Utah Atlas of
Healthcare Volume 1, Number 2, October 2010
Making Cents of Utah’s Healthy Population
About this Publication: The Utah Atlas of Healthcare is a publication of the Utah Department of Health, Health Data Committee, Office of Healthcare Statistics. The findings in this publication are based upon data from the Utah All Payer All Claims Database.
Suggested Citation: Masheter, C., Gaskill, M., Vanous, S., Cofrin Allen, K. Making Cents of Utah’s Healthy Population. Utah Department of Health, Health Data Committee, Office of Health Care Statistics. Utah Atlas of Healthcare: 1(2), October 2010.
About the Authors: Carol Masheter, Ph.D. is with the Utah Department of Health, Health Data Committee, Office of Healthcare Statistics. Dr. Masheter currently supports the Office of Health Care Statistics as an epidemiologist. Mark Gaskill, MFT is with the Utah Department of Health, Health Data Committee, Office of Healthcare Statistics. Mark currently serves as the Utah All Payer Database Project Manager. Sam Vanous, Ph.D. is with the Utah Department of Health, Health Data Committee, Office of Healthcare Statistics. Dr. Vanous currently supports the Office of Health Care Statistics as the Health Plan Program Manager. Keely Cofrin Allen, Ph.D is with the Utah Department of Health, Health Data Committee, Office of Healthcare Statistics. Dr. Cofrin Allen currently serves as the Director of the Office of Health Care Statistics and serves as the Executive Secretary of the Utah Health Data Committee.
Overview Utah is ranked as having one of the healthiest populations in the nation.
In fact, between 2008 and 2009 Utah moved from the 5th to the 2nd position among healthiest states.(1) Utah has several advantages over other states: a lower prevalence of smoking, a lower obesity rate, a lower prevalence of binge drinking, and a lower percentage of children living in poverty. Also, Utah has led the nation in enacting progressive public health and healthcare legislation while fostering strong and productive relationships between policy makers and the healthcare insurance industry. Public health is founded on the principle that population health is improved by preventing the premature onset of disease and disability, insuring access to needed healthcare, and promoting healthier lifestyles. Efforts to advance these principles in Utah have been met with notable success. In recent years Utah has seen an improvement in state ranking for obesity, premature deaths, infant mortality, cardiovascular deaths, and incidents of stroke. In addition, several racial and ethnic minority groups saw improvements in health status with a corresponding decrease in certain common diseases. However, in recent years Utah has also seen a decrease in state ranking for heart attacks, cardiac disease and diabetes.(1-2) Improvements in the health of Utah’s population are certainly impressive, but preventing disease and disability, improving access to healthcare, and promoting healthier lifestyles are continuous processes involving many factors and stakeholders. Improving public health is also a core tenet in healthcare reform efforts in Utah. New data tools are now emerging which support these moving parts, stakeholders and reform efforts. One such tool is the Utah All Payer Claims Database (APCD).(3) The Utah APCD possesses the capability to provide policymakers, consumers, providers, and insurers serving Utah residents with a variety of data on the health of Utah’s population. Moreover, the Utah APCD is capable of providing snapshots of Utah’s healthcare consumers never before seen, including detailed views of Utah’s healthy population. Until recently, data defining Utah’s healthy people has been elusive. Questions such as: Who are the healthy Utahns? What does it take to keep them healthy? and, How much does preventive and routine healthcare cost? have been difficult to answer. These are important questions for a variety of reasons. They can help policymakers, consumers, providers, and insurance companies better determine how chronic diseases progress, cost effective ways for maintaining health, best practices for the healthy, and they can provide a baseline by which we can gauge future progress in supporting public health. This report shall present a snapshot of healthy Utahns: Who are the healthy Utahns? Where do they reside? What does it take to keep them healthy? (1)
United Health Foundation: America’s Heath, State Health Rankings. http://www.americashealthrankings.org/ measure/2009/overall.aspx# ; http://www.americashealthrankings.org/2009/pdfs/UT.pdf (2) http://health.utah.gov/cmh/data/movingforward.pdf (3) http://health.utah.gov/opha/publications/hsu/09Jul_APD.pdf ; http://health.utah.gov/hda/apd/about.php
