Michelle Kloc, Ph.D., MSN, RN November 4, 2013

Altarum Institute integrates independent research and client-centered consulting to deliver comprehensive, systems-based solutions that improve health and health care. A nonprofit, Altarum serves clients in both the public and private sectors. For more information, visit www.altarum.org

Age-Focused Evaluation of Prevalence, Healthcare Costs, and

Utilization, by CCS Condition, in the Military Health System

Michelle Kloc, Ph.D., MSN, RN

November 4, 2013

American Public Health Association 141st APHA Annual Meeting

2

Research Team

Altarum Institute Michelle Kloc, Ph.D., MSN, RN

[[email protected]] Joe Dorris, MA Charles Roehrig, Ph.D.

Department of Defense Office of the Assistant Secretary of Defense (Health

Affairs), Defense Health Agency, Defense Health Cost Assessment and Program Evaluation• Diana Jeffery, Ph.D.

3

Presenter Disclosures

The following personal financial relationships with commercial interests relevant to this presentation

existed during the past 12 months:

Michelle Kloc

“No relationships to disclose”

4

Disclaimer

The opinions expressed herein are those of the authors, and are not necessarily representative of the opinions or policies of the Department of Defense (DOD); or the United States Army, Navy, Air Force, or Coast Guard

5

Introduction

Study builds on interest in determining health care condition prevalence, costs and utilization by various demographics (e.g. enrollment, age, gender, beneficiary category, etc.) and assessing trends over time.

A driving research interest related to identification of the ‘chronic’ population and its characteristics in order to appropriately determine Patient Centered Medical Home (PCMH) design, policy and resource allocation.

6

Methods

Population: All unique MHS beneficiaries alive and eligible within the study period, within

the U.S.• Beneficiaries with death during the study period were flagged• All MHS eligibles which represented approximately 10 million people each

year, with a focus on those age 18 – 64• Excluded beneficiaries overseas for the full year

Time Frame: FY06 through FY11, inclusive

Data: Obtained from SADR, SIDR, TED-I/N, PDTS, Ancillary (Laboratory/Radiology),

DEERS VM6 PITE representing directly provided and purchased inpatient, ambulatory, pharmacy, and ancillary care linked to enrollment and eligibility records.

** Results present data from 2 studies of the same population conducted from FY06-10 (excludes Alaska) and FY07-11 (includes Alaska and Hawaii).

7

Methods

Classification of Diseases HEDIS-based measures

• A beneficiary was considered to have a given chronic condition if they had a minimum of: a) 2 outpatient visits within a FY with the same ICD-9; and/or b) 1 inpatient admission for a given ICD-9. Chronic conditions by ICD-9 were defined using AHRQ chronic condition definition set.

Individual ICD-9s were grouped into higher level conditions using the Agency for Healthcare Research and Quality's (AHRQ) Clinical Classification Software (CCS) • Over 14,000 ICD-9s were grouped into approximately 264 CCS conditions

CCS Classification based upon primary ICD-9 DX only To provide greater operational relevance, Clinical Classification Software

(CCS) condition categories were further grouped into higher level Medical Conditions based upon the method used by Dr. Charlie Roehrig (Altarum Institute)• The approximately 264 CCS were aggregated into approximately 43 Medical

Conditions

8

Population demographics

2007 2008 2009 2010 2011

N % N % N % N % N %

GenderSub-

Population Overall 2,595,885 46.40% 2,639,742 46.30% 2,692,251 46.30% 2,725,329 46.40% 2,737,525 46.50%

FEMALE

Beneficiary Category

Active Duty 265,885 10.24% 267,629 10.14% 273,745 10.17% 278,095 10.20% 274,524 10.03%

Retired 77,379 3.00% 83,072 3.10% 88,411 3.30% 93,999 3.40% 99,560 3.60%

Other 2,252,621 86.78% 2,289,041 86.71% 2,330,095 86.55% 2,353,235 86.35% 2,363,441 86.33%

Age Group 18-24 571,588 22.00% 582,777 22.10% 602,787 22.40% 611,451 22.40% 608,159 22.20%

25-44 950,177 36.60% 964,230 36.53% 983,699 36.54% 998,563 36.64% 1,005,839 36.74%

