare in retirement What you need to know for 2014 How Medicare works What Medicare covers How much Medicare costs INTRODUCTION
More informationTask 7: Study of the Uninsured and Underinsured
75 Washington Avenue, Suite 206 Portland, Maine04101 Phone: 207-767-6440 Email: research@marketdecisions.com www.marketdecisions.com Task 7: Study of the Uninsured and Underinsured Vermont Office of Health
More informationand the uninsured June 2005 Medicaid: An Overview of Spending on Mandatory vs. Optional Populations and Services
I S S U E kaiser commission on medicaid and the uninsured June 2005 P A P E R Medicaid: An Overview of Spending on vs. Optional Populations and Services Medicaid is a federal-state program that provides
More informationACTUARIAL VALUE AND EMPLOYER- SPONSORED INSURANCE
NOVEMBER 2011 ACTUARIAL VALUE AND EMPLOYER- SPONSORED INSURANCE SUMMARY According to preliminary estimates, the overwhelming majority of employer-sponsored insurance (ESI) plans meets and exceeds an actuarial
More informationMedicare- Medicaid Enrollee State Profile
Medicare- Medicaid Enrollee State Profile Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...
More informationHow To Calculate The Cost Of Diabetic Foot Ulcers
Medical, Drug, and Work-Loss Costs of Diabetic Foot Ulcers Brad Rice, PhD; 1 Urvi Desai, PhD; 1 Alice Kate Cummings, BA; 1 Michelle Skornicki, MPH; 2 Nathan Parsons, RN BSN; 2 and Howard Birnbaum, PhD
More informationSTATISTICAL BRIEF #167
Medical Expenditure Panel Survey STATISTICAL BRIEF #167 Agency for Healthcare Research and Quality March 27 The Five Most Costly Conditions, 2 and 24: Estimates for the U.S. Civilian Noninstitutionalized
More informationSee page 331 of HEDIS 2013 Tech Specs Vol 2. HEDIS specs apply to plans. RARE applies to hospitals. Plan All-Cause Readmissions (PCR) *++
Hospitalizations Inpatient Utilization General Hospital/Acute Care (IPU) * This measure summarizes utilization of acute inpatient care and services in the following categories: Total inpatient. Medicine.
More informationGAO MEDICARE ADVANTAGE. Relationship between Benefit Package Designs and Plans Average Beneficiary Health Status. Report to Congressional Requesters
GAO United States Government Accountability Office Report to Congressional Requesters April 2010 MEDICARE ADVANTAGE Relationship between Benefit Package Designs and Plans Average Beneficiary Health Status
More informationAnalysis of Care Coordination Outcomes /
Analysis of Care Coordination Outcomes / A Comparison of the Mercy Care Plan Population to Nationwide Dual-Eligible Medicare Beneficiaries July 2012 Prepared by: Varnee Murugan Ed Drozd Kevin Dietz Aetna
More informationBreathe With Ease. Asthma Disease Management Program
Breathe With Ease Asthma Disease Management Program MOLINA Breathe With Ease Pediatric and Adult Asthma Disease Management Program Background According to the National Asthma Education and Prevention Program
More informationUpstate New York adults with diagnosed type 1 and type 2 diabetes and estimated treatment costs
T H E F A C T S A B O U T Upstate New York adults with diagnosed type 1 and type 2 diabetes and estimated treatment costs Upstate New York Adults with diagnosed diabetes: 2003: 295,399 2008: 377,280 diagnosed
More informationUsing Predictive Analytics to Build a World Class Healthcare System
Using Predictive Analytics to Build a World Class Healthcare System Swati Abbott CEO, Blue Health Intelligence Doug Porter SVP and CIO, Blue Cross/Blue Shield Association Using Predictive Analytics to
More information2013 Health Care Cost and Utilization Report
2013 Health Care Cost and Utilization Report October 2014 Copyright 2014 Health Care Cost Institute Inc. Unless explicitly noted, the content of this report is licensed under a Creative Commons Attribution
More informationBrief Research Report: Fountain House and Use of Healthcare Resources
