PEBB Disease Burden Report PEBB Board of Directors August 21, 2007

1. Bdattach.10 PEBB Disease Burden Report PEBB Board of Directors August 21, 2007

2. Report Overview • DxCG Definitions • DxCG as a Tool • Population Demographics • Findings • Conclusions • Next Steps PEBB Board of Directors: August 21, 2007

3. DxCG (Diagnostic Clinical Groupings) • DxCG is one of a type of actuarial and clinically based statistical applications that evaluates claims transaction data in the past, to define the risk profile of participants and to forecast claims arising in the next year • Results in a prospective predictor of what is emerging • Predicts, by looking at PEBB’s past utilization profile, what resource utilization by condition is expected in the future based on disease risks and demographics • Different from previous studies because it focuses on the health and diseases of PEBB’s members, not the services they used PEBB Board of Directors: August 21, 2007

4. Benchmark • Medstat Marketscan Commercial Dataset of 10 million covered lives • Comprehensive data from nearly 100 health plans • Representation by a wide range of industries • Widely respected data which has been the source of more than 100 peer reviewed published studies in the past five years • Longitudinal tracking of individuals, which provides the ability to follow people over multiple years • Medstat dataset includes inpatient, outpatient, Rx and enrollment PEBB Board of Directors: August 21, 2007

5. Risk Score Defined • Predicted resource use by either PEBB’s population or individual PEBB member, as compared to the mean of PEBB’s population • This is not the same risk score that may be established by a Health Risk Assessment • Identifies the current resources utilization and projects what resource needs will be required in the next year PEBB Board of Directors: August 21, 2007

6. DxCG as a Tool • Actuarial/Financial Applications • Impact of member plan selection on risk (i.e., degree of adverse selection) • How risk/illness burden changes over time among plan offerings, business units, and other key measures • How member cost shares impact utilization patterns and member’s selection of plans • Number of large dollar cases projected for the next year • Identification of current low-cost members that are expected to be high-cost next year • Identification of current high-cost members expected to be low-cost next year (e.g., differentiates among cases that are one-time events) • Forecasts future costs by group, plan, product, or benefit • Provider network efficiency determination PEBB Board of Directors: August 21, 2007

7. DxCG as a Tool(continued) • Clinical Applications • Clinical conditions and membership cohorts that drive plan costs • How disease prevalence compares to benchmarks • Whether Care Management can impact illness burden • Identify members who would benefit from high touch/high cost disease management • Whether health plan case managers are identifying large cases • Which members are likely to be hospitalized next year • Impact of disease specific interventions over time; how members participating in these programs compare to those who do not actively participate • Burden of illness borne by each health plan PEBB Board of Directors: August 21, 2007

8. Distribution of Claimants by Allowed Charges per year PEBB Board of Directors: August 21, 2007

9. Population Utilization Characteristics PEBB Board of Directors: August 21, 2007

10. Population Demographics (continued) PEBB Board of Directors: August 21, 2007

11. Case/Disease Management Health Promotion Care Management Staying Healthy (70% population) Living w/Illness (16% population) Getting Better (14% population) 15% costs 25% costs 60% costs Complex Cases • Transplants • Cancer • Trauma cases Chronic Care • Diabetes, asthma • CAD, CHF, COPD • Depression Risk Factors • Alcohol/tobacco usage • Physical inactivity • Poor nutrition • Health history • Unmanaged stress • Inadequate self-care Acute Care • Broken leg • Kidney stones • Pneumonia Aon Health Management Model PEBB Board of Directors: August 21, 2007

12. Findings • PEBB members are*: • 21% more likely to have preventive screenings than the benchmark population 2977 (Benchmark) vs 3612 (2005) vs 3842 (2006) • 22% less likely than the benchmark population to have hypertension 801 (Benchmark) vs 591 (2005) vs 624 (2006) • Less likely than the benchmark population to have chronic illness in the following areas • Heart 1097 (Benchmark) vs 761 (2005) vs 779 (2006) • Lung 1003 (Benchmark) vs 854 (2005) vs 763 (2006) • Cerebro-vascular 62 (Benchmark) vs 39 (2005) vs 43 (2006) * Rates per 10,000 and are statistically significant PEBB Board of Directors: August 21, 2007

13. Findings (continued) • PEBB Members are*: • 16% more likely to seek medical care (79% in 2005 and 78% in 2006) versus a benchmark of 75.3% • 12% more likely than the benchmark population to have musculoskeletal conditions 1896 (Benchmark) vs 2118 (2005) vs 2176 (2006) • 3% more likely than the benchmark population to have diabetes 303 (Benchmark) vs 313 (2005) vs 337 (2006) • 63% more likely than the benchmark population to have behavioral health conditions 602 (Benchmark) vs 982 (2005) vs 1013 (2006) • 16% more likely than the benchmark population to have physical complaints that do not result in a diagnosis 2406 (Benchmark) vs 2790 (2005) vs 3108 (2006) * Rates per 10,000 and are statistically significant PEBB Board of Directors: August 21, 2007

14. Findings (continued) PEBB Members are*: • 28% more likely than the benchmark population to have injuries 1319 (Benchmark) vs 1696 (2005) v 1692 (2006) • 24% more likely than the benchmark population to have a substance abuse diagnosis 58 (Benchmark) vs 72 (2005) vs 74 (2006) • 16% more likely than the benchmark population to have an obesity related condition * Rates per 10,000 and are statistically significant PEBB Board of Directors: August 21, 2007

15. Conclusions • PEBB’s messaging regarding preventive screenings is working • PEBB’s benefit design is providing easy access to members • PEBB’s population is slightly older than the benchmark commercial population • PEBB’s benefit modification for morbid obesity has provided additional access to treatment for members PEBB Board of Directors: August 21, 2007

16. Conclusions (continued) • PEBB’s focus on diabetes and back conditions is warranted due to the higher prevalence than the benchmark population • PEBB may want to evaluate its focus on chronic illnesses in addition to diabetes in order to best target other areas of need • PEBB should evaluate its focus and activities to address behavioral health (including chemical dependency) issues PEBB Board of Directors: August 21, 2007

17. Next Steps • Council of Innovators will be reviewing over the next months: • Behavioral health issues (including substance abuse) and its relationship to other co-morbid conditions such as ill defined symptoms or injuries • Diabetes and what cardio-vascular co-morbid conditions are found with what frequency • Morbid Obesity and what co-morbid conditions are associated with this condition • Examination of the birth to 17 year old’s burden of disease PEBB Board of Directors: August 21, 2007