45-64 1,074,120 41.40% 1,092,735 41.40% 1,105,765 41.10% 1,115,315 40.90% 1,123,527 41.00%

MALE

Overall 2,996,526 53.60% 3,056,250 53.60% 3,115,186 53.60% 3,151,749 53.60% 3,147,033 53.50%

Beneficiary Category

Active Duty 1,511,866 50.45% 1,529,402 50.04% 1,560,117 50.08% 1,569,035 49.78% 1,540,873 48.96%

Retired 1,072,613 21.70% 1,079,273 21.50% 1,075,338 21.00% 1,072,864 20.70% 1,069,615 20.60%

Other 412,047 13.75% 447,575 14.64% 479,731 15.40% 509,850 16.18% 536,545 17.05%

Age Group 18-24 894,707 29.90% 913,541 29.90% 936,839 30.10% 935,694 29.70% 916,295 29.10%

25-44 1,048,694 35.00% 1,070,308 35.02% 1,094,982 35.15% 1,119,850 35.53% 1,129,763 35.90%

45-64 1,053,125 35.10% 1,072,401 35.10% 1,083,365 34.80% 1,096,205 34.80% 1,100,975 35.00%

9

Top 5 CCS Conditions, based on Cost, by Age Group, FY2006-2010

Fiscal Year 2006

Fiscal Year 2007

Fiscal Year 2008

Fiscal Year 2009

Fiscal Year 2010

RankAge

Group CCS CategoryCCS CategoryCCS CategoryCCS CategoryCCS Category

1

Age 18-24 Exam/eval Exam/eval Exam/eval Exam/eval Exam/evalAge 25-34 Exam/eval Exam/eval Exam/eval Exam/eval Exam/evalAge 35-44 Back problem Back problem Back problem Back problem Back problemAge 45-64 Back problem Back problem Back problem Back problem Back problem

2

Age 18-24 Social admin Mood disorders Mood disorders Mood disorders Mood disordersAge 25-34 Back problem Back problem Back problem Back problem Back problemAge 35-44 Exam/eval Exam/eval Exam/eval Exam/eval Exam/evalAge 45-64 Coron athero Coron athero Coron athero Coron athero Ot conn tiss

3

Age 18-24 Mood disorders Social admin Rehab Rehab Adjustment disordersAge 25-34 Social admin Social admin Mood disorders Mood disorders Mood disordersAge 35-44 Ot conn tiss Ot conn tiss Ot conn tiss Ot conn tiss UnclassifiedAge 45-64 Chest pain Chest pain Ot conn tiss Ot conn tiss Unclassified

4

Age 18-24 Sprain Rehab Sprain Sprain Ot preg compAge 25-34 Ot compl bir Mood disorders Rehab Rehab Anxiety disordersAge 35-44 Unclassified Unclassified Unclassified Unclassified Ot conn tissAge 45-64 Ot conn tiss Ot conn tiss Chest pain Unclassified Osteoarthros

5

Age 18-24 Ot compl bir Sprain Social admin Adjustment disorders Ot joint dxAge 25-34 Mood disorders Ot compl bir Social admin Anxiety disorders Ot joint dxAge 35-44 Rehab Rehab Ot joint dx Ot joint dx Ot joint dxAge 45-64 Osteoarthros Unclassified Osteoarthros Osteoarthros Coron athero

10

Top 5 CCS Conditions, based on Cost, by Age Group, FY2006-2010

Fiscal Year 2006 Fiscal Year 2007 Fiscal Year 2008 Fiscal Year 2009 Fiscal Year 2010

RankAge

Group CCS Category

Total Condition Costs (excl

Rx) CCS Category


Rx) CCS Category


Rx) CCS Category


Rx) CCS Category


Rx)

1

Age 18-24 Exam/eval $151,481,874Exam/eval $155,510,697Exam/eval $181,356,045Exam/eval $211,894,623Exam/eval $233,611,404Age 25-34 Exam/eval $161,785,718Exam/eval $169,658,498Exam/eval $203,623,217Exam/eval $246,455,282Exam/eval $280,587,201Age 35-44 Back problem $155,056,055Back problem $158,621,205Back problem $174,129,983Back problem $184,942,844Back problem $190,023,678Age 45-64 Back problem $264,341,912Back problem $290,101,874Back problem $315,231,532Back problem $338,503,211Back problem $350,387,954

