Upload
priyapsalms
View
222
Download
0
Embed Size (px)
Citation preview
8/3/2019 Healthcare Trends in America
1/101
HealthcareTrendsin AmericaA Reference Guide from BCBSA
2010 Edition
8/3/2019 Healthcare Trends in America
2/101
Contents
Introduct ion................................................ ......................................... 1
Section1:ImprovingAccesstoHealthCoverage...........................3
Section2 :KeepingHealth careAf fordable..................................... 17
Section3:ImprovingQualityandSafety.......................................33
Section4:ImprovingConsumerHealth.........................................53
Section5:ChangingCareDeliveryModels....................................77
Methodology.............................................. ....................................... 90
Glossaryof Abbreviat edTerms...................................................... 91
IndexofTables..................................................................................92
Bibliography............................................... ....................................... 95
8/3/2019 Healthcare Trends in America
3/101
1 Blue Cross and Blue Shield Association
Dear Colleague:
I am pleased to share with you the 2010 Healthcare Trends
in America: A Reference Guidefrom the Blue Cross and Blue
Shield Association, offering a comprehensive compendium and
analysis of healthcare economics and key trends inuencing
healthcare in our country.
Now in its eighth year of publication, the guide organizes
data in four key categories essential to improving our nations
healthcare system: improving access to health coverage,
keeping healthcare affordable, raising the quality and safety
of care and improving consumer health. We have also devoted
an entire section of the guide to changing care delivery models
designed to improve our healthcare system.
Through the use of national research and other well-respected,
fact-based data sources, the guide is designed to make us all
more informed about healthcare and the economics of health-
care through an extensive annual examination of healthcare
costs and trends.
In keeping with our 80-year heritage of local and national
healthcare leadership, Blue Cross and Blue Shield companies
are collaborating with key stakeholders from policy makers
and leading medical organizations to consumer groups and
major employers to design and implement a better healthcare
delivery system for our nation.
New data from Blue Health Intelligence (BHI) the nationslargest healthcare data warehouse with claims information on
more than 54 million members is helping us achieve our goal.
The robust new information and insights from BHI included in
the Reference Guideprovides far greater transparency to help
alter the way we view healthcare and help change the way care
is delivered in our country.
We also have included a CD-ROM in the guide with an interac-
tive PDF version for access to PowerPoint slides of each chart.
Yours in good health,
Scott P. Serota
President and Chief Executive Ofcer
Blue Cross and Blue Shield Association
8/3/2019 Healthcare Trends in America
4/101
2HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
8/3/2019 Healthcare Trends in America
5/101
3 Blue Cross and Blue Shield Association
Improving Access to Health Coverage
U.S.Populatio nwithHeal thInsuranc einMillions.....................................................5
CoveragebyTypeofHeal thInsuran ce........................................................................6
EmployersO fferi ngHealthBen ets............................................................................7
Employer-Spo nsoredHe althPlanEnrollm ent............................................................8
EnrollmentinC OBRA.....................................................................................................9
AccountImplementationofBenetChangesasaResult
ofCurrent EconomicEnvir onment............................................................................. 10
EnrollmentinM edicaidandM edicare....................................................................... 11
Medicar eAdvantageEnr ollmentinMillio ns............................................................. 12
Percent ageofUninsure dbyIncomeLevel...............................................................13
Percent ageofUninsure dbyState............................................................................. 14
Breakdowno ftheUninsure d......................................................................................15
3 Blue Cross and Blue Shield Association
Improving Access to Health Coverage
Section
1
Improving Access to Health Coverage
8/3/2019 Healthcare Trends in America
6/101
Improving Access to Health Coverage
4HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
While more than 85 percent of the nations 300 million people
have health insurance, 15 percent of Americans do not have
coverage and many others may lose their health insurancedue to the struggling economy.
Of the insured population, nearly 60 percent receive their
health insurance through their employers. Enrollment in
government programs has risen slightly in the past few years
and now represents nearly 30 percent of those with coverage.
Direct purchasers represent the remainder.
Blue Cross and Blue Shield is committed to extending healthinsurance to those who do not have coverage, and The Blues
believe the best way to accomplish this goal is to build on
our employer-based system. In 2009, more than 95 percent
of American rms with more than 50 employees offered health
insurance coverage to their employees. However, less than
half of companies with fewer than 10 employees offer health
benets. Increasing the percentage of small employers that
offer health benets is critical to increasing coverage levels.
Additionally, there must be a focus on those most likely tolack coverage, such as young adults aged 18-34, Hispanics,
and African-Americans.
The Blues have been active participants in the ongoing health-
care reform debate and have led the industry in identifying
insurance reforms that would guarantee coverage to everyone,
regardless of pre-existing conditions or health status. In order
to accomplish this goal and keep coverage affordable for
everyone, there must be a mechanism for ensuring that peoplehave insurance and not simply wait until they are sick to
purchase insurance. It is imperative that we nd new and
innovative ways to address the crisis of the uninsured.
