Healthcare Spending Among Privately Insured Individuals Under Age 65 - February 2012
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Healthcare
Spending Among
Privately Insured
Individuals
Under Age 65
February 2012
Report by the IMS Institute for Healthcare Informatics
Healthcare
Spending Among
Privately Insured
Individuals
Under Age 65
February 2012
Report by the IMS Institute for Healthcare Informatics
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 IMS Institute for Healthcare Informatics
of the privately insured population is critical to successfully address cost growth 11 Waterview Boulevard
trends, and ensure appropriate planning for this evolving population. Parsippany, NJ 07054
USA
Using comprehensive, proprietary data consisting of more than 10 million info@theimsinstitute.org
privately insured members under age 65, we were able to examine the www.theimsinstitute.org
distinctions between IMS aggregated healthcare use and spending patterns and
those commonly cited among health services researchers, including the Analysis and support from IMS Payer Solutions gratefully
Agency for Healthcare Research and Quality (AHRQ) and Centers for acknowledged in the development of this report.
Medicare and Medicaid Services (CMS).
©2012 IMS Health Incorporated and its affiliates.
In this report, we highlight the differences, examine healthcare spending All reproduction rights, quotations, broadcasting,
patterns among the privately insured under age 65 by considering spending publications reserved. No part of this publication may be
on outpatient, inpatient and pharmacy, and discuss the potential implications. 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
Murray L. Aitken Institute for Healthcare Informatics.
Executive Director
IMS Institute for Healthcare Informatics
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Healthcare Spending Among Privately Insured Individuals Under Age 65.
Report by the IMS Institute for Healthcare InformaticsContents
Executive Summary ............................................................... 1
Total Healthcare Spending ..................................................... 3 APPROACH AND METHODOLOGY
- All Payers The LifeLink™ Health Plan Claims Database, which
- Privately Insured comprises 6.7 billion medical and pharmacy claims,
79 health plans, and 79.4 million members from 2001 to
Outpatient Spending ........................................................... 14 the present, was used to conduct this study. A more
- Privately Insured detailed description can be found in the Appendix.
These analyses were derived from an analytic subset of the
Inpatient Spending ............................................................. 17 database, covering the time period from January 1, 2009
- Privately Insured through December 31, 2010 for only privately insured
health plan members under age 65 with continuous
Pharmacy Spending ............................................................. 21 enrollment and medical and pharmacy benefit coverage.
- Privately Insured Cost and use patterns in the overall study population,
including 17 chronic conditions, 12 cancers, and 10
Top 1% Member Spending Cohort Profiles ............................. 25 auto-immune and other specialty conditions were studied.
- Total Healthcare Spending Costs reported reflect the plan allowed amount (i.e., plan
- Spending Profile paid amount plus member contribution) for a given service.
- RA and MS Spending Profiles 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
Potential Implications .......................................................... 30 conditions studied can be found in the Appendix.
End Notes ........................................................................... 32 Findings in this report may differ from prior analyses of US
Notes on Sources ................................................................ 33 and Medicare spending due to inherent differences in the
health status and age distribution of the privately insured
Appendix ........................................................................... 35 and differences in analytic methods, such as requiring
continuous member enrollment and medical and pharmacy
About the IMS Institute ...................................................... 45 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.
Healthcare Spending Among Privately Insured Individuals Under Age 65.
Report by the IMS Institute for Healthcare InformaticsExecutive summary
In 2010, 184 million Americans were enrolled in a total cost was incurred by the 50% of members with Among health plan members, spending is highly
private health insurance plan and collectively were the least annual spending. disproportionate to prevalence rates. Over one-third
responsible for $822 billion in healthcare This reinforces the importance of understanding the of members have one or more chronic conditions
expenditures. By 2020, enrollment is expected to be profile, behavior and interventions that can be and account for over two-thirds of total spending for
198 million and expenditures will reach $1.4 optimally applied to the relatively small number of all members. Members with cancer amount to only
trillion. This commercially insured segment of the members who have a substantial impact on overall 1.5% of all health plan members and account for
healthcare system and in particular the under 65 year healthcare costs. almost 8% of total spending.
segment will remain the dominant part of the Other members with auto-immune or other
payment system even as the impact of Overall spending levels of the privately insured
under 65 population are mostly focused on specialty conditions represent 1.7% of all members,
implementation of the Affordable Care Act and consume 7% of total spending.
transforms the healthcare landscape. A deep outpatient and pharmacy services, representing 59%
understanding of the characteristics, dynamics and and 21% of total spending, respectively. Inpatient OUTPATIENT SPENDING
drivers of utilization and cost within the services represent the remaining 20% of spending. Outpatient services represent the largest share of
commercially insured under 65 segment is This distribution of costs differs significantly from total spending, averaging $2,251 per member per
particularly important as we stand on the threshold that reported by the Medical Expenditure Panel year, or $188 per member per month. Professional
of substantial increases in spending and dependence Survey (MEPS) for all payers and for the Medicare and facility visits account for 74% of overall
by enrollees in such programs. 65 and over population. In particular, Medicare 65 spending, with emergency room visits a further 10%.
and over population spending on inpatient services Outpatient medical drug therapy, including office,
TOTAL HEALTHCARE SPENDING LEVELS represents 43% of total spending, while outpatient facility and home-based injections and infusions,
For the total sample of more than 10.6 million and pharmacy services represent 39% and 18%, were 5% of all outpatient spending, or $9 per
privately insured health plan members analyzed in respectively. The differences in spending distribution member per month on average. However,
this report, average healthcare spending in 2010 was between the privately insured under 65 population and outpatient drug therapy for oncology,
$3,840, or $320 per member per month. However the Medicare 65 and over population are substantial auto-immune and other specialty condition
the 5% highest cost members accounted for 50.6% and highlight the need for correspondingly populations studied were significantly higher, and
of the total cost, and over 25% of the total cost was differentiated analysis, understanding, and actions amount to 19% and 18%, respectively.
for just 1% of the members. Conversely, just 3% of aimed at bending the overall US healthcare cost curve.
continued on next page...