2Age 18-24 Social admin $78,218,733

Mood disorders $84,312,035




Age 25-34 Back problem $99,900,046Back problem $106,466,714Back problem $121,033,702Back problem $142,928,202Back problem $155,628,789Age 35-44 Exam/eval $116,369,228Exam/eval $115,302,036Exam/eval $128,171,859Exam/eval $148,254,259Exam/eval $158,538,877Age 45-64 Coron athero $194,786,538Coron athero $189,640,948Coron athero $176,692,757Coron athero $173,096,562Ot conn tiss $167,200,337

3

Age 18-24Mood disorders $74,444,363Social admin $82,007,625Rehab $70,817,509Rehab $73,182,522

Adjustment disorders $74,814,640

Age 25-34 Social admin $82,552,596Social admin $83,955,289Mood disorders $81,740,508



Age 35-44 Ot conn tiss $64,970,699Ot conn tiss $67,086,947Ot conn tiss $74,454,011Ot conn tiss $81,000,176Unclassified $88,525,228Age 45-64 Chest pain $138,737,466Chest pain $143,759,774Ot conn tiss $142,854,699Ot conn tiss $159,889,785Unclassified $154,962,062

4

Age 18-24 Sprain $63,230,254Rehab $65,328,898Sprain $70,113,025Sprain $71,385,843Ot preg comp $73,850,201

Age 25-34 Ot compl bir $70,769,337Mood disorders $73,173,663Rehab $78,834,719Rehab $82,837,603

Anxiety disorders $93,766,107

Age 35-44 Unclassified $52,046,242Unclassified $57,980,090Unclassified $68,400,363Unclassified $78,267,236Ot conn tiss $85,023,515Age 45-64 Ot conn tiss $119,973,898Ot conn tiss $126,903,701Chest pain $142,331,300Unclassified $141,808,421Osteoarthros $149,865,874

5

Age 18-24 Ot compl bir $59,772,419Sprain $64,035,536Social admin $67,443,596Adjustment disorders $71,219,825Ot joint dx $70,888,173

Age 25-34Mood disorders $68,936,159Ot compl bir $69,177,966Social admin $71,566,136

Anxiety disorders $78,532,444Ot joint dx $88,143,761

Age 35-44 Rehab $51,229,381Rehab $54,725,950Ot joint dx $59,935,295Ot joint dx $65,432,216Ot joint dx $72,250,378Age 45-64 Osteoarthros $105,639,710Unclassified $115,302,988Osteoarthros $129,184,659Osteoarthros $141,118,225Coron athero $143,819,288

11

Utilization for Top 5 CCS Conditions, based on Cost, by Age Group, FY2006-2010

Fiscal Year 2006 Fiscal Year 2007 Fiscal Year 2008 Fiscal Year 2009 Fiscal Year 2010

RankAge

Group CCS CategoryTotal Visits CCS Category

Total Visits CCS Category



Total Visits

1

Age 18-24 Exam/eval 1,102,061Exam/eval 1,188,717Exam/eval 1,342,777Exam/eval 1,532,823Exam/eval 1,624,210

Age 25-34 Exam/eval 1,026,876Exam/eval 1,103,407Exam/eval 1,291,221Exam/eval 1,556,096Exam/eval 1,718,700

Age 35-44 Back problem 553,584Back problem 612,064Back problem 685,472Back problem 771,033Back problem 883,593

Age 45-64 Back problem 1,208,341Back problem 1,399,546Back problem 1,590,656Back problem 1,824,139Back problem 2,083,374

2

Age 18-24 Social admin 590,118Mood disorders 220,885Mood disorders 239,948Mood disorders 275,141Mood disorders 288,890

Age 25-34 Back problem 381,983Back problem 434,106Back problem 507,955Back problem 614,913Back problem 748,331

Age 35-44 Exam/eval 681,238Exam/eval 700,254Exam/eval 765,555Exam/eval 891,500Exam/eval 931,108

Age 45-64 Coron athero 90,415Coron athero 87,017Coron athero 80,417Coron athero 72,216Ot conn tiss 1,412,643

