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ENROLLMENT COMPARISONS

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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ENROLLMENT COMPARISONS

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  1. Medicaid Health Plans of AmericaApril 20, 2006Washington, D.C.John Lovelace,Vice PresidentUPMC Health Plan

  2. ENROLLMENT COMPARISONS All SNP versus Utilizing Members Medical and Pharmacy Medical or Pharmacy Medical Only Pharmacy Only (By Race and By Age)

  3. Race Comparison – Medical or Pharmacy Expenses

  4. Race Comparison – Medical And Pharmacy Expenses

  5. Race Comparison – Medical Expenses Only

  6. Race Comparison – Pharmacy Expenses Only

  7. Age Comparison – Data Tables

  8. Age Comparison – Medical or Pharmacy Expenses

  9. Age Comparison – Medical and Pharmacy Expenses

  10. Risk Score Comparison • By Race, Age Group • SNP versus Total Medicare Population

  11. Average Risk Score by Race and by Age Group

  12. Average Risk Score – SNP compared to All Other Medicare Members

  13. MEDICAL EXPENSE ANALYSIS • Claim Stratification (No IBNR) • Unique Member (IBNR) • Gender • Race • Financial Service Category • Inpatient, Outpatient, PCP, etc

  14. Claim StratificationUnder 65 Years of Age(Total Medical and Pharmacy Expenses – No IBNR)

  15. Claim StratificationOver 65 Years of Age(Total Medical and Pharmacy Expenses – No IBNR)

  16. Medical Expense Utilization Unique Members Age, Gender

  17. Medical Expense Utilization Unique Members Age, Gender - PMPM

  18. Medical Expense Utilization by Race

  19. Medical Expense Utilization by Race, Age Unique Members

  20. Medical Expense Utilization by Race, Age PMPM

  21. Medical Expense Utilization by Financial Service Category PMPM

  22. Medical Expense Utilization by Financial Service Category, by Age GroupUnique Members

  23. Medical Expense Utilization by Financial Service Category, by Age Group PMPM

  24. SNP Population Comparison • All Other Medicare Members • SSI/Medicaid

  25. SNP Payment ComparisonMedicare/SSI

  26. SNP Comparison to Medicare/SSIPrescriptions per Member

  27. SNP Comparison – Medicare/SSIRX: Generic v Brand Scripts

  28. SNP Comparison – Medicare/SSIRX: Generic v Brand - Payment

  29. 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)

  30. Pharmacy Utilization – SNP Population • Utilizing Members • Prescriptions per 1000 • PMPM • Top 10 Drugs/Therapy Classes • Rx Utilization for Members > 6 Drugs • Rx Utilization Trends

  31. Pharmacy Utilization – SNP Population

  32. Pharmacy Utilization – SNP Population

  33. Pharmacy Utilization – SNP Population

  34. Pharmacy Utilization – SNP Population

  35. Pharmacy Utilization – SNP PopulationBy Race

  36. Pharmacy Utilization – SNP PopulationBy Race

  37. Pharmacy Utilization – SNP PopulationBy Race

  38. Pharmacy Utilization – SNP PopulationBy Gender

  39. Pharmacy Utilization – SNP PopulationBy Gender

  40. SNP PopulationTop 10 Drugs

  41. SNP PopulationTop 10 Therapy Classes

  42. TOP 5 THERAPY CLASSES BY MEMBER COUNT FOR MEMBERS UTILIZING > 6 DRUGS

  43. TOP 5 THERAPY CLASSES BY MEMBER COUNT FOR MEMBERS UTILIZING > 6 DRUGS

  44. Rx UtilizationTrend/Drug Stratification

  45. Rx UtilizationTrend/Drug Stratification

  46. Rx UtilizationDrug Stratification - Month

  47. Rx UtilizationDrug Stratification – Age Group

  48. Rx UtilizationDrug Stratification – Age Group

  49. Rx UtilizationDrug Stratification – Age Group

  50. SNP Members Behavioral Health Analysis

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