Utah All Payer Database (APD)

Utah All Payer Database(APD)

Introduction to the Reporting Capabilities of the Utah All Payer Database

Mark Gaskill, [email protected]

Keely Cofrin Allen, [email protected]

Utah Department of HealthOffice of Health Care Statistics

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.

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?

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)

Top Ten Diseases Driving CostAnalysis Period Ending: 2008-12

  Disease Number of Members * Percent of Total Total Cost Percent of Total Cost

1 Diabetes 17,184 3.03 % $99,704,469 11.32 %

2 Hypertension 23,202 4.09 % $55,667,008 6.32 %

3 Asthma 11,743 2.07 % $34,677,484 3.94 %

4 CAD 2,691 0.47 % $27,548,104 3.13 %

5 Breast Cancer 1,033 0.18 % $18,016,742 2.05 %

6 Depression 14,405 2.54 % $16,423,053 1.86 %

7 ESRD 752 0.13 % $14,951,415 1.70 %

8 CVA 1,009 0.18 % $14,416,917 1.64 %

9 CHF 751 0.13 % $8,154,696 0.93 %

10 COPD 706 0.12 % $6,699,488 0.76 %

* Unique members with the disease

Top Five Conditions Driving Cost

  Disease Number of Members *Percent of TotalMembers

Total Paid ClaimsPercent of TotalPaid Claims

1 Healthy 320,423 56.42 % $84,501,388 9.59 %

2 Cancer 6,414 1.13 % $77,252,448 8.77 %

3 Cardiac 22,458 3.95 % $68,180,554 7.74 %

4Psychiatric

24,432 4.30 % $63,062,501 7.16 %

5 GU 21,551 3.79 % $56,900,444 6.46 %

Other Other 35,631 6.27 % $160,163,120 18.19 %

Top Ten Therapeutic Classes by Volume

  Therapeutic Class Total CostUtilizing Members

Script PMPYCost Per Member

Number of ScriptsAverage Cost Per Script

Percent Generic

1 *ANTIDEPRESSANTS* $13,759,111 64,911 16.78 $593 389,494 $35 76 %

2 *ANALGESICS - OPIOID* $7,247,717 92,374 20.31 $440 334,445 $22 97 %

3 *ULCER DRUGS* $17,308,656 42,209 16.27 $1,466 192,155 $90 48 %

4*ANTIHYPERLIPIDEMICS*

$10,809,476 33,110 15.94 $948 181,827 $59 57 %

5 *CONTRACEPTIVES* $3,953,771 34,789 15.75 $360 173,187 $23 56 %

6 *ANTIHYPERTENSIVES* $5,536,940 30,021 15.36 $500 170,152 $33 58 %

7 *PENICILLINS* $980,075 100,131 13.68 $87 154,660 $6 99 %

8 *ANTIDIABETICS* $12,798,762 19,528 19.12 $1,723 141,974 $90 50 %

9 *THYROID AGENTS* $1,424,257 27,341 15.30 $155 140,098 $10 97 %

10 *DERMATOLOGICALS* $6,360,403 66,334 16.72 $760 139,962 $45 66 %

Top Ten Therapeutic Classes by Cost

  Therapeutic Class Total CostUtilizing Members

Script PMPY

Cost Per Member

Number of Scripts

Average Cost Per Script

Percent Generic

1 *ULCER DRUGS* $17,308,656 42,209 16.27 $1,466 192,155 $90 48 %

2 *ANTIDEPRESSANTS* $13,759,111 64,911 16.78 $593 389,494 $35 76 %

3 *ANTIDIABETICS* $12,798,762 19,528 19.12 $1,723 141,974 $90 50 %

4 *ANTIHYPERLIPIDEMICS* $10,809,476 33,110 15.94 $948 181,827 $59 57 %

5 *ANTICONVULSANTS* $10,086,379 19,758 17.11 $1,538 112,157 $90 52 %

6*ANTIASTHMATIC AND BRONCHODILATOR AGENTS*

$8,438,799 35,740 17.76 $1,231 121,808 $69 20 %

7*ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*

$7,563,897 20,361 15.34 $1,128 102,857 $74 34 %

8 *ANTIPSYCHOTICS* $7,371,748 7,003 18.97 $3,298 42,410 $174 19 %

9 *ANALGESICS - OPIOID* $7,247,717 92,374 20.31 $440 334,445 $22 97 %

10 *DERMATOLOGICALS* $6,360,403 66,334 16.72 $760 139,962 $45 66 %

Pharmacy Statistics Scripts PMPY

Average Cost PMPY

Brand Percent by Volume

Generic Percent by Volume

Brand Cost PMPY Generic Cost PMPY

9.7 $406 28 % 72 % $281 $124

Top Twenty Drugs by Cost - Retail

  Name Total CostUtilizing Members

Total Scripts Cost Per Script Cost Per Member

1 Prevacid $4,546,670 8,381 42,510 $107 $10

2 Oxycodone Hcl $3,064,268 3,078 23,522 $130 $7