Summary
8/3/2019 Healthcare Trends in America
7/101
5 Blue Cross and Blue Shield Association
Improving Access to Health Coverage
U.S. PopulationPersons with Health InsurancePersons with Employer-Sponsored Coverage
20082007200620052004
176.9 177.2 176.3177.4176.2
247.7 249.0253.4 255.1249.8
291.2293.8
296.8299.1
301.5
U.S. Population with Health Insurance in Millions
In 2008, about 85 percent of more than 300 million Americans had health insurance.
Source: U.S. Census Bureau (2009) Historical Health Insurance Tables, Table HIA-2.
85.1% 84.7% 84.2% 84.7% 84.6%
PercentagewithHealthInsurance
8/3/2019 Healthcare Trends in America
8/101
Improving Access to Health Coverage
6HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Private Insurance
66.7%
69.0%
58.5%
60.5%
8.9%
9.5%Direct Purchase
Employment-Based
Any Private Plan*
Military Healthcare**
Medicaid
Medicare
Any Government Plan
Government Insurance
29.0%
27.3%
14.3%
13.6%
14.1%
13.0%
3.8%
3.7%
Uninsured
Uninsured
15.4%
14.9%
2004 2008
Coverage by Type of Health Insurance
Among those with health insurance coverage, two-thirds are covered by private insurance plans.
*Any private plan includes employment-based and direct purchase health insurance plans.**Military healthcare includes Comprehensive Health and Medical Plan for Uniformed Services (CHAMPUS)/Tricare and Civilian Health and Medical Program of the Department ofVeterans Affairs (CHAMPVA), as well as care provided by the Department of Veterans Affairs and the militar y.Note: The estimates by types of coverage are not mutually exclusive; people can be covered by more than one type of health insurance during the year.Source: U.S. Census Bureau (2009) Historical Health Insurance Tables, Table HIA-2.
8/3/2019 Healthcare Trends in America
9/101
7 Blue Cross and Blue Shield Association
Improving Access to Health Coverage
60%
2005 2009
60%
33%
31%
28%29%
Offering Health Benefits*
Offering Retiree Health Benefits**
Offering Health Benefits to Part-Time Workers***
3 - 9 10 - 24 25 - 49 50 - 199 200 or
moreNumber of Workers per Firm
47% 46%
72% 72%
87% 87%
93% 95%98% 98%
Percentage of Firms Offering
Health Benefits by SizePercentage of Employers
Offering Health Benefits
2005 2009
Employers Offering Health Benets
The percentage of employers offering health benets to employees has been relatively stable. At least 95 percent of rms with morethan 50 employees offer health benets.
*Among all rms.**Among all rms with 200 or more workers offering health benets to active workers.***Among rms offering health benets.Source: Employer Hea lth Benets 2009 Annual Survey, (#7936), The Henry J. Kaiser Family Foundation and HRET, September 2009.This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation is a non-prot private operating foundation based in Menlo Park, Calif., dedicated
to producing and communicating the best possible information, research and analysis on health issues.
Employer-Sponsored Insurance Coverage
8/3/2019 Healthcare Trends in America
10/101
Improving Access to Health Coverage
8HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
2005 2009
Employer-Sponsored Health Plan
Enrollment by Plan Type
15%
61%
21%
3%
8%
10%
60%
20%
1%
HDHP/SOPOSPPOHMOConventional
Among Firms Offering Health Benefits, Percentage that
Offer an HDHP/HRA or an HSA-Qualified HDHP
2005 2006 2007 2008 2009
2% 2%
1%
6%
3%
7%
3%
11%
2%
10%
HDHP/HRA HSA-Qualified HDHP
Employer-Sponsored Health Plan Enrollment
Sixty percent with employer-sponsored coverage are covered by PPOs. Over time, HDHP enrollment has increased to 8 percent,likely driven by more employers offering them.
Note: HMO is health maintenance organization. PPO is preferred provider organization. POS is point-of-service.Source: Employer Hea lth Benets 2009 Annual Survey, (#7936), The Henry J. Kaiser Family Foundation & HRET, September 2009.This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation is a non-prot private operating foundation, based in Menlo Park, Calif.,dedicated to producing and communicating the best possible analysis and information on health issues.
Employer-Sponsored Insurance Coverage
Denitions
High-deductiblehealthplanswithsavingsoption(HDHP/SOs)aredenedasa: HDHP/HRA:Healthplanwithadeductibleofatleast$1,000forsinglecoverageand$2,000forfamilycoverageofferedwithaHealthReimbursementArrangement(HRA) HSA-qualiedHDHP:High-deductiblehealthplanthatmeetsthefederallegalrequirementsadeductibleofatleast$1,150forsinglecoverageand$2,300forfamily
coveragein2009topermitanenrolleetoestablishandcontributetoaHealthSavingsAccount(HSA).
8/3/2019 Healthcare Trends in America
11/101
9 Blue Cross and Blue Shield Association
Improving Access to Health Coverage
Dec-09
Oct-09
Aug-09
Jun-09
Apr-09
Feb-09
Dec-08
Oct-08
Aug-08
Jun-08
Apr-08
Feb-08
Est.
