NAHDO Annual Conference; October 2009 Patrick Miller, MPH; Research Associate Professor Jo Porter,...

NAHDO Annual Conference; October 2009Patrick Miller, MPH; Research Associate

ProfessorJo Porter, MPH; Deputy Director

NH Institute for Health Policy and Practice

1NAHDO Annual Conference October 2009

222

NH Hospital Acute Care Pricing Comparison

Source NH Insurance Department, 2008NAHDO Annual Conference October 2009

3

Change in Distribution of Costs by Insurance Type: Concord

72% 72%59%

19% 18%

21%

9% 10%19%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2005 2006 2007

PPO

POS

HMO

NAHDO Annual Conference October 2009

NAHDO Annual Conference October 2009 4

Proportion of Annual Cost Increase Attributable to Each Category

2005-2007

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Manchester Nashua Concord

Pharmacy

Other

Health Status

Complications of Surgical &MedicalSigns & Symptoms

Congenital Anomalies

Injuries, Muscles & Skeletal

Cellulitis, Dermatitis andOther DiseasesPregnancy & Newborns

Genitourinary Diseases

Digestive System Diseases

Respiratory System Disorders

Heart & Other CirculatoryDiseasesDiseases of the Eye, Ear &Nervous SystemMental Disorders

Anemia & Other Blood

Nutritional & Metabolic

Cancers

Infectious Diseases

5

Payer by HAA

2005 Payments PMPM

2005 Total Payments PMPM2

2008 Payments PMPM

2008 Total Payments PMPM2

Berlin Carrier A $316.25 $324.57 $322.97 $340.72 Carrier B $310.87 $323.71 $313.59 $338.18 Carrier C $649.72 $668.37 $368.72 $377.45 Other $238.69 $260.63 $345.71 $383.32 Totals $297.92 $312.85 $351.21 $374.22

Colebrook Carrier A $284.94 $295.09 $278.18 $297.02 Carrier B $263.96 $278.17 $413.95 $450.80 Carrier C $326.27 $343.12 $323.50 $334.11 Other $188.43 $208.72 $322.50 $354.18 Totals $256.71 $271.84 $324.21 $347.21

Concord Carrier A $209.24 $222.14 $309.09 $327.66 Carrier B $247.19 $254.54 $260.16 $295.87 Carrier C $194.07 $204.87 $269.68 $288.56 Other $199.20 $214.96 $244.24 $268.52 Totals $224.75 $236.32 $287.35 $310.61 NAHDO Annual Conference October 2009

66

Prevalence of Adult Coronary Artery Disease by Age, NH Prevalence of Adult Coronary Artery Disease by Age, NH Medicaid (non-Dual) and NH CHIS Commercial Members, 2005 Medicaid (non-Dual) and NH CHIS Commercial Members, 2005

4%

0% 0% 0%

3%

7%

13%

20%

23%

2%

0% 0% 0%1%

2%

3%

6%

10%

0%

5%

10%

15%

20%

25%

All Ages 19-20 21-24 25-34 35-44 45-49 50-54 55-59 60-64

Medicaid-only CHIS Commercial


77

Percent of Children Age 3 to 6 Years with a Well-Child Visit Percent of Children Age 3 to 6 Years with a Well-Child Visit During the Year, SFY2006During the Year, SFY2006

70%

78% 77%

63% 66%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NH MedicaidClaims

NH SCHIPClaims

NH CHISCommercial

Claims

National HEDISMedicaid

National HEDISCommercial


88

Outpatient Emergency Department Visit Rates per 1,000 Outpatient Emergency Department Visit Rates per 1,000 Members by Age, SFY2006Members by Age, SFY2006

872

992

526

385

589

489

309

227

360

244303

194146

226

0

200

400

600

800

1,000

1,200

<1 (0-11 mos) 1-2 (12-35 mos) 3-6 (36 mos-6 yrs) 7-11 12-18

Medicaid SCHIP CHIS Commercial



Maine IP DischargesRate / 1,000 Discharges Total Paid Average Paid

2006 747 26.7 $ 11,864,264 $ 15,883 2007 770 34.5 $ 13,705,995 $ 17,800 Total 1,517 30.1 $ 25,570,259 $ 16,856 % Increase 3% 29% 16% 12%