Healthcare Spending Among Privately Insured Individuals Under Age 65. 1
Report by the IMS Institute for Healthcare Informatics...continued from previous page
Executive summary
INPATIENT SPENDING Specialty drugs represent about 1% of the total of The distribution of spending among the 1% cohort
Spending per inpatient admission was $14,248 on pharmacy prescriptions but 17% of total pharmacy is similar to that of the Medicare 65 and over
average, and accounts for 20% of overall spending spending. Relative to total healthcare spending – population, with 45% of spending being for
per member. Facility costs account for 84% of the including inpatient costs, outpatient medical costs inpatient services, 45% for outpatient services, and
total inpatient spending, with the balance being and non-specialty pharmacy costs – specialty drug 10% for pharmacy benefits.
professional costs. Members with chronic conditions therapy and outpatient medical drug therapy are Average spending for the top 1% of members with
had 63% of all hospital admissions, and averaged particularly high for members with auto-immune or specific chronic conditions is between five- and ten-
$15,566 per admit. These costs include average 4.5 other specialty conditions and represent 33% of their fold the average spending for all members with the
days of stay, and 219 professional visits per 1,000 total healthcare spending. By comparison, these drugs same conditions. For example, members with
members. Oncology patients had the highest average represent 17% of spending for oncology patients, and diabetes average $11,858 in annual spending, while
cost per admission, at $20,074 but admissions only just 6% for those members with chronic conditions. those suffering from diabetes who are in the top 1%
totaled 2.8 admissions per 1,000 members cohort average $102,465 in annual spending.
compared to 29.3 admissions per 1,000 members for TOP 1% SPENDING COHORT
Consistent with patterns across the healthcare Similarly, those with chronic renal failure on average
chronic conditions. spend $33,801 per year, but those within the top 1%
system, privately insured under 65 health plan
cohort spend over $150,000 annually.
PHARMACY SPENDING members who are among the top 1% in annual
Average pharmacy spending – including outpatient spending are vastly disproportionate users of Efforts to address healthcare spending levels and
drug claims for both specialty and non-specialty healthcare resources. They average almost $100,000 ensure optimal care for patients require detailed
medicines – amounts to 21% of total healthcare in annual spending per member. Within the top 1% understanding from timely and robust information.
spending for the privately insured under age 65 cohort, our analysis shows that 77% of the members This analysis is intended to focus attention on the
population. For every 1,000 members, 11,950 had at least one chronic condition, 16% had one or patient segments, care settings, and treatment options
prescriptions were filled in 2010, of which 78% were more cancers, and 13% suffered from auto-immune that can best bring improved health outcomes at
for those members with chronic illnesses. Members or other specialty conditions (some members had lowest cost to those in need. Understanding the
with oncology and those with auto-immune or more than one of these condition groupings). The privately insured under 65 populations and
other specialty conditions filled only 4% and 5% of oncology patients had the highest average spending, addressing their health needs efficiently will bring
the total number of prescriptions. of $118,000 per year. significant benefits to the entire healthcare system.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 2
Report by the IMS Institute for Healthcare InformaticsTotal Healthcare Spending – All Payers
HIGHLIGHTS
• Private insurance will remain the largest segment (57%) of
the covered population through 2020.
• Insurance exchanges are projected to include 12.5% of the
privately insured by 2020.
• Private insurance expenditures will remain the largest share
of insurance spending (41%) through 2020.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 3
Report by the IMS Institute for Healthcare InformaticsTOTAL HEALTHCARE SPENDING – ALL PAYERS
Enrollment in private insurance will reach 197.8Mn by 2020
• In 2010, 63.4%, 183.9 million, of insured
Insurance Enrollment in the US(Mn) individuals in the US were enrolled in
private health insurance, while 16.1%,
46.8 million, and 18.5%, 53.7 million, of
25.9 insured individuals were enrolled in
25.8
18.8 24.8 Medicare and Medicaid, respectively.
48.5 7.3 5.2 197.8Mn
individuals, • By 2016, private insurance enrollment is
195Mn 57% of
21.1 projected to increase by 6%, from 183.9
individuals, insured
183.9Mn 58% of population million to 195 million people. Health
individuals, insured 167.8 insurance exchange plans will represent
168.9 population
63% of
insured
18.8 million people, 9.6%, of all private
162.8 population enrollment.
• By 2020, private health insurance
1.4 enrollees are projected to remain the
5.2
largest proportion of the overall insured
5.9 83.5
80.6 population, at 57.3%, with Medicare and
53.7 Medicaid accounting for 18.1%,
62.3 million, and 24.2%, 83.5 million
55.4 62.3
46.8 individuals, respectively.
2010 2016 2020
Uninsured Exchanges Other Private Employer Chart notes
CHIP Medicaid Medicare Medicare volume includes individuals under age 65.
Medicare enrollees who purchase supplemental private
insurance are represented in both Medicare and private
Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group4 Dec 2010 insurance categories.11
Healthcare Spending Among Privately Insured Individuals Under Age 65. 4
Report by the IMS Institute for Healthcare InformaticsTOTAL HEALTHCARE SPENDING – ALL PAYERS
Spending on private insurance will exceed $1.4 trillion in 2020
• Private health insurance spending in
Healthcare Expenditures in the US($Bn) 2010 was $822.3Bn, or 44.5% of total
insurance expenditures. Medicare and
145 Medicaid expenditures were 28.4%,
3
$525Bn, and 21.7%, $400.7Bn,
$1,402Bn, respectively.
