Medicaid Health Plans of America April 20, 2006 Washington, D.C. John Lovelace, Vice President UPMC Health Plan

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Medicaid Health Plans of AmericaApril 20,
2006Washington, D.C.John Lovelace,Vice
PresidentUPMC Health Plan
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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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Race Comparison Medical or Pharmacy Expenses
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Race Comparison Medical And Pharmacy Expenses
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Race Comparison Medical Expenses Only
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Race Comparison Pharmacy Expenses Only
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Age Comparison Data Tables
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Age Comparison Medical or Pharmacy Expenses
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Age Comparison Medical and Pharmacy Expenses
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• Risk Score Comparison
• By Race, Age Group
• SNP versus Total Medicare Population

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Average Risk Score by Race and by Age Group
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Average Risk Score SNP compared to All Other
Medicare Members
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• MEDICAL EXPENSE ANALYSIS
• Claim Stratification (No IBNR)
• Unique Member (IBNR)
• Gender
• Race
• Financial Service Category
• Inpatient, Outpatient, PCP, etc

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Claim StratificationUnder 65 Years of Age(Total
Medical and Pharmacy Expenses No IBNR)
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Claim StratificationOver 65 Years of Age(Total
Medical and Pharmacy Expenses No IBNR)
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Medical Expense Utilization Unique Members Age,
Gender
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Medical Expense Utilization Unique Members Age,
Gender - PMPM
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Medical Expense Utilization by Race
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Medical Expense Utilization by Race, Age Unique
Members
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Medical Expense Utilization by Race, Age PMPM
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Medical Expense Utilization by Financial Service
Category PMPM
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Medical Expense Utilization by Financial Service
Category, by Age GroupUnique Members
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Medical Expense Utilization by Financial Service
Category, by Age Group PMPM
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• SNP Population Comparison
• All Other Medicare Members
• SSI/Medicaid

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SNP Payment ComparisonMedicare/SSI
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SNP Comparison to Medicare/SSIPrescriptions per
Member
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SNP Comparison Medicare/SSIRX Generic v Brand
Scripts
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SNP Comparison Medicare/SSIRX Generic v Brand
- Payment
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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)

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

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Pharmacy Utilization SNP Population
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Pharmacy Utilization SNP Population
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Pharmacy Utilization SNP Population
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Pharmacy Utilization SNP Population
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Pharmacy Utilization SNP PopulationBy Race
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Pharmacy Utilization SNP PopulationBy Race
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Pharmacy Utilization SNP PopulationBy Race
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Pharmacy Utilization SNP PopulationBy Gender
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Pharmacy Utilization SNP PopulationBy Gender
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SNP PopulationTop 10 Drugs
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SNP PopulationTop 10 Therapy Classes
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TOP 5 THERAPY CLASSES BY MEMBER COUNT FOR MEMBERS
UTILIZING gt 6 DRUGS
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TOP 5 THERAPY CLASSES BY MEMBER COUNT FOR MEMBERS
UTILIZING gt 6 DRUGS
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Rx UtilizationTrend/Drug Stratification
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Rx UtilizationTrend/Drug Stratification
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Rx UtilizationDrug Stratification - Month
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Rx UtilizationDrug Stratification Age Group
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Rx UtilizationDrug Stratification Age Group
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Rx UtilizationDrug Stratification Age Group
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• SNP Members Behavioral Health Analysis

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Behavioral Health Analysis
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Behavioral Health Analysis
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Behavioral Health Analysis
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Behavioral Health AnalysisComorbidities
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Behavioral Health AnalysisComorbidities
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Behavioral Health Analysis
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Behavioral Health Analysis
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Behavioral Health AnalysisTop 10 Diagnostic
Related Groups (DRGs)Under 65 Age Group
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Behavioral Health AnalysisTop 10 Diagnostic
Related Groups (DRGs)Over 65 Age Group