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Utah All Payer Database (APD) Introduction to the Reporting Capabilities of the Utah All Payer Database Mark Gaskill, MFT Keely Cofrin.

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Presentation on theme: "Utah All Payer Database (APD) Introduction to the Reporting Capabilities of the Utah All Payer Database Mark Gaskill, MFT Keely Cofrin."— Presentation transcript:

1 Utah All Payer Database (APD) Introduction to the Reporting Capabilities of the Utah All Payer Database Mark Gaskill, MFT Keely Cofrin Allen, PhD Utah Department of Health Office of Health Care Statistics

2 History On July 8, 2008 the Utah Health Data Committee unanimously approved a health data plan outlining the creation of an APD. Funding for the APD was provided via House Bill 133, Health Care Reform (2008). The Utah Department of Health (UDOH), Office of Health Care Statistics (OHCS) is responsible for building and managing the APD. Other states have APDs; however, Utah is now the first state in the country to have an All Payer Database that can analyze episodes of care (EOC) derived from statewide – cross payer – health insurance claims.

3 The Utah APD now provides the capability of reporting: Medically, what happened? (by EOC) When and where did it happen? How much did it cost? Greater Degrees of Healthcare Transparency Who paid for what (including healthcare consumer out of pocket costs)? Which costs were not covered? (including denied claims) What other influences impact outcome (disease burden, co-morbidities, demographics, environmental issues, access to specialists, etc.)? What impact does preventive care or lack there of, have on outcome? Were relevant standards of care met? How do healthcare consumers migrate between commercial plans; between commercial and public plans?

4 Where the Utah APD Stands Today: $1,847,869,396 - Utah Health Care Dollars Represented in the Utah APD 1,079,270 - Unique Utah lives identified, linked and grouped 48,567,000- Medical Claims processed and parsed in the APP primary data warehouse 67,989,000 - Pharmacy Claims process and parsed in the APD primary data warehouse Second Phase Pilot will be competed February 2010 (initial APD reporting will commence during Second Phase Pilot); Third Phase Pilot Completed Summer 2010 (APD fully operational)

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9 Top Ten Diseases Driving Cost Analysis Period Ending: DiseaseNumber of Members *Percent of TotalTotal CostPercent of Total Cost 1Diabetes17, %$99,704, % 2Hypertension23, %$55,667, % 3Asthma11, %$34,677, % 4CAD2, %$27,548, % 5Breast Cancer1, %$18,016, % 6Depression14, %$16,423, % 7ESRD %$14,951, % 8CVA1, %$14,416, % 9CHF %$8,154, % 10COPD %$6,699, % * Unique members with the disease

10 Top Five Conditions Driving Cost DiseaseNumber of Members * Percent of Total Members Total Paid Claims Percent of Total Paid Claims 1Healthy320, %$84,501, % 2Cancer6, %$77,252, % 3Cardiac22, %$68,180, % 4Psychiatric24, %$63,062, % 5GU21, %$56,900, % Other 35, %$160,163, %

11 Top Ten Therapeutic Classes by Volume Therapeutic ClassTotal Cost Utilizing Members Script PMPY Cost Per Member Number of Scripts Average Cost Per Script Percent Generic 1*ANTIDEPRESSANTS*$13,759,11164, $593389,494$3576 % 2*ANALGESICS - OPIOID*$7,247,71792, $440334,445$2297 % 3*ULCER DRUGS*$17,308,65642, $1,466192,155$9048 % 4*ANTIHYPERLIPIDEMICS*$10,809,47633, $948181,827$5957 % 5*CONTRACEPTIVES*$3,953,77134, $360173,187$2356 % 6*ANTIHYPERTENSIVES*$5,536,94030, $500170,152$3358 % 7*PENICILLINS*$980,075100, $87154,660$699 % 8*ANTIDIABETICS*$12,798,76219, $1,723141,974$9050 % 9*THYROID AGENTS*$1,424,25727, $155140,098$1097 % 10*DERMATOLOGICALS*$6,360,40366, $760139,962$4566 %

12 Top Ten Therapeutic Classes by Cost Therapeutic ClassTotal Cost Utilizing Members Script PMPY Cost Per Member Number of Scripts Average Cost Per Script Percent Generic 1*ULCER DRUGS*$17,308,65642, $1,466192,155$9048 % 2*ANTIDEPRESSANTS*$13,759,11164, $593389,494$3576 % 3*ANTIDIABETICS*$12,798,76219, $1,723141,974$9050 % 4*ANTIHYPERLIPIDEMICS*$10,809,47633, $948181,827$5957 % 5*ANTICONVULSANTS*$10,086,37919, $1,538112,157$9052 % 6 *ANTIASTHMATIC AND BRONCHODILATOR AGENTS* $8,438,79935, $1,231121,808$6920 % 7 *ADHD/ANTI-NARCOLEPSY/ANTI- OBESITY/ANOREXIANTS* $7,563,89720, $1,128102,857$7434 % 8*ANTIPSYCHOTICS*$7,371,7487, $3,29842,410$17419 % 9*ANALGESICS - OPIOID*$7,247,71792, $440334,445$2297 % 10*DERMATOLOGICALS*$6,360,40366, $760139,962$4566 %