41.1% of
79 insurance • By 2016, private health insurance
4 $1,141Bn, 1,253 expenditures expenditures are projected to exceed
42.6% of
insurance $1 trillion, increasing by 38.8%, to
expenditures $1,141Bn.
1,058
6 • In 2020, private health insurance
39 $822Bn,
44.5% of expenditures will reach nearly $1.5
insurance
expenditures 16 trillion and represent 41.1%, the largest
783 908.1
proportion of insurance spending for
healthcare in the US. Medicare and
684.6
12 Medicaid will represent 27.7%, $922Bn,
400.7 and 26.7%, $908.1Bn, respectively, of total
healthcare spending on insurance.
922.0
707.4
525.0
2010 2016 2020
Chart notes
Exchanges Other Private Employer Medicare volume includes individuals under age 65.
Medicare enrollees who purchase supplemental private
CHIP Medicaid Medicare
insurance are represented in both Medicare and private
Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group4, Dec 2010 insurance categories.11
Healthcare Spending Among Privately Insured Individuals Under Age 65. 5
Report by the IMS Institute for Healthcare InformaticsTotal 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.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 6
Report by the IMS Institute for Healthcare InformaticsTOTAL HEALTHCARE SPENDING – PRIVATELY INSURED
Spending was highly concentrated
• A sample of more than 10 million
Distribution of Spending in the Privately Insured privately insured health plan members,
from the IMS LifeLink database, showed
96.9%
that over 25% of all spending was for just
1% of the total number of health plan
85.4% members.
80.7%
74.3%
• More than 50% of the total spending was
for only 5% of all health plan members.
65.2%
• Slightly more than 3% of expenditures
50.6%
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
25.6% overall US population, where AHRQ also
reports that 3% of spending was driven by
the bottom 50%, while 22% of spending
3.1% 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) (TOTAL HEALTHCARE SPENDING – PRIVATELY INSURED
Spending increased with age in the under 65 population
• Health plan members between the ages of
Average Annual Spending Per Member 45 and 64 expended, on average, $5,900
annually on healthcare services, or nearly
By Age and Gender ($) twice that of their counterparts between
the ages of 20 and 44, and four times that
$6,297 of members in the youngest age group -
$5,601
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,
$3,893 predominately due to higher rates of
healthcare utilization overall. This was
especially true for women aged 20 to 44.
$2,188
$1,784 $1,779
$1,580
$1,308
F M F M F M F M
0-9 10 - 19 20 - 44 45 - 64 Chart notes
Estimates of annual spending are averages based on
spending of all health plan members, including members
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 with no service use and no spending in the analysis year.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 8
Report by the IMS Institute for Healthcare InformaticsTOTAL HEALTHCARE SPENDING – PRIVATELY INSURED
Spending continued to increase in the Medicare population
• As with privately insured under age 65
Annual Program Payments Per Member ($) individuals, spending for Medicare
enrollees increased with age, with average
annual spending per enrollee higher than
$14,527 for the IMS privately insured population.
• On average, Medicare spending was
$10,109 per member across the age 65
$10,953 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
$6,550 prevalence of chronic conditions,
including hypertension, chest pain and
coronary artery disease.6
65-74 years 75-84 years 85 years or over
Chart notes
Graph represents data from 2010.
See Appendix for the definition of Medicare program
payments.
Source: Centers for Medicare & Medicaid Services, Office of Information Services, 2010
Healthcare Spending Among Privately Insured Individuals Under Age 65. 9
Report by the IMS Institute for Healthcare InformaticsTOTAL HEALTHCARE SPENDING – PRIVATELY INSURED
Spending increases differed as males and females aged
• Males, from birth to age nine, had higher
Average Annual Spending Per Member ($) 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
0-9 0-9 10-19 10-19 20-44 20-44 45-64 45-64
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 Chart notes
See Appendix: Cost and Use by Age and Gender for detailed
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 age-gender spending profiles.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 10
Report by the IMS Institute for Healthcare InformaticsTOTAL HEALTHCARE SPENDING – PRIVATELY INSURED
Spending was outpatient driven, in contrast to Medicare
• Among the IMS privately insured study
Distribution of Spending by Payer Type 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+
18% spending on inpatient care was 43%, more
21% 22%
than double the IMS population, while
spending for outpatient services, 39%, and
pharmacy, 18%, were much lower than
39% the IMS population.
47% • Inpatient spending remained a higher
59% proportion of overall spend.
43%
31%
20%
IMS Privately Insured MEPS All Payers MEPS Medicare
Under Age 65 65 and Over
Chart notes
Inpatient Outpatient Pharmacy MEPS represents data from 2009. See Notes on
Sources for details.
IMS place of service definitions differ slightly from
Source: IMS LifeLink Health Plan Claims Database, Dec 2010; Medical Expenditure Panel Survey2, 2009 MEPS definitions. See Appendix for detail.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 11
Report by the IMS Institute for Healthcare InformaticsTOTAL HEALTHCARE SPENDING – PRIVATELY INSURED
Share of spending was disproportionate for certain conditions
• Spending was highly disproportionate to
Proportion of Spending by Health Services Channel prevalence rates among health plan
members with chronic conditions, cancer,
auto-immune or other specialty diseases.
Condition Members $PMPM
• When the prevalence of these various
$PMPM conditions was compared to total
Set (N) (%)
spending for members affected by these
All Members 10,657,042 100.0% $320 100.0% specific diseases, their impact was
immediately evident and dramatic.