! Brief Research Report: Fountain House and Use of Healthcare Resources Zachary Grinspan, MD MS Department of Healthcare Policy and Research Weill Cornell Medical College, New York, NY June 1, 2015 Fountain
More informationUtah s All Payer Claims Dataset: A vital resource for health reform
TennCare Annual Meeting January19, 2011 Utah s All Payer Claims Dataset: A vital resource for health reform Keely Cofrin Allen, Ph.D. Director, Office of Health Care Statistics Utah Department of Health
More informationMedicare. Medicare Overview. Medicare Part D Prescription Plans. Medicare
58 requires enrollment as soon as a retiree, spouse or dependent of a retiree is eligible for. Parts A & B MUST be elected. Overview There are three parts to : Hospital Insurance (also called Part A. Your
More informationThe Potential Impact of State Mandatory Assignment Legislation on Consumers
The Potential Impact of State Mandatory Assignment Legislation on Consumers September 4, 2003 Prepared by: Jon M. Wander, F.S.A., M.A.A.A. Daniel E. Freier, F.S.A., M.A.A.A. At the Request of the Blue
More informationTHE MEDICAID PROGRAM AT A GLANCE. Health Insurance Coverage
on on medicaid and and the the uninsured March 2013 THE MEDICAID PROGRAM AT A GLANCE Medicaid, the nation s main public health insurance program for low-income people, covers over 62 million Americans,
More informationResearch. Dental Services: Use, Expenses, and Sources of Payment, 1996-2000
yyyyyyyyy yyyyyyyyy yyyyyyyyy yyyyyyyyy Dental Services: Use, Expenses, and Sources of Payment, 1996-2000 yyyyyyyyy yyyyyyyyy Research yyyyyyyyy yyyyyyyyy #20 Findings yyyyyyyyy yyyyyyyyy U.S. Department
More informationAPPLICATION FOR MEDICARE SUPPLEMENT COVERAGE
CENTRAL STATES INDEMNITY CO. OF OMAHA Home Office: Omaha, NE Administration: P.O. Box 10816 Clearwater, Florida 33757-8816 APPLICATION FOR MEDICARE SUPPLEMENT COVERAGE SECTION A. PROPOSED INSURED INFORMATION
More information7/31/2014. Medicare Advantage: Time to Re-examine Your Engagement Strategy. Avalere Health. Eric Hammelman, CFA. Overview
Medicare Advantage: Time to Re-examine Your Engagement Strategy July 2014 avalerehealth.net Avalere Health Avalere Health delivers research, analysis, insight & strategy to leaders in healthcare policy
More informationJanuary 2016. Price Declines after Branded Medicines Lose Exclusivity in the U.S.
January 2016 Price Declines after Branded Medicines Lose Exclusivity in the U.S. Introduction When novel medicines lose exclusivity in the United States, competitors quickly enter the market and bring
More informationMedicare Advantage Stars: Are the Grades Fair?
Douglas Holtz-Eakin Conor Ryan July 16, 2015 Medicare Advantage Stars: Are the Grades Fair? Executive Summary Medicare Advantage (MA) offers seniors a one-stop option for hospital care, outpatient physician
More informationAppendix VI. Patient-Centered Medical Homes (Initiative Memorandum) APRIL 2013
Appendix VI. Patient-Centered Medical Homes (Initiative Memorandum) APRIL 2013 http://berkeleyhealthcareforum.berkeley.edu 1 Appendix VI. Patient-Centered Medical Homes (Initiative Memorandum) See Appendix
More informationSECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS HIGHLIGHTS
SECTION 4 COSTS FOR INPATIENT HOSPITAL STAYS EXHIBIT 4.1 Cost by Principal Diagnosis... 44 EXHIBIT 4.2 Cost Factors Accounting for Growth by Principal Diagnosis... 47 EXHIBIT 4.3 Cost by Age... 49 EXHIBIT
More informationAetna Individual Medicare Supplement Plan Application Aetna Life Insurance Company PO Box 13547, Pensacola, FL 32591-3547
Aetna Individual Medicare Supplement Plan Application Aetna Life Insurance Company PO Box 13547, Pensacola, FL 32591-3547 INSTRUCTIONS: To be considered complete, all sections on this form must be filled
More informationHousehold health care spending: comparing the Consumer Expenditure Survey and the National Health Expenditure Accounts Ann C.
