Diabetics make up a sliver of the population, but they cost insurance companies the most to cover, according to new data released Wednesday.
And the top drug prescribed to insured Utahns is anti-depressants, with depression another disease that is driving up health care costs.
The data is part of the Utah Department of Health’s All-Payer Database, a collection of medical and pharmacy claims from commercial insurance companies. Patients’ names are removed, but replaced by a unique identifier so their care can be tracked.
Knowing where insurance companies spend money should eventually help consumers shop for insurance plans and improve health care as researchers dig into where money is spent and whether it improves or hurts patients.
For example, the report showed insurance companies spent $293 million last year on radiology procedures, including x-rays, mammograms, MRIs and CT scans. Aside from mammograms, were all of those doses of radiation necessary and helpful? Or were doctors practicing defensive medicine?
The health department provided the Legislature a glimpse of the power of the database showing tidbits such as :
” Insurers paid an average of $3,046 per pregnancy where the baby was delivered vaginally. The cost includes care from the first prenatal visit to the six-week postpartum check-up. It costs another $1,000 to have a Cesarean-section delivery.
” Sixty percent of insured Utahns are considered “healthy,” costing insurance companies just $39 per member per month in medical claims.
” Utahns with any two major chronic diseases cost $652 per member per month. Those patients eat up one-third of the money spent on health care ‘ more than catastrophic conditions such as extreme prematurity and complicated cancers.
The database doesn’t include information on Medicaid or Medicare patients ‘ though adding them is in the works ‘ or the uninsured.
When it comes to diabetes, 11 percent of the money insurance companies spend is on the 3 percent of the patients with diabetes.
The $169 million spent last year on diabetes vastly underestimates the true costs because diabetes prevalence increases with age and people older than 65 aren’t included in the database, noted Richard C. Bullough, director of the health department’s Diabetes Prevention and Control Program.
It’s costly to treat because “it has to be managed all the time. To be managed effectively, it takes expensive medications and relatively frequent office visits,” he said.
When it isn’t managed, the disease can lead to blindness, amputations, heart attacks, strokes and kidney disease requiring dialysis.
Bullough expects costs to continue to climb as more Utahns are diagnosed as the population ages and gets heavier.
Public health officials and researchers will be able to use the database to find out if patients in areas with the highest costs for diabetes care got the necessary tests and drugs to keep the disease in check.
If not, “We can target providers whose patients don’t appear to get all the testing,” said Christie North, vice president of HealthInsight, which has a government contract to improve health care and will use this database, along with others, to focus on diabetes.
SelectHealth, one of the insurers that provided data for the database, mines its internal data to help diabetics manage their disease ‘ and it actually costs more in the short-term.
Kelly Whiting, director of care management, said getting diabetics with out-of-control blood sugar levels to take their medications and get regular check-ups ‘ even sending them a portion-control plate ‘ increases costs even as their emergency room visits and hospitals stays drop.
The hope is over time the costs will drop as those patients don’t develop other diseases, he said.
Insurers spent $25.7 million to treat 23,400 patients with depression in 2009, making the disease the sixth most-expensive to treat. More than half a million prescriptions were written for anti-depressants, making it the most-prescribed type of drug.
Sherri Wittwer, director of the National Alliance on Mental Illness of Utah, said the numbers may mean doctors do a good job screening patients for depression or Utah has a high incidence of depression.
Depression, she added, can go hand in hand with other chronic illnesses, too, including cancer and heart disease.
“It just makes sense if you’re not feeling well your mental health suffers as well and you get depressed,” she said.
By Heather May
The Salt Lake Tribune