Chronic Conditions 3,862,984 36.2% $216 67.5% • More than one-third of all members,
36%, were shown to have at least one
Oncology 162,767 1.5% $25 7.9% chronic condition, and comprised
approximately two-thirds, 67.5%, of
Auto-Immune/Other 183,393 1.7% $22 7.0% spending for all members.
Specialty
Chart notes
$PMPM is a population-based measure that reflects the
proportion of all plan spending attributable to overall
members or member sub-populations. Estimates for
subgroups will be relatively low, even when spending for
each member in the subgroup is high, because the
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 denominator is the overall population.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 12
Report by the IMS Institute for Healthcare InformaticsTOTAL HEALTHCARE SPENDING – PRIVATELY INSURED
Treatment pattern differences across conditions were noteworthy
• Treatment patterns were outpatient
Distribution of Spending by Treatment Setting ($) driven among members with chronic or
oncology conditions, and pharmacy
driven for members with auto-immune
and other specialty conditions.
14% • For members with chronic conditions, 55%
21% 24% of all spending was for outpatient services,
12% 39% of which 3% was for medical drug therapy.
3%
3%
• Outpatient services comprised 65% of all
spending for members being treated for
8% cancer, with 12% of all spending for
56% 53%
medical drug therapy.
52%
• Inpatient spending represented a smaller
37% share of all spending for members with
auto-immune and other specialty conditions,
while outpatient spending was 45% and
21%
medical drug therapy 8% of all spending.
20% 21%
16%
• Pharmacy spending was 39% of
All Members Chronic Conditions Oncology Auto-Immune / all spending for members with auto-
($320 PMPM ($216 PMPM ($25 PMPM Other Specialty immune and other specialty conditions.
N=10,657,042) N=3,862,984) N=162,767) ($22 PMPM
N=183,393) Chart notes
Inpatient Outpatient Medical Outpatient Medical Rx Pharmacy Outpatient Medical Rx includes injected or infused drug
therapy administered in a facility, office, or home
health setting.
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 $PMPM is spending per member per month.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 13
Report by the IMS Institute for Healthcare InformaticsOutpatient 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.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 14
Report by the IMS Institute for Healthcare InformaticsOUTPATIENT SPENDING – PRIVATELY INSURED
Most outpatient spending was on professional and facility services
• Emergency room visits, at $18 per
Distribution of Outpatient Spending $PMPM member per month, was 10% of all
outpatient spending.
• Home health medical services
Home Health Laboratory/Pathology,
$7, 4% Radiology, $8, 4% represented 3% of all outpatient spending,
Medical, $5, 3% followed by radiology and laboratory/
Emergency Room,
pathology at 4% each.
$18, 10% • Outpatient medical drug therapy,
including office, facility and home-based
injections and infusions, were 5% of all
Home Health
$1
outpatient spending, or $9 per member
per month.
Facility
Professional
Medical Rx, $9, 5% $2
Medical, $74, 39%
Facility Medical,
Professional
$65, 35%
$6
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.
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 $PMPM is spending per member per month.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 15
Report by the IMS Institute for Healthcare InformaticsOUTPATIENT SPENDING – PRIVATELY INSURED
Medical drug therapy use resulted in different spending profiles
• In oncology, auto-immune and other
Distribution of Outpatient Spending $PMPM specialty condition populations studied,
higher use of medical drug therapy
1% 1% 1% 1% resulted in outpatient spending profiles
3% 3% 2% 4% that differed from the overall or chronic
23% patient populations.
30%
39% 38%
• 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
44% specialty conditions, compared to all
34%
members and members with chronic
35% 36% conditions at 5% each.
• Professional and facility spending
5% 19% 18% represented the largest share of outpatient
5%
4% 4% spending for members overall, and for
4% 5% 2% 3%
4% members with chronic conditions.
10% 8% 6%
3% 6%
All Members Chronic Conditions Oncology Auto-Immune /
Gary Gatyas
($188 Outpatient ($120 Outpatient ($16 Outpatient Other Specialty
PMPM PMPM PMPM ($10 Outpatient 11/15/2011
N=10,657,042) N=3,862,984) N=162,767) PMPM N=183,393) Should we add a- Y
axis on the right to
Emergency Room Radiology Laboratory/Pathology Medical Rx show dollars?
Facility Medical Professional Medical Home Health Medical Other
Chart notes
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 $PMPM is spending per member per month.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 16
Report by the IMS Institute for Healthcare InformaticsInpatient 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.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 17
Report by the IMS Institute for Healthcare InformaticsINPATIENT SPENDING – PRIVATELY INSURED
84% of inpatient spending was for facility-based care
• Spending per inpatient admission was,
Inpatient Spending Distribution and Service Use on average, $14,248.
• Each inpatient admission lasted 4.2 days,
on average, with 46.4 admissions per
1,000 members per year.
Cost Per Admit • Inpatient spending included professional
Measure
($)/Rate visits, with 310 visits per 1,000 members
Inpatient $PMPM $65
per year.
Professional
Allowed Amount ($) Per Admit $14,248
16%
Average Length of Stay (ALOS) 4.2
Admits Per 1,000 46.4
Days Per 1,000 195.4
Professional Visits Per 1,000 310.0
Facility
84%
Chart notes
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 $PMPM is spending per member per month.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 18
Report by the IMS Institute for Healthcare InformaticsINPATIENT SPENDING – PRIVATELY INSURED
Inpatient was a lower share of spending for specialty conditions
• Inpatient spending was 16%, or $4 per
Distribution of Total Spending $PMPM member per month, of all spending for
members with auto-immune and other
specialty conditions.