Household health care spending: comparing the Consumer Expenditure Survey and the National Health Expenditure Accounts Ann C. Foster Health care spending data produced by the Federal Government include
More informationMEDICARE PHYSICAL THERAPY. Self-Referring Providers Generally Referred More Beneficiaries but Fewer Services per Beneficiary
United States Government Accountability Office Report to Congressional Requesters April 2014 MEDICARE PHYSICAL THERAPY Self-Referring Providers Generally Referred More Beneficiaries but Fewer Services
More informationSPECIALTY TREND MANAGEMENT
SPECIALTY TREND MANAGEMENT Table of Contents Specialty drives pharmacy trend... Chapter 1 Managing price, mix and utilization... Chapter 2 Expand preferred drug strategies... Chapter 3 Cost-effective site
More informationMajor Depressive Disorder:
Major Depressive Disorder: An Actuarial Commercial Claim Data Analysis July 2013 Prepared by: Milliman, Inc. NY Kate Fitch RN, MEd Kosuke Iwasaki FIAJ, MAAA, MBA This report was commissioned by Takeda
More informationSTATISTICAL BRIEF #8. Conditions Related to Uninsured Hospitalizations, 2003. Highlights. Introduction. Findings. May 2006
HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #8 Agency for Healthcare Research and Quality May 2006 Conditions Related to Uninsured Hospitalizations, 2003 Anne Elixhauser, Ph.D. and C. Allison
More informationChapter 7 Acute Care Inpatient/Outpatient Hospital Services
Chapter 7: Acute Care Inpatient/ Outpatient Hospital Services Executive Summary Description Acute care hospitals are the largest group of enrolled hospital providers. Kansas Medicaid has 144 acute care
More informationGeneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population
Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population November 18, 2013 Diana Dennett EVP, Global Issues and Counsel America s Health Insurance Plans (AHIP) America
More information8/14/2012 California Dual Demonstration DRAFT Quality Metrics
Stakeholder feedback is requested on the following: 1) metrics 69 through 94; and 2) withhold measures for years 1, 2, and 3. Steward/ 1 Antidepressant medication management Percentage of members 18 years
More informationHealth Care Utilization and Costs of Full-Pay and Subsidized Enrollees in the Florida KidCare Program: MediKids
Health Care Utilization and Costs of Full-Pay and Subsidized Enrollees in the Florida KidCare Program: MediKids Prepared for the Florida Healthy Kids Corporation Prepared by Jill Boylston Herndon, Ph.D.
More informationMedicare Economics. Part A (Hospital Insurance) Funding
Medicare Economics Medicare expenditures are a substantial part of the federal budget $556 billion, or 15 percent in 2012. They also comprise 3.7 percent of the country s gross domestic product (GDP),
More informationJohns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases
Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases Epidemiology Over 145 million people ( nearly half the population) - suffer from asthma, depression and other chronic
More informationButler Memorial Hospital Community Health Needs Assessment 2013
Butler Memorial Hospital Community Health Needs Assessment 2013 Butler County best represents the community that Butler Memorial Hospital serves. Butler Memorial Hospital (BMH) has conducted community
More informationIntroduction to Risk Adjustment Programs for Medicare Advantage and the Affordable Care Act (Commercial Health Insurance Exchange)
Introduction to Risk Adjustment Programs for Medicare Advantage and the Affordable Care Act (Commercial Health Insurance Exchange) November, 2014 An independent licensee of the Blue Cross and Blue Shield
More informationCENTRAL STATES INDEMNITY CO. OF OMAHA Home Office: Omaha, NE Administration: P.O. Box 10816 Clearwater, Florida 33757-8816
CENTRAL STATES INDEMNITY CO. OF OMAHA Home Office: Omaha, NE Administration: P.O. Box 10816 Clearwater, Florida 33757-8816 APPLICATION FOR MEDICARE SUPPLEMENT COVERAGE SECTION A. PROPOSED INSURED INFORMATION
More informationStay Healthy. In the Know. Screenings you and your family need. Protect yourself against health care fraud. www.aultcare.com
good health FALL 2015 YOUR FAST TRACK TO LIVING WELL Stay Healthy Screenings you and your family need In the Know Protect yourself against health care fraud www.aultcare.com TELL US HOW WE ARE DOING Whether
More informationThe Value Quadrant of Healthcare Reform. 2008 Pharos Innovations, LLC. All Rights Reserved.
