School Districts Post Unusually High Claims

A recent analysis shows that 99 percent of employees who had Providence or ODS insurance filed a medical or pharmacy claim
October 26, 2010 -- School district employees continue using more healthcare services than their national counterparts, according to consultants for the Oregon Educators Benefit Board.
 
Steve Carlson and Geoff Brown of Towers Watson presented their findings at the board’s Oct. 14 meeting.
 
In fact, 99 percent of employees who had Providence or ODS insurance filed a medical or pharmacy claim between March 2009 and April 2010, compared to 88 percent by Kaiser members, which Carlson called “unusually high.”
 
“The issues haven’t changed much, and the data still support actions we’ve taken for the coming year,” Carlson said. “It’s good that we haven’t been surprised.”
 
Three hospitals around the state also stood out for having higher than average costs – St. Charles Medical Center in Bend, Oregon Health & Science University and Good Samaritan Regional Medical Center in Corvallis.
 
With the state facing a $3.2 billon deficit next biennium, coupled with higher medical costs anticipated for school employees, the future looks grim. Several factors threaten the system’s sustainability, Carlson said -- limited health system integration and provider information sharing, inconsistent treatment patterns, revenue struggles for providers and contracting differences.
 
Taking a look at the specific claims costs, generic prescriptions outpaced the more expensive brand-name drugs -- 67.6 percent for ODS and Providence subscribers, and 73.7 percent for Kaiser members; the national norm is 63.3 percent.
 
Employees also reported lower emergency room utilization than the national norm: ODS and Providence, with 144 visits per 1,000 members, made 18.2 percent fewer emergency room visits than the national norm of 176 per 1,000 members, while Kaiser members’ use of emergency room services, 126 per 1,000 members, fell 28.2 percent below the norm, indicating that members sought non-emergency care appropriately through office visits.
 
Office visits for acute conditions, totaling 3,472 visits per 1,000 ODS and Providence members , occurred 21.4 percent more frequently than the national norm of 2,861 visits per 1,000 members. Kaiser members, with 2,369 visits per 1,000 members, made acute office visits at a rate 17.2 percent below the national norm of 2,861 visits.
 
The number of preventive claims, however, was 8.3 percent lower than the national norm for ODS and Providence: 388 per 1,000 members, compared to a national norm of 423 per 1,000. Even fewer preventive claims were filed by Kaiser members: 356 per 1,000 members versus the norm of 423, or 15.8 percent below the norm, indicating that subscribers were postponing care until symptoms occurred. Greater use of preventive services could identify conditions before the need for more intense and costly services, Carlson said.
 
Other examples of utilization and cost included:
  • Hospital admissions for ODS and Providence members, at 59 per 1,000 members, matched the national norm exactly, but hospital stays were longer: 233.7 days per 1,000 members, versus a national norm of 225.5 days per 1,000. Kaiser members, on the other hand, logged 8.5 percent fewer admissions than the norm, at only 54 per 1,000 members. And Kaiser members, with stays of 165.3 days per 1,000 members, had shorter stays than the norm of 225.5 days per 1,000 members.
  • Outpatient surgeries for ODS and Providence members numbered 18 percent more than the norm: 580.3 per 1,000 members versus the norm of 491.9. Outpatient surgeries for Kaiser members, however, fell 20.9 percent below the norm, with 389.3 per 1,000 for Kaiser members versus the norm of 491.9.
  • The number of radiology claims for ODS and Providence members was 12.3 percent higher than the norm: 975.4 per 1,000 versus a national norm of 868.4 per 1,000. In contrast, the number of radiology claims for Kaiser members, 731.3 per 1,000, was 15.8 percent lower than the norm of 868.4.
  • Utilization and cost for ODS and Providence members were significantly above the norm for physical, occupational and speech therapy, coming in at 119 percent higher than the norm: 1,843.3 per 1,000 members versus the norm of 839.6. Utilization for Kaiser members, however, was 63.2 percent below the norm – 309.1 per 1,000 members versus the norm of 839.6
The demographics of district employees no doubt contributed to the higher utilization and cost of services, according to Carlson. “Members are slightly older than the national norm and families are larger,” he said, noting that 44.6 percent of ODS and Providence members were over the age of 45, as were 34.6 percent of Kaiser members, compared to the national norm of 32.6 percent.

For More Information

To learn more about the Oregon Educators Benefit Board, visit http://www.oregon.gov/DAS/OEBB/

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