• Spending on inpatient services, for
All Members $65 $254 members with chronic conditions and
members with cancers, more closely
resembled the proportion spent for
inpatient services in the overall
All Chronic
$44 $171 population.
Conditions
All Oncology $5 $20
All Auto-
Immune/Other $4 $19
Specialty
0% 20% 40% 60% 80% 100%
Inpatient Outpatient & Pharmacy
Chart notes
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 $PMPM is spending per member per month.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 19
Report by the IMS Institute for Healthcare InformaticsINPATIENT SPENDING – PRIVATELY INSURED
Members with chronic conditions had 63% of all inpatient admissions
• Members with chronic conditions had
All Chronic Auto-Immune the largest share of inpatient facility
Description Oncology
Members Conditions /Other Specialty admits at 29 admissions per thousand;
they also had the largest share of
Inpatient $PMPM $65.33 $44.49 $5.33 $3.59 professional visits, logging 219 visits per
1,000 members.
Cost Per Admit($) $14,248 $15,566 $20,074 $16,856
• Oncology patients had the highest
Admits Per 1,000 46.4 29.3 2.8 2.2
average spending per admission, at
$20,074, which was nearly $6,000 higher
Average Length of than the average spending per admission
4.2 4.5 5.2 5.1 across all members.
Stay (ALOS)
• Oncology patients also had a longer
Days Per 1,000 195.4 132.1 14.4 11.3 average length of stay compared to the
overall member population and members
Professional Visits with a chronic condition, making cancer
310.0 219.0 23.7 18.6
Per 1,000 admissions the most expensive.
Chart notes
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 $PMPM is spending per member per month.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 20
Report by the IMS Institute for Healthcare InformaticsPharmacy 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.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 21
Report by the IMS Institute for Healthcare InformaticsPHARMACY SPENDING – PRIVATELY INSURED
Specialty pharmacy was 1% of utilization, yet 17% of spending
• Overall, 11,950 prescriptions per 1,000
Specialty vs. Non-Specialty Rx Spend and Usage members were filled annually, with 174
prescriptions per 1,000 members for
specialty medications, the majority of
$66.88 11,950 which were branded.
1%
17%
• At $11.31 per member per month,
specialty prescriptions were 17% of
pharmacy spending.
99%
83%
$PMPM Scripts/1,000 Chart notes
Figures reflect outpatient drug claims typically processed
Non -Specialty Specialty
by a pharmacy benefit manager utilizing NDC codes.
See Appendix for detail.
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 $PMPM is spending per member per month.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 22
Report by the IMS Institute for Healthcare InformaticsPHARMACY SPENDING – PRIVATELY INSURED
Members with chronic conditions filled most prescriptions
• Health plan members diagnosed with a
Prescriptions Per 1,000 Members chronic condition filled 78%, or 9,359 of
the 11,950 prescriptions filled per year
per 1,000 members.
• Members with auto-immune and other
All Members
specialty conditions filled nearly 5% of all
11,776 174 prescriptions, while those being treated
(Total Rx=11,950)
for cancer filled only about 4% of all
prescriptions.
Chronic Conditions • Specialty medications comprised 9% of
(Total Rx=9,359) 9,237 122 prescriptions filled by members with
auto-immune and other specialty
conditions, and 3% of those filled by
members with cancers.
Oncology
447 15
(Total Rx=462)
Auto-Immune/Other Specialty
525 51
(Total Rx=575)
Chart notes
Prescriptions per 1,000 is a measure of the total number
of prescriptions attributable to members with the specified
Non - Specialty Specialty
conditions relative to the overall population.
See Appendix for details. Figures reflect outpatient drug
claims typically processed by a pharmacy benefit manager
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 utilizing NDC codes. See Appendix for detail.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 23
Report by the IMS Institute for Healthcare InformaticsPHARMACY SPENDING – PRIVATELY INSURED
Total specialty drug spending was 6% to 33% of all spending
• Medical drug therapy and specialty
Percent of $PMPM pharmacy combined share of spending
was highest in specialty conditions.
$20.38 $14.14 • Across all members, medical drug therapy
$4.20 and specialty pharmacy combined were
$7.50 $20.38 per member per month, and
represented 6% of all spending.
• By contrast, medical drug therapy and
PERCENT OF $PMPM
specialty pharmacy represented 33%, or
$7.50 per member per month, of all
spending for members with auto-
$299.41 $201.71 immune and other specialty conditions.
$21.12
• At 17% of all spending, expenditures
$14.92
for medical drug and specialty pharmacy
were also higher among members
with cancers.
All Members All Chronic All Oncology All Auto-
Conditions Immune/Other
Specialty
Chart notes
Inpatient, Outpatient Medical, Non-Specialty Pharmacy Outpatient Medical Rx and Specialty Pharmacy includes
Outpatient Medical Rx, Specialty Pharmacy drugs administered in the facility, office, home, or
pharmacy settings.
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 $PMPM is spending per member per month.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 24
Report by the IMS Institute for Healthcare InformaticsTop 1% Member Spending Cohort Profiles
• Average annual spending approached $100,000 per member.
• More than 75% of the members had at least one chronic
condition; 16% had at least one cancer.
• Inpatient spending was more than double the proportion
observed in the overall population.
• The share of spending for inpatient services resembled the share
reported in the Medicare 65+ population.
• Members with certain chronic conditions had much higher
costs than all members with the same conditions, reflecting
higher inpatient spending.
• Spending on medical drug therapy administered in the
outpatient facility, office or home was:
• 6 times higher for members with rheumatoid arthritis
(RA) in the top 1% versus all members with RA.