The Value Quadrant of Healthcare Reform ACOs in PPACA Provider Organizations or networked groups Accountable for quality, cost and overall care of defined population of Medicare FFS benes Key metrics to
More informationEmployee Population Health Management:
Employee Population Health Management: a stepping stone for accountable care Richard Boehler, MD, MBA, FACPE President and Chief Executive Officer St. Joseph Hospital, Nashua N.H. Learning to Manage Populations
More informationLouisiana Report 2013
Louisiana Report 2013 Prepared by Louisiana State University s Public Policy Research Lab For the Department of Health and Hospitals State of Louisiana December 2015 Introduction The Behavioral Risk Factor
More informationLimited Pay Policy (L-222B) - Underwriting Guidelines
Limited Pay Policy (L-222B) - Underwriting Guidelines 1 Addiction/Abuser Drug - Past or Present Presently Recovered - AA for last 2 years 2 Aids 3 Alcoholic Presently Recovered - AA for last 2 years 4
More informationI. INFORMATION ABOUT THE DEMONSTRATION
EVALUATION DESIGN FOR THE WISCONSIN SENIORCARE SECTION 1115 PHARMACEUTICAL BENEFIT DEMONSTRATION I. INFORMATION ABOUT THE DEMONSTRATION This Evaluation Design is for project number 11-W-00149/5, the Wisconsin
More informationSecondary Uses of Data for Comparative Effectiveness Research
Secondary Uses of Data for Comparative Effectiveness Research Paul Wallace MD Director, Center for Comparative Effectiveness Research The Lewin Group Paul.Wallace@lewin.com Disclosure/Perspectives Training:
More informationIntegrating Data to Support Care Management Transformation
Integrating Data to Support Care Management Transformation The Washington State Experience David Mancuso, PhD Director, Research and Data Analysis Division Washington State Department of Social and Health
More informationOpportunities for advancing biomarkers for patient stratification and early diagnosis in liver disease
Opportunities for advancing biomarkers for patient stratification and early diagnosis in liver disease 80 Liver Disease and Obesity Liver disease biomarkers: Percent of adult population (United States)
More informationCompare your plan options
SMALL BUSINESS GROUP Compare your plan options 2014 plans for businesses with 1 50 employees I SMALL BUSINESS GROUP Group Health plans offer value, choice, and more A well-run business takes a lot of time,
More informationStar Quality Ratings: Legal, Operational and Strategic Questions for MA Organizations and Part D Plan Sponsors
Where Do We Go From Here? Star Quality Ratings: Legal, Operational and Strategic Questions for MA Organizations and Part D Plan Sponsors American Health Lawyers Association 2011 Payors, Plans and Managed
More informationApplication for Blue Shield of California Medicare Supplement plans
Application for Blue Shield of California Medicare Supplement plans FOR OFFICE USE ONLY Here's how to apply Accept. code Plan type Market code 1 Provide ALL requested information and print clearly in blue
More informationImproving risk adjustment in the Medicare program
C h a p t e r2 Improving risk adjustment in the Medicare program C H A P T E R 2 Improving risk adjustment in the Medicare program Chapter summary In this chapter Health plans that participate in the
More informationNew York. UnitedHealthcare Community Plan Claims System Migration Provider Quick Reference Guide. Complete Claims. Our Claims Process
Our Claims Process Here are a few steps to ensure you receive prompt payment: 1 Review and copy both sides of the member s ID card. members receive an ID card containing information that helps you process
More informationP.O. Box 91120, MS 295 Seattle, WA 98111-9220 1-800-752-6663 Fax: 425-918-5278
Washington Medicare Supplement Enrollment Application for Plans A, F, High Deductible F and N P.O. Box 91120, MS 295 Seattle, WA 98111-9220 1-800-752-6663 Fax: 425-918-5278 ou are eligible to apply for
More informationHEALTH CARE COSTS 11
2 Health Care Costs Chronic health problems account for a substantial part of health care costs. Annually, three diseases, cardiovascular disease (including stroke), cancer, and diabetes, make up about
More information2016 Summary of Benefits
2016 Summary of Benefits Health Net Violet Option 3 (PPO) Douglas and Josephine counties, OR Benefits effective January 1, 2016 H5520 Health Net Life Insurance Company H5520_2016_0202 CMS Accepted 09162015
More informationIdentifying High-Risk Medicare Beneficiaries with Predictive Analytics
Identifying High-Risk Medicare Beneficiaries with Predictive Analytics September 2014 Until recently, with the passage of the Affordable Care Act (ACA), Medicare Fee-for-Service (FFS) providers had little
More information9 Expenditure on breast cancer
9 Expenditure on breast cancer Due to the large number of people diagnosed with breast cancer and the high burden of disease related to it, breast cancer is associated with substantial health-care costs.
More informationUniversity of Nebraska Prescription Drug Program 2014
University of Nebraska Prescription Drug Program 2014 The University of Nebraska s prescription benefit program is administered by CVS Caremark, a leading national provider of prescription drug benefit
More information!"#$%$&!"'()*+,-".-,/ &01*+("12"31+4156"$,+0"!*7("819".5(<(/4*<("&,5( :(()";(,-40"&,5( !"#$%$&!",/)"'()*+,5(
submitted anytime during the year to your institution HR/Benefits Office, and the tobacco premium will be waived beginning the first of the month following submission of the form. Important: A member is
More information