3Age 18-24 Mood disorders 207,086Social admin 692,409Rehab 352,835Rehab 381,016

Adjustment disorders 206,467

Age 25-34 Social admin 656,550Social admin 732,119Mood disorders 298,284Mood disorders 345,525Mood disorders 385,162

Age 35-44 Ot conn tiss 330,850Ot conn tiss 360,584Ot conn tiss 393,514Ot conn tiss 438,066Unclassified 181,200

Age 45-64 Chest pain 125,457Chest pain 123,592Ot conn tiss 1,174,233Ot conn tiss 1,297,108Unclassified 341,194

4

Age 18-24 Sprain 254,779Rehab 357,115Sprain 273,245Sprain 278,037Ot preg comp 104,122

Age 25-34 Ot compl bir 83,557Mood disorders 282,237Rehab 431,197Rehab 474,525Anxiety disorders 320,463

Age 35-44 Unclassified 97,646Unclassified 101,719Unclassified 123,129Unclassified 153,835Ot conn tiss 482,912

Age 45-64 Ot conn tiss 938,066Ot conn tiss 1,050,044Chest pain 123,358Unclassified 309,675Osteoarthros 458,034

5Age 18-24 Ot compl bir 57,217Sprain 255,143Social admin 598,608

Adjustment disorders 192,926Ot joint dx 459,038

Age 25-34 Mood disorders 269,114Ot compl bir 88,806Social admin 689,253Anxiety disorders 269,191Ot joint dx 582,676

Age 35-44 Rehab 352,273Rehab 363,831Ot joint dx 417,900Ot joint dx 501,445Ot joint dx 587,228

Age 45-64 Osteoarthros 305,309Unclassified 245,256Osteoarthros 389,506Osteoarthros 428,558Coron athero 69,000

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Top 5 Conditions, based on Cost, for Females by Age Group, FY2007-2011

Rank Age Group

FY 2007 FY 2008 FY 2009 FY 2010 FY 2011

Condition Category

Total Govt Paid

Condition Category

Total Govt Paid

Condition Category

Total Govt Paid

Condition Category

Total Govt Paid

Condition Category

Total Govt Paid

1 18-24 Maternal $421,649,687Maternal $451,519,004Maternal $489,241,540Maternal $522,106,843Maternal $527,404,993

2 18-24 Screening $101,859,343Gastrointestinal $109,599,437Screening $119,927,009Screening $129,620,094Screening $145,952,668

3 18-24 Gastrointestinal $97,016,478Screening $107,078,861Gastrointestinal $119,009,860Reproductive $124,052,909Reproductive $130,027,109

4 18-24 Reproductive $97,016,189Reproductive $106,321,358Reproductive $116,598,956Gastrointestinal $119,326,142Mental disorders $120,842,476

5 18-24 Mental disorders $75,580,272Mental disorders $85,265,949Mental disorders $97,404,064Mental disorders $108,583,420Gastrointestinal $118,680,440

1 25-44 Maternal $472,298,884Maternal $517,605,599Maternal $571,493,008Maternal $653,663,040Maternal $714,750,380

2 25-44 Reproductive $227,152,279Reproductive $247,073,960Reproductive $279,062,108Reproductive $304,110,787Reproductive $325,138,601

3 25-44 Gastrointestinal $209,406,833Gastrointestinal $229,786,810Gastrointestinal $248,848,584Gastrointestinal $256,016,658Gastrointestinal $263,974,409

4 25-44 Screening $169,472,239Screening $180,828,992Screening $204,882,531Screening $222,929,191Screening $241,682,231

5 25-44 Cancers $132,997,214Cancers $146,267,411Mental disorders $165,724,771Mental disorders $187,117,204Mental disorders $214,138,976

1 45-64 Cancers $338,949,511Cancers $363,867,874Cancers $376,071,218Cancers $377,416,266Cancers $392,998,511

2 45-64 Gastrointestinal $240,975,023Musculoskeletal $259,800,672Musculoskeletal $293,036,365Musculoskeletal $317,467,622Musculoskeletal $349,703,547

3 45-64 Musculoskeletal $226,525,111Gastrointestinal $251,998,953Gastrointestinal $269,734,559Gastrointestinal $271,522,850Gastrointestinal $280,611,854