• 3 times higher for members with multiple sclerosis (MS)
in the top 1% versus all members with MS.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 25
Report by the IMS Institute for Healthcare InformaticsTOTAL HEALTHCARE SPENDING – TOP 1% SPENDING COHORT
Annual spending neared $100,000 per member in the top 1%
• Annual spending neared $100,000 per
Average Annual Spending Per Member member for the top 1% cohort, in contrast
to $3,837 per member for the overall
Top 1% Cohort ($) population.
• In the top 1% cohort, 77% of members
$118,203 diagnosed with one or more chronic
conditions had annual spending of $97,652
$98,310 $97,652
per member.
$86,289
• Additionally, 16% of members in this
cohort had one or more cancers, and
average annual spending per member for
those with cancer was higher, at $118,203,
than for members with chronic, auto-
immune or other specialty conditions.
• Average annual per member spending for
the top 1% cohort members with auto-
immune and other conditions treated with
specialty medication, was lower, relative to
cancer, at $86,289.
All Top 1% Chronic Conditions Oncology Auto-Immune /
Members (N=82,152) (N=17,230) Other Specialty
(N=106,570) (N=13,387)
Chart notes
Members in this cohort may be more likely to have
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 multiple conditions within and across condition groupings.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 26
Report by the IMS Institute for Healthcare InformaticsTOTAL HEALTHCARE SPENDING – TOP 1% SPENDING COHORT
Nearly half of all spending in the top 1% cohort was for inpatient
• Spending in the top 1% cohort of the
Distribution of Spending by Treatment Setting IMS population resembled the Medicare
65+ spending distribution.
• Inpatient spending in the top 1%
population was more than twice the
10% proportion observed in the overall
21% 18%
population.
• Pharmacy and outpatient services
represented a smaller share of spending
45% 39% for the top 1% cohort relative to the
overall population.
59%
45% 43%
20%
IMS Privately Insured Top 1% IMS Privately MEPS Medicare
Under Age 65 Insured Under Age 65 65 and Over
Inpa ent Outpa ent Pharmacy Chart notes
MEPS represents data from 2009.
IMS place of service definitions differ slightly from MEPS
Source: IMS LifeLink Health Plan Claims Database, Dec 2010; Medical Expenditure Panel Survey2, 2009 definitions. See Appendix for detail.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 27
Report by the IMS Institute for Healthcare InformaticsSPENDING PROFILE - OVERALL AND TOP 1% COHORT
Inpatient spending for the top 1% with chronic conditions was higher
• The top 1% cohort of members with
Average Annual Spending Per Member chronic conditions had much higher,
inpatient driven spending.
By Chronic Condition ($)
• Members with diabetes in the top 1%
cohort had spending that was nearly nine
$150,226
times higher, on average, than all members
with diabetes.
$115,445
• The difference in diabetes and other top
$104,058
1% chronic conditions was reflective of
$102,465
higher inpatient spending.
• Pharmacy remained a small proportion of
spending for members with these
conditions across the top 1% cohort.
• On average, more than $150,000 was spent
$33,801 annually for each member in the top 1%
$22,107 cohort with chronic renal failure, which
$11,858 $15,173 was considered particularly high.
All Diabetes Top 1% All MI Top 1% All Stroke Top 1% All CRF Top 1%
(N=517,997) Diabetes (N=21,146) MI (N=64,457) Stroke (N=39,503) CRF Chart notes
(N=17,155) (N=2,054) (N=3,116) (N=5,329) Results reflect Year 2 costs incurred by members with
Type 1 or Type 2 diabetes, stroke, myocardial infarction
Inpatient Outpatient Pharmacy
(MI) or chronic renal failure (CRF) in Year 1 of the
study period. Top 1% cohort estimates for these conditions
exclude members with cancer, auto-immune and other
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 specialty conditions.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 28
Report by the IMS Institute for Healthcare Informatics$29,602
RA AND MS SPENDING PROFILES - OVERALL AND TOP 1% $16,932
Inpatient spending for top 1% with specialty conditions was higher
All MS Top 1% MS All RA Top 1% RA
(N=16,361) (N=2,885) (N=53,120) (N=3,131)
Inpatient Outpatient Medical Outpatient Rx
Specialty Rx Non-Specialty Rx
• At $15,141 per member per year, specialty
Average Annual Spending Per Member pharmacy was 51% of spending for all
members with multiple sclerosis. For the top
By Specialty Condition ($) 1% cohort, specialty pharmacy spending was
higher at $27,522, but represented a smaller
proportion of overall spending at 41%.
$79,407 • Outpatient medical drug spending was
$66,445
similar for all members with multiple
$21,045
sclerosis or rheumatoid arthritis, but six
(27%) times higher for rheumatoid arthritis and
three times higher for multiple sclerosis for
$35,781 members in the top 1% cohort.
(52%)
$29,602 • Specialty pharmacy and medical drug
spending combined were 58% for all
$16,932
$17,308 members with multiple sclerosis, and 52%
(58%) $5,448 for the top 1%; it was 32% for all
(32%)
members with rheumatoid arthritis and
All MS Top 1% MS All RA Top 1% RA 27% for the top 1% cohort.
(N=16,361) (N=2,885) (N=53,120) (N=3,131)
• Inpatient spending was a smaller proportion
Non-Speciality Rx $2,768 $6,520 $2,255 $6,132 of all spending than for top 1% members
Speciality Rx $15,141 $27,522 $3,606 $9,367 with diabetes, stroke or myocardial infarction.