3 Aciphex $2,860,993 4,128 23,903 $120 $6

4 Valtrex $2,705,683 7,137 16,994 $159 $6

5 Seroquel $2,655,297 2,615 15,837 $168 $6

6 Advair Diskus $2,634,016 5,638 18,955 $139 $6

7 Amphetamine Salt Combo $2,587,354 5,313 33,276 $78 $6

8 Venlafaxine Hcl $2,549,370 4,275 31,737 $80 $6

9 Topamax $2,468,824 2,524 13,647 $181 $5

10 Novolog $2,425,164 2,729 15,267 $159 $5

11 Cymbalta $2,389,788 4,372 27,409 $87 $5

12 Testosterone $2,251,443 2,791 13,288 $169 $5

13 Provigil $2,051,114 1,908 11,365 $180 $4

14 Lamotrigine Chewable Dispersible $1,961,555 2,441 12,352 $159 $4

15 Abilify $1,863,646 1,274 6,254 $298 $4

16 Imitrex $1,846,456 2,729 13,340 $138 $4

17 Singulair $1,729,044 6,351 26,582 $65 $4

18 Isotretinoin $1,669,039 1,771 7,172 $233 $4

19 Methylphenidate Hcl $1,667,514 4,158 26,157 $64 $4

20 Lovenox $1,493,515 1,024 2,657 $562 $3

Generic Utilization Total Prescriptions                                                                                    

    Average Membership Percent of Total Total Paid Percent of Total Paid Average PMPM Paid

Healthy 1 272,581 58.88 % $121,033,058 13.74 % $37

One or More Significant Acute Diseases 2 31,372 6.78 % $80,806,041 9.18 % $215

One Minor Chronic Disease 3 47,487 10.26 % $72,885,749 8.28 % $128

Multiple Minor Chronic Diseases 4 16,659 3.60 % $49,025,967 5.57 % $245

One Significant Chronic Disease 5 55,327 11.95 % $163,910,470 18.61 % $247

Two Significant Chronic Diseases 6 35,542 7.68 % $276,306,871 31.37 % $648

Three or More Significant Chronic Diseases 7 1,518 0.33 % $28,821,831 3.27 % $1,582

Complicated Malignancies 8 1,417 0.31 % $51,385,538 5.83 % $3,023

Catastrophic Conditions 9 1,014 0.22 % $36,522,613 4.15 % $3,002

Total   462,915   $880,698,138   $159

Health Status and Cost Drivers

Average PMPM Distribution by Health Status                                                                         

Member Distribution and BOI by Demographics and Age

 Average Membership Average Cost PMPM Average Burden of Illness

2008-12 2008-12 2008-12

Total 462,915 $159 0.88

Male 231,621 $141 0.70

  0-2 12,988 $270 0.65

  3-17 69,797 $69 0.33

  18-24 28,187 $90 0.41

  25-34 39,342 $92 0.43

  35-44 30,398 $126 0.66

  45-54 28,001 $215 1.24

  55-64 19,185 $342 2.05

  65+ 3,723 $439 2.92

Female 231,294 $176 1.07

  0-2 12,142 $176 0.55

  3-17 66,074 $64 0.30

  18-24 28,754 $130 0.72

  25-34 41,138 $180 1.40

  35-44 30,459 $204 1.22

  45-54 29,666 $286 1.74

  55-64 19,898 $382 2.39

  65+ 3,164 $325 2.37

Top Twenty-Five Drugs by Volume - Retail

  Name Total CostUtilizing Members

Total Scripts Cost Per Script Cost Per Member

1 Acetaminophen/hydrocodone $333,839 59,439 177,855 $2 $1

2 Amoxicillin $272,884 71,020 100,836 $3 $1

3 L-Thyroxine Sodium $451,573 13,678 81,720 $6 $1

4 Azithromycin $488,684 48,297 68,057 $7 $1

5 Acetaminophen/oxycodone $669,824 25,084 55,838 $12 $1

6 Omeprazole $538,808 15,306 54,633 $10 $1

7 Citalopram Hydrobromide $70,266 12,398 54,379 $1 $0

8 Simvastatin $81,273 11,750 52,936 $2 $0

9 Child Ibuprofen $152,463 30,718 52,843 $3 $0

10 Alprazolam $109,335 11,243 48,232 $2 $0

11 Fluoxetine Hcl $170,902 10,205 48,180 $4 $0

12 Sertraline Hcl $111,257 9,463 45,171 $2 $0

13 Prevacid $4,546,670 8,381 42,510 $107 $10

14 Metformin Hcl $107,712 8,142 37,217 $3 $0

15 Bupropion Er $1,272,777 8,064 35,854 $35 $3

16 Amphetamine Salt Combo $2,587,354 5,313 33,276 $78 $6

17Amoxicillin/clavulanate Potassium

$547,409 24,592 32,095 $17 $1

18 Yasmin 28 $872,781 7,407 31,844 $27 $2

19 Venlafaxine Hcl $2,549,370 4,275 31,737 $80 $6

20 Fluconazole $37,047 13,370 31,596 $1 $0