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Findings Utah’s Healthy Population: Who are they and how much do they cost? There are many ways to define healthy people. Quantifying health means more than merely counting people who are free from disease or infirmity. Significant resources are dedicated to maintaining and promoting health. Examining the demographics of the healthy population and the resources utilized to support and maintain health is an important step to better understanding the characteristics of the state’s healthy population. For this report commercial health insurance claims from 899,323 Utah residents were examined, representing more than $1.5 billion in healthcare expenditures in 2009.(4) From these claims people between birth and 64 years old were identified. Healthy members of this group were defined as people without significant acute or chronic disease or medical conditions and who were engaged in or received some degree of routine healthcare. Routine healthcare included, but was not necessarily limited to: preventive care, such as check ups, health screenings and immunizations, and treatment for relatively minor acute conditions, such as common colds, simple fractures and appendicitis, as well as relatively minor chronic conditions, such as migraine headache and minor hearing loss. Certain members were excluded from the healthy group who might otherwise be considered healthy. For example, women who gave birth without significant illness or complications are considered healthy. Their healthcare needs and costs differ significantly from other healthy members, so this report excluded them. Another group who might be considered healthy are health plan non-users, people who are enrolled in a health plan but did not use it to access healthcare. The health of non-users is unknown. Some non-users may be healthy, while others may have a potentially serious, undetected condition, such as high blood pressure, high cholesterol, or diabetes. Since it was impossible to determine the health of this group, they were excluded from the report. In all, this report considered 354,357 Utah residents, between birth and 64 years of age, who were defined as healthy.
At a glance....... On average, in 2009 people in Utah with commercial health insurance cost $2,768 annually, or $231 per person per month (excluding healthy people). On average, in 2009 healthy people in Utah cost $385 annually, or just $32 per person per month. Nine percent of the dollars spent on healthcare in Utah in 2009 were spent on healthy people. Slightly more than five percent of the dollars spent on healthcare in Utah in 2009 were for spent on healthy children. Slightly more than three percent of the dollars spent on healthcare in Utah in 2009 were for spent on healthy adults. Healthy males represent 21% of the Utah residents evaluated. Healthy females represent 18% of the Utah residents evaluated.
(4)
Persons receiving Medicaid and Medicare are not represented in this report. Demographic and cost trends may change as these data become available for future APCD reports. 4
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Findings Utah’s Healthy Population: Who are they and how much do they cost? - Continued The percentage of healthy people in Utah decreases across the lifespan. As people age they become increasingly susceptible to chronic disease, environmental hazards, and physical wear and tear. The percentage of healthy people can serve as a highlevel benchmark for a variety of public health and insurance industry efforts to prevent disease and disability, improve access to needed healthcare and to promote healthy lifestyles. Ultimately, the success of public health interventions would be reflected by increases in the percentage of healthy people across age groupings.
There are differences in costs for healthcare between healthy males and females. Additional evaluation of the data will pinpoint the exact source of these differences. Early review points to regular and more frequent preventive health screenings among women and different pharmaceutical utilization profiles as probable explanations for the difference.
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Findings Utah’s Healthy Population: Who are they and how much do they cost? - Continued
Review of medical and pharmacy insurance claims for people commercially insured shows the period between birth and four years old is the most costly for healthy people in Utah. Frequent routine and preventive healthcare for the younger age groups are likely due to immunization schedules, well baby and well child check-ups and frequent visits to a pediatrician or primary care provider for colds and infections. Future analyses of medical and pharmacy claims data will focus on identifying and defining diagnosis, healthcare procedures, and pharmaceutical profiles associated with each age grouping. The results of these analyses, combined with cost data, will define valuable benchmarks for a variety of public health and healthcare reform initiatives.
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Findings Utah’s Healthy Population: What are we paying for?
