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Medicaid Health Plans of America April 20, 2006 Washington, D.C. John Lovelace, Vice President UPMC Health Plan. ENROLLMENT COMPARISONS. All SNP versus Utilizing Members Medical and Pharmacy Medical or Pharmacy Medical Only Pharmacy Only (By Race and By Age).
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Medicaid Health Plans of AmericaApril 20, 2006Washington, D.C.John Lovelace,Vice PresidentUPMC Health Plan
ENROLLMENT COMPARISONS All SNP versus Utilizing Members Medical and Pharmacy Medical or Pharmacy Medical Only Pharmacy Only (By Race and By Age)
Risk Score Comparison • By Race, Age Group • SNP versus Total Medicare Population
Average Risk Score – SNP compared to All Other Medicare Members
MEDICAL EXPENSE ANALYSIS • Claim Stratification (No IBNR) • Unique Member (IBNR) • Gender • Race • Financial Service Category • Inpatient, Outpatient, PCP, etc
Claim StratificationUnder 65 Years of Age(Total Medical and Pharmacy Expenses – No IBNR)
Claim StratificationOver 65 Years of Age(Total Medical and Pharmacy Expenses – No IBNR)
Medical Expense Utilization Unique Members Age, Gender - PMPM
Medical Expense Utilization by Financial Service Category PMPM
Medical Expense Utilization by Financial Service Category, by Age GroupUnique Members
Medical Expense Utilization by Financial Service Category, by Age Group PMPM
SNP Population Comparison • All Other Medicare Members • SSI/Medicaid
Pharmacy UtilizationSNP versus Medicare/SSI • The top ten drugs (by payment) for the Special Needs Program (SNP) membership account for 30% of total pharmacy payments and 11% of total prescriptions. • Included in the top ten are four medications used for schizophrenia / bipolar disorder (Zyprexa, Seroquel, Risperdal and Abilify). Also included are Zocor and Lipitor (cholesterol medications), Plaviax (blood clot prevention), Topamaz (migraines / seizures), Advair Diskus (asthma medication) and Oxycodone (pain). • For the SSI membership within Medical Assistance, these same ten drugs account for 26% of pharmacy payments and 8% of total prescriptions. • For the rest of Medicare (excluding SNP), only the cholesterol medications (Zocor and Lipitor), Plavix and Advair Diskus are in the top ten drugs by payment. However, these same ten drugs still account for 25% of payments and 8% of prescriptions for the rest of Medicare. • Other drugs utilized frequently by the SNP population and other Medicare members include One Touch Ultra Strips and Actos (diabetes medications), Fosamax (osteoporosis) and Remicade (rheumatoid arthritis / Chrohn's Disease)
Pharmacy Utilization – SNP Population • Utilizing Members • Prescriptions per 1000 • PMPM • Top 10 Drugs/Therapy Classes • Rx Utilization for Members > 6 Drugs • Rx Utilization Trends
TOP 5 THERAPY CLASSES BY MEMBER COUNT FOR MEMBERS UTILIZING > 6 DRUGS
TOP 5 THERAPY CLASSES BY MEMBER COUNT FOR MEMBERS UTILIZING > 6 DRUGS