4 45-64 Heart conditions $141,995,316Back Problems $155,924,288Back Problems $172,014,624Back Problems $183,701,985Back Problems $196,750,417

5 45-64 Back Problems $139,887,171Heart conditions $149,395,828Heart conditions $156,939,787Screening $167,349,582Screening $180,909,347

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Top 5 Conditions, based on Cost, for Males by Age Group, FY2007-2011

Rank Age GroupFY 2007 FY 2008 FY 2009 FY 2010 FY 2011

Condition CategoryTotal Govt

PaidCondition Category

Total Govt Paid

Condition Category

Total Govt Paid

Condition Category

Total Govt Paid

Condition Category

Total Govt Paid

1 18-24 Trauma/Injury $195,263,268Trauma/Injury $196,248,414Screening $216,166,149Screening $252,615,999Screening $314,163,812

2 18-24 Screening $170,225,509Screening $186,680,568Trauma/Injury $190,762,494Mental disorders $191,863,020Mental disorders $220,421,011

3 18-24 Mental disorders $112,340,648Mental disorders $147,904,888Mental disorders $177,501,253Trauma/Injury $187,880,805Trauma/Injury $202,049,334

4 18-24 Musculoskeletal $86,524,139Musculoskeletal $99,507,616Musculoskeletal $104,988,021Musculoskeletal $114,217,468Musculoskeletal $126,175,074

5 18-24 Gastrointestinal $82,556,795Gastrointestinal $88,939,530Gastrointestinal $96,357,940Gastrointestinal $98,268,905Rehab $99,284,800

1 25-44 Screening $247,793,739Screening $274,917,291Screening $330,469,425Screening $384,312,091Screening $435,134,278

2 25-44 Trauma/Injury $192,321,672Musculoskeletal $217,515,146Musculoskeletal $241,006,037Musculoskeletal $272,202,312Mental disorders $316,573,279

3 25-44 Musculoskeletal $182,845,814Trauma/Injury $207,973,416Trauma/Injury $209,140,037Mental disorders $247,491,825Musculoskeletal $314,393,246

4 25-44 Back Problems $145,066,905Back Problems $167,106,297Mental disorders $198,021,182Trauma/Injury $228,255,512Trauma/Injury $248,674,212

5 25-44 Gastrointestinal $145,007,112Gastrointestinal $157,154,059Back Problems $195,288,578Back Problems $212,343,242Back Problems $246,061,569

1 45-64 Cancers $285,799,124Cancers $311,599,022Cancers $313,927,189Cancers $322,223,032Cancers $339,275,041

2 45-64 Gastrointestinal $182,121,915Gastrointestinal $192,503,302Gastrointestinal $208,838,705Musculoskeletal $230,642,624Musculoskeletal $254,233,643

3 45-64 Heart conditions $171,456,424Heart conditions $183,425,920Musculoskeletal $206,903,161Gastrointestinal $219,398,411Gastrointestinal $227,255,478

4 45-64 Musculoskeletal $149,335,832Musculoskeletal $178,379,810Heart conditions $192,292,343Heart conditions $189,444,043Heart conditions $196,389,823

5 45-64 Coron athero $127,330,094Back Problems $129,033,807Back Problems $145,688,038Back Problems $157,848,035Back Problems $175,154,752

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Top 5 Medical Conditions, by Unique Diagnosis, Females Ages 18-44

Status

FY 2007 FY 2008 FY 2009 FY 2010 FY 2011

ConditionUnique Diagnosis Condition

Unique Diagnosis Condition



Unique Diagnosis

Active Duty

Screening 214,485Screening 218,604Screening 227,967Screening 234,210Screening 232,502

Reproductive 103,260Reproductive 105,082Reproductive 109,366Reproductive 113,720Reproductive 114,315

Immunization 90,361Immunization 101,534Immunization 105,067Immunization 110,104Immunization 107,103

Acute bronchitis and URI 83,771

Musculoskeletal 84,407









Retirees


Reproductive 4,391Reproductive 4,374Reproductive 4,568Reproductive 4,492Reproductive 4,602Musculoskeletal 3,895