13 Pharmacy Statistics Scripts PMPY Average Cost PMPY Brand Percent by Volume Generic Percent by Volume Brand Cost PMPYGeneric Cost PMPY 9.7$40628 %72 %$281$124 Top Twenty Drugs by Cost - Retail NameTotal CostUtilizing MembersTotal ScriptsCost Per ScriptCost Per Member 1Prevacid$4,546,6708,38142,510$107$10 2Oxycodone Hcl$3,064,2683,07823,522$130$7 3Aciphex$2,860,9934,12823,903$120$6 4Valtrex$2,705,6837,13716,994$159$6 5Seroquel$2,655,2972,61515,837$168$6 6Advair Diskus$2,634,0165,63818,955$139$6 7Amphetamine Salt Combo$2,587,3545,31333,276$78$6 8Venlafaxine Hcl$2,549,3704,27531,737$80$6 9Topamax$2,468,8242,52413,647$181$5 10Novolog$2,425,1642,72915,267$159$5 11Cymbalta$2,389,7884,37227,409$87$5 12Testosterone$2,251,4432,79113,288$169$5 13Provigil$2,051,1141,90811,365$180$4 14Lamotrigine Chewable Dispersible$1,961,5552,44112,352$159$4 15Abilify$1,863,6461,2746,254$298$4 16Imitrex$1,846,4562,72913,340$138$4 17Singulair$1,729,0446,35126,582$65$4 18Isotretinoin$1,669,0391,7717,172$233$4 19Methylphenidate Hcl$1,667,5144,15826,157$64$4 20Lovenox$1,493,5151,0242,657$562$3

14 Generic Utilization Total Prescriptions

15 Average MembershipPercent of TotalTotal PaidPercent of Total PaidAverage PMPM Paid Healthy1272, %$121,033, %$37 One or More Significant Acute Diseases231, %$80,806, %$215 One Minor Chronic Disease347, %$72,885, %$128 Multiple Minor Chronic Diseases416, %$49,025, %$245 One Significant Chronic Disease555, %$163,910, %$247 Two Significant Chronic Diseases635, %$276,306, %$648 Three or More Significant Chronic Diseases71, %$28,821, %$1,582 Complicated Malignancies81, %$51,385, %$3,023 Catastrophic Conditions91, %$36,522, %$3,002 Total 462,915 $880,698,138 $159 Health Status and Cost Drivers

16 Average PMPM Distribution by Health Status

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18 Member Distribution and BOI by Demographics and Age Average MembershipAverage Cost PMPMAverage Burden of Illness Total462,915$ Male231,621$ ,988$ ,797$ ,187$ ,342$ ,398$ ,001$ ,185$ ,723$ Female231,294$ ,142$ ,074$ ,754$ ,138$ ,459$ ,666$ ,898$ ,164$

19 Top Twenty-Five Drugs by Volume - Retail NameTotal CostUtilizing MembersTotal ScriptsCost Per ScriptCost Per Member 1Acetaminophen/hydrocodone$333,83959,439177,855$2$1 2Amoxicillin$272,88471,020100,836$3$1 3L-Thyroxine Sodium$451,57313,67881,720$6$1 4Azithromycin$488,68448,29768,057$7$1 5Acetaminophen/oxycodone$669,82425,08455,838$12$1 6Omeprazole$538,80815,30654,633$10$1 7Citalopram Hydrobromide$70,26612,39854,379$1$0 8Simvastatin$81,27311,75052,936$2$0 9Child Ibuprofen$152,46330,71852,843$3$0 10Alprazolam$109,33511,24348,232$2$0 11Fluoxetine Hcl$170,90210,20548,180$4$0 12Sertraline Hcl$111,2579,46345,171$2$0 13Prevacid$4,546,6708,38142,510$107$10 14Metformin Hcl$107,7128,14237,217$3$0 15Bupropion Er$1,272,7778,06435,854$35$3 16Amphetamine Salt Combo$2,587,3545,31333,276$78$6 17Amoxicillin/clavulanate Potassium$547,40924,59232,095$17$1 18Yasmin 28$872,7817,40731,844$27$2 19Venlafaxine Hcl$2,549,3704,27531,737$80$6 20Fluconazole$37,04713,37031,596$1$0


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