Outpatient Medical Rx $2,167 $7,259 $1,842 $11,678
Outpatient Medical $7,175 $16,332 $6,434 $25,780 Chart notes
Inpatient $2,351 $8,813 $2,795 $26,449 Results reflect Year 2 costs incurred by members with
rheumatoid arthritis (RA) and members with multiple
sclerosis (MS) in Year 1 of the study period. Top 1% cohort
Source: IMS LifeLink Health Plan Claims Database, Dec 2010 for myocardial infarction (MI) excludes members with
cancers, stroke, MI or chronic renal failure (CRF).
Healthcare Spending Among Privately Insured Individuals Under Age 65. 29
Report by the IMS Institute for Healthcare InformaticsPotential Implications
• Health plan management strategies for • Members with chronic conditions are responsible • Managing health status among health plan
privately insured, under 65 members cannot for the majority of healthcare expenditure in the members with chronic conditions may result
simply be an extension of Medicare strategies, overall as well as the top 1% spending cohort in cost savings down the road for Medicare, if
given their lower share of spending for populations studied.These members and their investment in these individuals reduces or
inpatient service spending, and higher shares health plans would benefit from: delays complications.
for outpatient and retail pharmacy spending. • Employer-led wellness efforts;
• Members with cancers remain a small
• Outpatient service pricing, use and • Prospective outpatient service management proportion of all members but have high per
management are important to private payers’ and outreach to reduce co-morbidity and patient spending, and higher proportions of
ability to manage costs across their complication risks; outpatient spending, including medical drug
membership, particularly as health exchanges • Healthcare payment and delivery model therapy.
result in large numbers of new entrants to the innovations that reward primary care • These members could benefit from
privately insured population. physicians for coordinating specialty care treatment pathway and setting management
for chronic care patients and align initiatives that align incentives among
incentives to facilitate care coordination providers for care coordination.
across providers; and
• When possible, providing coverage for
• Care management programs that target self-administered therapies through retail
reductions in re-admission rates among pharmacy outlets may lead to greater
members with conditions like MI, Stroke, efficiency and better quality of life for
Diabetes or Chronic Renal Failure, which members with cancer.
could lead to system cost savings and
improved member quality of life. • Emerging guidelines around cancer
screening and treatment may improve
treatment effectiveness, lower cost, and
improve quality of life for patients with
different cancers.
Continued on next page...
Healthcare Spending Among Privately Insured Individuals Under Age 65. 30
Report by the IMS Institute for Healthcare InformaticsPotential Implications Continued
• In certain disease populations, increased use of • Medicare and private payers face similar
specialty retail drug therapy may lead to challenges managing spending and utilization
decreased overall member spend. for drug therapy administered in an outpatient
• Specialty medications dispensed through facility, office or home setting and paid under
the traditional or specialty retail pharmacy the medical benefit. These challenges include:
setting are a key cost driver and need • Coordinating the management of
contracting and utilization management. outpatient medical and retail pharmacy
• At the same time, patients with auto- drug use, spending, and appropriateness
immune and other specialty conditions had • Evaluating effects of offering specialty
lower spending and use rates for inpatient medications through the retail or home
services than members with cancers or for health setting, in addition to or instead of in
chronic conditions without specialty drugs. the outpatient facility or office setting,
• Additionally, members with auto-immune when clinically possible.
and other specialty conditions in the top
1% cohort, including MS and RA, had
lower overall per member spending, despite
higher shares of retail pharmacy spending.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 31
Report by the IMS Institute for Healthcare InformaticsEND NOTES
1 IMS Literature Review. August 2011. 10
Office of Information Services; Data from the MEPS-HC Summary Data Tables Technical Notes.
Standard Analytical files; data development by the Agency for Healthcare Research and Quality. May
2Medical Expenditure Panel Survey: Tables of Office of Research, Development and Information. 2004. http://www.meps.ahrq.gov/survey_comp/
Expenditures by Health Care Services. Agency for 2010. https://www.cms.gov/MedicareMedicaid hc_technical_notes.jsp
Healthcare Research and Quality. 2009. StatSupp/08_2011.asp
http://meps.ahrq.gov/mepsweb/data_stats/quick_ 11
Projections of National Health Expenditures:
tables_results.jsp 6
Van Den Bos J. Low Cost vs. High Cost Patients: Methodology and Model Specification. Centers for
What Medical Conditions are Most Common. Medicare & Medicaid Services, Office of the Actuary,
3Cohen, S. and Yu, W. The Concentration and Milliman Pharmaco-Actuarial Advisor. 2010. National Health Statistics Group. July 2011.
Persistence in the Level of Health Expenditures http://publications.milliman.com/periodicals/pa/p https://www.cms.gov/NationalHealthExpendData/
over Time: Estimates for the U.S. Population, dfs/low-cost-high-cost.pdf downloads/projections-methodology.pdf
2008–2009. Statistical Brief #354. January 2012.
Agency for Healthcare Research and Quality, 7
IMS Clinical Benchmarks, Disease & Condition 12
2010 Glossary. Medicare & Medicaid Services
Rockville, MD. http://www.meps.ahrq.gov/mepsweb Product. 2010. Statistical Supplement. Centers for Medicare
/data_files/publications/st354/stat354.pdf & Medicaid Services. June 2011.
8
Healthcare in America: Trends in Utilization. http://www.cms.gov/MedicareMedicaidStatSupp/LT
4National Health Expenditure Projections 2010- US Department of Health and Human Services. /list.asp#TopOfPage
2020. Centers for Medicare & Medicaid Services, Center for Disease Control, National Center for
Office of the Actuary, National Health Statistics Health Statistics. 2004.
