This article has been corrected from an earlier version.
July 12, 2013 — A Towers Watson report paid for by the Oregon Educators Benefit Board was released at its meeting on Thursday, and the numbers for inpatient, outpatient and physician services showed promising signs. Costly inpatient services are on the decline, and inpatient service use is showing a sharp uptick without a parallel increase in costs.
The report also laid down some metrics designed to control costs through more screenings and better management of chronic conditions, but poorly tracked data left few conclusions to be drawn on these measures.
OEBB offers health plans for its members through Kaiser Permanente and Moda Health, formerly known as ODS Health Plan. About 105,000 members have chosen Moda Health while 42,000 are on Kaiser. The study compared a year’s worth of data in September 2012 with data from the year prior.
Moda Health’s enrollment numbers are down 7 percent from the year before, and Towers Watson consultant Steve Carlson said half of that number came from individuals choosing not to receive health insurance through OEBB.
Despite a 38 percent increase in the use of outpatient services, overall costs for outpatient services per member per month under the Moda Health plans were up only 4 percent. But physician services also climbed 4 percent despite a 20 percent decrease in use of these services.
Hospital inpatient usage rates were down 1 percent, while costs went up 2 percent. Moda Health did a better job of controlling medication costs — up just 1 percent per member per month while the drug costs for those on the Kaiser plans rose by 6 percent.
Hospital inpatient costs for Kaiser members, meanwhile, fell sharply by 11 percent while inpatient use of its hospital system went down by 15 percent between 2011 and 2012.
Outpatient services for Kaiser were up 4 percent while the overall average costs actually went down 4 percent for outpatient services. Use of Kaiser’s physician services increased at the same rate as its costs, 4 percent.
The preventive health metrics prepared by the Strategies on Evidence and Outcomes Workgroup were particularly insufficient for Moda Health, which has not yet developed benchmarks for more than half of the measurements.
The health plans generally did a good job reaching goals for breast cancer screening and diabetes management, with results above personal benchmarks as well as standards set by the National Committee for Quality Assurance.
One possible red flag in the report was the low number of children covered by Moda Health who are receiving their vaccinations. Adolescent vaccination rates were only 39 percent while the rate for toddlers receiving their scheduled vaccination plan was 62 percent.
Oregon has the lowest childhood immunization rates against preventable contagious diseases in the nation, and the Legislature recently passed a law to tighten the exemption against vaccination for children entering kindergarten.
Mary Lou Hennrich, an OEBB board member and a senior consultant to the Oregon Public Health Institute, said there had also been a decline in the number of providers offering vaccinations.
But consultants from Towers Watson explained that little could be drawn from the vaccination data because it only counts immunizations paid for through insurance, and not necessarily those received at public health departments or school clinics.
The OEBB report did show some other positive signs: the emergency department visits were fairly low, with hospital admissions decreasing. Moda Health members used a greater proportion of generic drugs. However, Kaiser’s use of generics was down for prescriptions filled through the mail.
“We continue to see OEBB’s ED usage as stable and well below problematic levels,” Carlson said.
Image for this story by Pat Joyce (CC BY-NC 2.0) via Flickr.
Christopher David Gray can be reached at [email protected].
