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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
NAHDO Annual Conference October 2009
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
NAHDO Annual Conference October 2009
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
NAHDO Annual Conference October 2009
NAHDO Annual Conference October 2009 9
10NAHDO Annual Conference October 2009
NAHDO Annual Conference October 2009 11
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%
NAHDO Annual Conference October 2009 12
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.
NAHDO Annual Conference October 2009 14APCD Meeting May 6, 2009 14
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.
NAHDO Annual Conference October 2009 15APCD Meeting May 6, 2009 15
$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
NAHDO Annual Conference October 2009 17
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