Healthy people in Utah are most often treated by medical specialists and primary care providers (PCPs). For this report PCPs were defined as general practitioners, family practice providers, internal medicine providers, and pediatricians. Initial examination found specialists represented a greater overall and per claim cost than PCPs when treating the healthy population. Future reports will examine whether healthy people receive more benefit and value from specialists than PCPs? The category of ‘other’ claims represent contacts with a variety of allied health professionals, such as chiropractors, psychologists, and audiologists. Although a significant number of healthy people received care and services from these other healthcare professionals (9.8% of the healthy group), the total cost to commercial insurers is relatively small (4.2% of the total cost).
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Findings Where Do Healthy People Live
Prevalence of Utah’s Healthy Population by Small Area, 2009
The prevalence of healthy people in Utah varied by geographic location. Prevalence is reported by Utah small area. Small areas were established by the Utah Department of Health in 1997 for the purpose of reporting health information on a community level. Criteria used to establish the 61 Utah small areas include population, local health district, county boundaries, ZIP code, income, and political boundaries.
The maps above illustrate prevalence of healthy people in Utah. Prevalence as represented on these maps is standardized by age and sex. Small areas with the lightest shade have the highest prevalence of healthy people, while small areas with the darkest shade have the lowest prevalence of healthy people. Appendix A contains a complete ranking of the 61 Utah small areas.
* These rankings were drawn from commercial healthcare claims and do not contain data from Medicaid pharmacy claims. Statewide rankings may change when Medicaid data are merged with commercial claims data.
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Findings What is the Cost of Preventive Care in Utah? There are a variety of routine preventive healthcare measures recommended for people throughout the lifespan. These preventive measures begin early with immunizations and well-baby/well-child examinations. As people age routine physical examinations, lipid testing, and a variety of cancer screenings are recommended at a various intervals. Although the efficacy of preventive care is well known, the costs associated with adhering to a schedule of recommended preventive care is significantly less transparent. Many healthcare consumers with commercial insurance need only worry about their co-pay or deductible. However, the healthcare insurance industry and marketplace is currently finding its way through a precarious period of growth and fluctuation. Defined contributions, healthcare savings accounts, and high deductible healthcare plans are just a few terms requiring careful attention by the healthcare consumer. Each requires the consumer to become increasingly aware of recommended standards of preventive care and costs. Further, each requires the healthcare consumer to shoulder a larger portion of his or her healthcare costs. Medical and pharmacy claims were examined to determine average costs for commonly recommended preventive care. Cost figures presented in this report represent medical and pharmacy claims paid by commercial insurance carriers to the providers rendering healthcare services. The amount billed to the insurance carrier is often significantly greater than what is paid. The discounted rate paid to commercial carriers may not be the same rate extended to a person seeking similar preventive care and paying cash. Appendix B presents the average billed and paid rates for several common preventive care screenings.
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Findings What is the Cost of Preventive Care in Utah? - Continued The battery of childhood immunizations are an important way of keeping children healthy. To ensure maximum benefit, these immunization are administered on precise schedules and timelines.(5) Childhood immunizations are effective in reducing illness, disability, and death from vaccinepreventable infections. Medical and pharmacy claims were examined to determine average costs for recommended immunization.
Although childhood immunizations are typically available to parents through a variety of resources, establishing a cost benchmark supports healthcare transparency. Medical and pharmacy claims from commercial insurance plans were examined to determine average costs for recommended immunizations. Costs are presented by the child’s age and reflect the recommended immunizations for that age. (5) The figures presented include both the costs associated with administering the immunizations and the cost of the vaccine itself.
(5)
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www.immunize-utah.org/ www.cdc.gov/vaccines/recs/schedules/child-schedule.htm www.UtahAtlas.Health.Utah.gov
Findings What Pharmaceuticals are Used by Utah’s Healthy Population?