Group. 2010. https://www.cms.gov/nationalhealth http://www.cdc.gov/nchs/data/misc/healthcare.pdf
expenddata/downloads/proj2010.pdf
9
A Data Book: Healthcare Spending and the
5Table 3.4 Persons Served and Program Payments Medicare Program, June 2010. MedPac. 2010; 27.
for Medicare Beneficiaries, by Demographic http://www.medpac.gov/documents/Jun10DataBoo
Characteristics: Calendar Year 2010. Medicare & kEntireReport.pdf
Medicaid Statistical Supplement. Centers for
Medicare & Medicaid Services,
Healthcare Spending Among Privately Insured Individuals Under Age 65. 32
Report by the IMS Institute for Healthcare Informaticscontinued on next page...
NOTES ON SOURCES
IMS LifeLink™ Health Plan Claims Database and • A contributing plan’s data submission undergoes healthcare coverage will have different patterns of
Study Sample rigorous quality review prior to its addition to the healthcare use and spending. However, this
Database, as well as with each subsequent standard design approach ensures consistency in
• The LifeLink™ Health Plan Claims Database is transmission of data, and at various stages of the underlying population.
comprised of de-identified, commercial health processing and use to ensure end-to-end data
plan information obtained from health plans integrity. • Treatment setting definitions differ slightly
throughout the United States. It is fully between IMS and publically available sources,
adjudicated medical and pharmaceutical claims, • Given the Year 1 identification and Year 2 despite best efforts to align them where possible.
including inpatient and outpatient facility, reporting framework, it is possible that members This may account for some differences in spending
professional, retail and mail order pharmacy diagnosed in Year 2 would increase the average distribution by setting.
experience as well as member enrollment detail. annual cost for some conditions (e.g., myocardial
infarction, stroke). However, this standard design
• Records in the LifeLink™ Health Plan Claims approach enables reporting of costs and service
Database are generally representative of the use across a consistent time frame for all
national, commercially insured population in conditions.
terms of age and gender. The data are also
longitudinal, with average member enrollment • Only health plan members with 24 months of
duration of two to three years. Only health plans continuous enrollment and evidence of a medical
that submit data for all members are included in and a pharmacy benefit are included in the study.
the database, ensuring complete data capture It is possible that individuals with shorter
and representative samples. enrollment duration and/or lower levels of
Healthcare Spending Among Privately Insured Individuals Under Age 65. 33
Report by the IMS Institute for Healthcare InformaticsNOTES ON SOURCES
Medical Expenditure Panel Survey: Tables of National Health Expenditure Projections Medicare & Medicaid Statistical Supplement
Expenditures by Health Care Services 2009 2010-2020 2010
• MEPS Household Component Data contain • National Health Expenditure Projection tables • This supplement provides metrics on Medicare,
individual and household-level estimates of present information on enrollment and Medicaid and other CMS programs. We used data
health expenditures and utilization. MEPS is expenditure by source of funds and type of from this source to find the weighted average of
comparable to IMS in its exclusion of service. We focused on enrollment and expenditure annual Medicare program payments from 2009.
institutionalized civilians and foreign visitors to tables with the effects of the Affordable Care Act.
the US. Furthermore, MEPS information is We manipulated the data to evaluate specific • The source presents Medicare program payments
available by age distribution and insurance type trends between 2010-2016, a time in which a per enrollee, which allows for comparison with
which allows for data manipulation into large amount of change is projected after the IMS metrics that also analyze enrolled members.
comparable cohorts. In contrast, CMS data immediate onset of the Affordable Care Act. We Not included in Medicare program payments are
include US citizens living abroad, military then continued trend analysis up to year 2020. interim payments to institutional providers,
personnel, inhabitants of US territories and payments to institutional providers resulting from
institutionalized civilians.1 • Trends are consistent with other internal IMS adjustments to the end of first-year cost reports,
deliverables, as well as external sources that use capitation payments for prepaid group health
• To the extent possible, MEPS treatment settings public data (e.g., Congressional Budget Office) or plans, beneficiary cost-sharing amounts and
were classified to mirror IMS definitions. Some private data sources.1 administrative costs.
definitional differences remain, however,
regarding professional and dental services. • Medicare enrollees in managed care plans are not
For example, MEPS data do not distinguish included in the denominator used to calculate
between professional inpatient and outpatient average payments, since these payments are not
visits or inpatient and outpatient dental borne by CMS directly.
services. Additional limitations to the MEPS/IMS
comparison include use of data from different
• Trends in growth of payments per capita by age is
years (MEPS 2009; IMS 2010) and definitional
consistent with other publicly available data, such
differences in private insurance payment
as National Health Expenditure data from 2004.1
amounts.
Healthcare Spending Among Privately Insured Individuals Under Age 65. 34
Report by the IMS Institute for Healthcare InformaticsAPPENDIX 1
Conditions Included in Analysis
Overall Membership and Disease Population Analysis
ALL MEMBERS
Chronic Conditions Anxiety/Phobia Diabetes - Type 2
Asthma Hyperlipidemia
Back Pain Hypertension
Chronic Renal Failure Myocardial Infarction
Congestive Heart Failure Obesity
Chronic Obstructive Pulmonary Disease Osteoarthritis
Coronary Artery Disease Osteoporosis
Depression Stroke
Diabetes - Type 1
Oncology Breast Cancer Lymphoma
Cervical/Uterine/Ovarian Cancer Pancreatic Cancer
Colorectal Cancer Prostate Cancer
Kidney Cancer Skin Cancer - Melanoma
Leukemia Stomach Cancer
Lung Cancer Thyroid Cancer
Auto-Immune & Crohn's Disease Multiple Sclerosis
Other Specialty Conditions Cystic Fibrosis Psoriasis
Growth Disorders Psoriatic Arthritis
Hemophilia Rheumatoid Arthritis
Hepatitis C Ulcerative Colitis
Healthcare Spending Among Privately Insured Individuals Under Age 65. 35
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