Gastrointestinal 2,934

Neurologic Disorder 3,012



Neurologic Disorder 3,385

15

Top 5 Medical Conditions, by Unique Diagnosis, Males Ages 18-44

Status

FY 2007 FY 2008 FY 2009 FY 2010 FY 2011





Unique Diagnosis

Active Duty

Screening 987,296Screening 1,045,683Screening 1,121,441Screening 1,171,335Screening 1,178,540

Immunization 410,121Immunization 475,533Immunization 483,709Immunization 498,772Immunization 488,112Trauma/Injury 321,183

Trauma/Injury 325,598





Musculoskeletal 322,310Trauma/Injury 328,376



Eye problems 310,172



Ear, Nose, Throat 310,844

Ear, Nose, Throat 303,468

Retirees

Screening 31,704Screening 31,365Screening 31,738Screening 31,313Screening 30,410Musculoskeletal 21,490








All Other Categories 20,141


Cardiovascular 17,398










16

Top 5 Medical Conditions, by Unique Diagnosis, Females Ages 45-64

Status FY 2007 FY 2008 FY 2009 FY 2010 FY 2011





Unique Diagnosis

Active Duty


Eye problems 5,959Musculoskeletal 6,240




Musculoskeletal 5,924Eye problems 5,822Eye problems 5,849Eye problems 6,015Eye problems 5,639

Reproductive 3,967Reproductive 3,992Immunization 4,493

Immunization 4,985Reproductive 4,718

Rehab 3,676Immunization 3,945Reproductive 4,368Reproductive 4,577


Retirees

Screening 26,682Screening 30,168Screening 34,361Screening 37,213Screening 39,693Musculoskeletal 15,494





Reproductive 11,464Eye problems 12,696Eye problems 14,181Eye problems 15,911Eye problems 17,303

Eye problems 11,162Reproductive 12,693Reproductive 14,127





Acute bronchitis and URI 13,749Reproductive 14,951Reproductive 15,959

17

Top 5 Medical Conditions, by Unique Diagnosis, Males Ages 45-64

Status FY 2007 FY 2008 FY 2009 FY 2010 FY 2011





Unique Diagnosis

Active Duty


Eye problems 25,841Eye problems 24,606Musculoskeletal 26,605




Musculoskeletal 24,371Eye problems 24,529Eye problems 24,498


Immunization 17,346Immunization 19,641Immunization 21,703Immunization 24,198Eye problems 22,986

Rehab 14,143All Other Categories 15,023


All Other Categories 20,935Immunization 22,121

Retirees



Cardiovascular 185,199Cardiovascular 193,091Cardiovascular 199,752


HTN 165,646HTN 176,181Musculoskeletal 184,649




Musculoskeletal 173,980HTN 183,772HTN 189,547HTN 189,253






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Summary

Back Problems is the highest cost and utilization CCS condition for the 35-44 and 45-64 age groups. This condition is the 2nd highest cost condition for ages 25-34.

Other Musculoskeletal-related CCS conditions also rank in the top 5 CCS conditions across age groups (Other Connective Tissue condition, Other Joint diagnosis, Sprain, Osteoarthritis).

Cost for Back Problems, in terms of Government Paid amounts, increase with age almost doubling in cost from age 35-44 to 45-64. Costs increase, within age groups, over the 5 year period.

Back Problems, Musculoskeletal, GI, Maternal, Reproductive and Cancers are within the top 5 most costly Medical Conditions for females.

Back Problems, Musculoskeletal, GI, Trauma/Injury, Mental Disorders and Cancers are within the top 5 most costly Medical Conditions for males.

Musculoskeletal is consistently the 2nd-4th most diagnosed condition for males and females, Active Duty and Retired. It is the most costly condition for Retirees (males and females) and within the top 5 for other age groups.

Results suggest that musculoskeletal conditions acquired while on Active Duty persist into retirement.

Altarum Institute integrates independent research and client-centered consulting to deliver comprehensive, systems-based solutions that improve health and health care. A nonprofit, Altarum serves clients in both the public and private sectors. For more information, visit www.altarum.org

Back-Up Slides

20

CCS Assignments, Example

TuberculosisICD-9: 010.0-018.9 (010) Primary tuberculous infection(010.0) Primary tuberculous infection(010.1) Tuberculous pleurisy in primary progressive tuberculosis(010.8) Other primary progressive tuberculosis(010.9) Primary Tuberculous infection, Unspecifed(011) Pulmonary tuberculosis (011.0) Tuberculosis of lung, Infiltrative…….