On this page, pharmaceutical utilization profiles of Utah’s healthy population (birth to 64 years old) are presented, broken down by sex of the healthcare consumer. Pharmaceutical use profiles for the healthy population differ significantly from the general population. (see Appendix C for an example of the general use profile for Utah’s adult population) Dermatological medications stand out as the dominant therapeutic classification among healthy males and females. The per capita cost for pharmaceuticals in 2009 among the healthy population was $35.19. The cost for females was higher than for males, $39.87 and $30.28 respectively
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Summary
Healthcare Cost, Quality, and Transparency: Putting together the pieces and moving forward
The healthcare insurance industry and marketplace is currently finding its way through a precarious period of growth and fluctuation. Data regarding healthcare cost and quality are going to be an important and supportive adjunct as industry and healthcare consumers find their way toward a sustainable and affordable healthcare delivery model. In a perfect world, the eventual model will reduce healthcare costs while improving access, quality, safety and outcome. This report presents a glance at Utah’s healthy population, including some of its demographic characteristics and the costs of several preventive care screenings and measures. There are several key findings. Perhaps the most notable is the difference in costs between caring for the healthy and treating the sick. On average, healthy people in Utah cost $385 annually, or just $32 per person per month. By contrast, the statewide aggregate cost for healthcare among people with commercial health insurance is $1,764 annually, or $147 per person per month. This report highlights how the number of healthy people decreases as age increases. This is an unavoidable reality as aging often brings an increase in a variety of age-related conditions. However, efforts to increase the percentage of healthy people across the lifespan would result in significantly lower healthcare costs and improved quality of life. Achieving this outcome will likely be the result of successful efforts to prevent disease and disability, improve access to needed healthcare and to promote healthy lifestyles. A better understanding of the healthy population provides the benchmarks necessary to support these efforts while achieving greater levels of healthcare transparency.
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Acknowledgments and Contributors Contributors: Utah Health Data Committee www.health.utah.gov/hda/HDC/members.php Utah Department of Health: Office of Health Care Statistics Staff: Keely Cofrin Allen, Ph.D., Director Mark Gaskill, MFT Jamie Martell Mike Martin, MBA Carol Masheter, Ph.D. John Morgan Lori Savoie Sam Vanous, Ph.D. Utah Department of Health: Disease Control and Prevention Robert T. Rolfs, MD, MPH Director, Div. Disease Control and Prevention State Epidemiologist University of Utah Dr. Jim VanDerslice, University of Utah, Division of Public Health, Department of Family Preventive Medicine CareAdvantage, Inc. William C. Vennart, MD, MBA National Medical Director Analytic and Software Support Provided by: Care Advantage Incorporated: The APCD data were analyzed using RightPath Navigator, a suite of data analysis tools developed by CareAdvantage, Inc. 3M Health Information Systems: Provides the Clinical Risk Grouping (CRG) Software which provides the clinical categories and risk grouping for the Utah APCD. Informatica: The APCD data were patient-linked using Informatica Identity Resolution, a software application developed by Informatica, the Data Integration Company. Spectre Enterprises, Inc.: Spectre provides innovative software and database solutions for the Utah APCD.
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Appendix A:
Ranking of the 61 Utah Small Areas.
Healthy Utahns by small area: This graph shows the percentage of healthy people by Utah small area. Small areas with the lightest shade have the highest prevalence of healthy people, while the small areas with the darkest shade have the lowest prevalence of healthy people.
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Appendix B:
Example of Differences Between Billed and Paid Healthcare Claims
The costs presented in this report represent medical and pharmacy claims paid by commercial insurance carriers to the providers rendering healthcare services. The amount billed to the insurance carrier is often significantly greater than what is paid. The discounted rate paid to commercial carriers may not be the same rate extended to a person seeking similar preventive care and paying cash. Below are examples of the differences between billed and paid healthcare claims for common preventive care and screenings.
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Appendix C:
Utah始s Pharmaceutical Utilization Profile
A much different pharmaceutical utilization profile emerges for all Utah residents (ages 18-64) than for the healthy population.(5) Pictured are pharmaceutical utilization rates by percentage of total dollars spent for all adults (ages 18-64) adult males, and adult females.
(5)
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Gaskill, M. Antidepressant Use in Utah. Utah Department of Health, Health Data Committee, Office of Health Care Statistics. Utah Atlas of Healthcare: 1(1), September 2010.
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Utah Health Data Committee Office of Health Care Statistics PO Box 144004 Salt Lake City, UT 84114-4004 801-538-7048