New Hampshire IP Discharges

Rate / 1,000 Discharges Total Paid Average Paid

2006 459 22.3 $ 5,712,414 $ 12,445 2007 504 25.1 $ 6,719,104 $ 13,332 Total 963 23.7 $ 12,431,518 $ 12,909 % Increase 10% 12% 18% 7%


Carrier (Blinded)

ME Discharges

Rate / 1,000

Discharges

ME Payments

% Total Payments

NH Discharges

Rate / 1,000

Discharges

NH Payments

% Total Charges

1 39 0.77 $273,288 1% 90 2.21 $609,840 5%2 127 2.52 $1,320,522 0% 0 0 $ 0 0.0%3 9 0.18 $55,807 0% 187 4.60 $1,831,766 15%4 1,254 24.92 $23,014,786

90%342 8.41 $5,736,175

46%5 4 0.08 $21,312 0% 0 0.00 $ 0 0.0%6 84 1.67 $884,545 3% 344 8.46 $4,253,737 34%

Total 1,517 30.14 $25,570,259 100% 963 23.67 $12,431,518 100.0%

NAHDO Annual Conference October 2009 13APCD Meeting May 6, 2009 13

Selected Chronic Diseases: Prevalence Rate - Trends 2005-2007

Healthcare Review: Healthcare Review: New Hampshire BenchmarksNew Hampshire Benchmarks

64 62

3730

1019

93

67 63

3729

1019

92

56

28

1710

2838

60

137145

150

0

20

40

60

80

100

120

140

160

Low Back Depression Diabetes Asthma CoronaryHeart

Disease

Newborns SmokingRelated*

BreastCancer

ColorectalCancer

Rate/1000

2005 2006 2007

** ‘Smoking related’ refers to diagnoses identified by published research with high mortality risk for persons who smoke. Rates shown can not be linked directly to smokers.


Percent of Members Receiving Preventive Services**: Trends 2005-2007

Healthcare Review: Healthcare Review: New Hampshire BenchmarksNew Hampshire Benchmarks

36%39%

33%

65%

36%

66%

52%

30%34%

39%

26%

66%

36%

66%

53%

41%

35%

23%

65% 66%

51%

0%

20%

40%

60%

80%

100%

Preventive VisitMale 40-64

Prostate CancerScreen 50-64

Colorectal CancerScreen 50-64

Preventive VisitFemale 40-64

GYN Exam 18-64 Mammography 50-64

Cervical CancerScreen 18-64

2005 2006 2007** Measures are calculated for a one-year time period. Results may not correspond to HEDIS-related measures that cover multi-year time periods.


$26.2 $28.0 $30.5

$4.7$7.5

$6.9

$0

$5

$10

$15

$20

$25

$30

$35

$40

2005 2006 2007

Med

ical

Pay

men

ts (M

illio

ns).

Healthcare Review: Company XYZHealthcare Review: Company XYZ

HealthCare Costs - Impact of High Cost Cases** on Overall Medical Costs - Trends 2005-2007

48 patients$97K per case0.5% members15% payments

58 patients$129K per case0.7% members18% payments

** High Cost Cases = Patients with greater than $50,000 in claims for the year.** High Cost Cases = Patients with greater than $50,000 in claims for the year.

$30.9Mw/0 RX $

$35.5M64 patients

$107K per case0.7% members18% payments

$37.4M

Claims-based web moduleThrough CDC Assessment Initiative funding,

NH is building a claims module for the NH Web-based Reporting and Query System (HealthWRQS).Will augment web modules that use other

administrative data Hospital discharge, birth, death, cancer registry,

BRFSS dataWill develop a Community Health Profile

To include most relevant indicators for each data set

Questions and Discussion

[email protected]

[email protected]


NAHDO Annual Conference; October 2009 Patrick Miller, MPH; Research Associate Professor Jo Porter,...

Documents

Transcript of NAHDO Annual Conference; October 2009 Patrick Miller, MPH; Research Associate Professor Jo Porter,...