CCS: Tuberculosis

There are 9 3-digit ICD-9’s and an additional 18 ‘sub-diagnoses’ (4-digit ICD-9s) for Tuberculosis-related conditions.

CCS groups all relevant ICD-9s into specific conditions or condition groups.Ex.: Cancer of head and neckSepticemia (except in labor)HIV infectionHepatitisViral infection

21

Medical Condition, Example

264 CCS Condition Groups14,900+ICD-9 Codes

(140-149) Malignant neoplasm of lip, oral cavity, and pharynx

(150-159) Malignant neoplasm of digestive organs and peritoneum

(160-169) Malignant neoplasm of respiratory and intrathoracic organs

(170-175) Malignant neoplasm of bone, connective tissue, skin, and breast

(176) Kaposi's sarcoma

Roll-up to

024 : Cancer of breast167 : Nonmalignant breast conditions019 : Cancer of bronchus; lung125 : Acute bronchitis240 : Burns

43 Medical Condition Groups

Acute bronchitis and URIADDAll Other CategoriesAsthmaBack ProblemsBirthBloodCancersCardiovascularCerebrovascular disease

Roll-up to

Medical Condition groups were based on ICD-9 chapters (e.g. Neoplasms, Respiratory, Musculoskeletal), but allowed for separation of specific diseases (e.g. ADD, Asthma, ‘Birth’)

22

Methods

Cost Calculation Laboratory/Radiology costs based upon primary diagnosis associated with the claim for

purchased care. Lab/Rad costs taken directly from SIDR/SADR for direct care. Focus on total government paid amounts/government costs. People with OHI identified to allow for OHI cost impact analysis. Costs in constant year dollars (standardized to FY10 based on DoD Green Book).

Utilization Based upon primary diagnosis associated with the visit/stay

Prevalence Person-level data de-duplicated to provide a count of unique patients per condition within

each fiscal years data

23

Top 5 Medical Conditions, by Total Government Paid, Females Ages 18-44

Status Condition 2007 2008 2009 2010 2011

Active Duty

Maternal $174,778,325 $185,738,844 $201,608,600 $218,922,969 $223,590,554

Screening $116,022,533 $125,945,686 $146,505,395 $163,125,598 $188,228,921

Mental disorders $72,638,721 $87,612,183 $103,884,533 $124,244,995 $151,357,977Musculoskeletal (including Back Problems) $98,658,076 $103,534,573 $109,323,907 $114,202,550 $122,019,911

Reproductive $73,817,232 $80,038,114 $88,135,107 $92,493,485 $100,014,841

Retirees

Musculoskeletal (including Back Problems) $5,180,198 $5,617,256 $5,968,605 $5,948,990 $6,233,799

Cancers $4,700,212 $4,827,885 $4,547,007 $3,565,399 $3,596,190

Gastrointestinal $3,658,659 $3,916,540 $4,284,858 $3,921,194 $4,658,034

Reproductive $3,089,842 $3,337,879 $3,848,042 $3,894,424 $4,036,285

Neurologic Disorder $2,670,510 $3,342,239 $3,293,703 $3,186,830 $3,519,714

24

Top 5 Medical Conditions, by Total Government Paid, Males Ages 18-44

Status Condition 2007 2008 2009 2010 2011

Active Duty

Screening $389,974,713 $429,826,695 $507,928,138 $591,319,425 $703,393,409


Trauma/Injury $342,443,176 $353,358,521 $342,811,123 $358,883,036 $389,947,956

Mental disorders $195,157,918 $270,854,537 $343,224,535 $400,973,830 $493,059,209


Retirees



Cancers $15,657,668 $14,742,891 $15,353,852 $12,099,145 $10,325,602

Trauma/Injury $11,869,087 $11,835,450 $12,677,898 $11,241,667 $12,291,620

Heart conditions $12,727,597 $12,377,684 $12,640,148 $11,025,530 $9,326,675

Michelle Kloc, Ph.D., MSN, RN November 4, 2013

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