Unemployed
Population -7.5 mil lion
Est.
Unemployed
Population -15.3 million
4.8%5.0%
5.5%
6.1%
6.6%
7.4%
8.2%
8.9%
9.5%
9.7%
10.1% 10.0%
2009(p)*200620052004
2.82.6
3.1
7.0
Uptake of COBRA
by eligible workersdoubled during
subsidy period
Enrollment in COBRA
Higher unemployment rates coupled with government subsidy is likely driving increased COBRA uptake.
*Projected by the Confessional Budget Ofce.Note: Government programs include American Recovery and Reinvestment Act (ARRA) and Defense Appropriations Bill.Source: U.S. Department of Labor, Bureau of Labor Statistics (2009); UBS Investment Research (2009) Managed Care UBS COBRA Tracker; Congressional Budget Ofce (2009); National BusinessGroup on Health (2009) Congress Extends Federal COBRA Subsidies; The COBRA Subsidy and Health Insurance for the Unemployed, (#7875-02), The Henry J. Kaiser Family Foundation, December 2009This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation is a non-prot private operating foundation, based in Menlo Park, Calif., dedicated to
producing and communicating the best possible analysis and information on health issues.
Employer-Sponsored Insurance Coverage
COBRA Subsidies
GovernmentlegislationprovidedtemporarysubsidiestosomeworkerswhowereinvoluntarilyterminatedbetweenSept.2008throughFeb.2010,tohelpmaintaincoverage:
Withoutsubsidy,eligibleworkerspaythefullpremiumplus2percentadministrativefee
Subsidiescovered65percentofthecostofCOBRAforacumulative15months
8/3/2019 Healthcare Trends in America
12/101
Improving Access to Health Coverage
10HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Plan to ImplementAlready Implemented
Limit New Hire Benefits
Provide Defined Contribution
Decrease or Eliminate
HSA Contribution
Limit or ExcludeDependent Coverage
Limit or Cut Retiree Benefits
Institute Single-Plan Design
as Full Replacement
Move Employees to HDHP
Increase Employee Cost Sharing 19% 30% 49%
32%
13%
12%
11%
10%
9%
7%
20%
6%
4%
6%
5%
4%
4%
12%
7%
8%
5%
5%
5%
3%
Account Implementation of Benet Changes as a Result of Current Economic Environment
As a result of current economic conditions, many large, multi-state employers are increasing employee cost sharing.
Source: Blue Cross and Blue Shield Association (2009) National Account Decision-Maker Survey.
Employer-Sponsored Insurance Coverage
8/3/2019 Healthcare Trends in America
13/101
11 Blue Cross and Blue Shield Association
Improving Access to Health Coverage
33.6
39.237.4
46.943.0
40.4
11.0
48.1
43.941.4
17.4
47.145.0
42.0
25.9
Medicare Part DMedicare Part BMedicare Part AMedicaid
2008200720062000
Medicaid and Medicare Beneficiaries(in Millions)
Stand-alonePDP
17.5M
Medicare
Advantage Drug Plan
9.2M
RetireeDrug
Coverage
7.9M
Other Drug
Coverage*6.2M
No DrugCoverage**
4.5M
Prescription Drug Coverage AmongMedicare Beneficiaries in 2009
Medicare Beneficiaries = 45.2 Million
Enrollment in Medicaid and Medicare
Enrollment in Medicaid and Medicare Part A and B has been relatively stable in the last three years. More than 90 percentof Medicare beneciaries have drug coverage.
*Includes Veterans Affairs, retiree coverage without retiree drug subsidy (RDS), Indian Health Service, state pharmacy assistance programs, employer plans for active workers, Medigap, multiple sourcesand other sources.**Includes RDS and FEHBP and TRICARE retiree coverage.Note: Medicare Part D was introduced in 2006. PDP is prescription drug plan. Figures may not add up due to rounding.Source: Centers for Medicare and Medicaid Services (2009); The Medicare Prescription Drug Benet An Updated Fact Sheet, (#7044-10) The Henry J. Kaiser Family Foundation, November 2009
This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation is a non-prot private operating foundation, based in Menlo Park, Calif.,dedicated to producing and communicating the best possible analysis and information on health issues.
Public Programs
8/3/2019 Healthcare Trends in America
14/101
Improving Access to Health Coverage
12HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
7.7
2010*2009200820072006
10.1
10.611.0
8.8
Medicare Advantage Enrollment in Millions
More than 11 million are enrolled in Medicare Advantage, growing more than 40 percent since 2006.
*2010 Medicare Advantage enrollment as of January 2010.Note: Enrollment gures are as of December of each year.Source: Centers for Medicare and Medicaid Services (2010).
Public Programs
8/3/2019 Healthcare Trends in America
15/101
13 Blue Cross and Blue Shield Association
Improving Access to Health Coverage
Uninsured by Income Level
(2008 Uninsured: 46.3M)
13.7M
14.9M
8.0M
9.7M
24.3% 24.2% 24.9% 24.5% 24.5%
21.1% 21.4%21.1%20.1%19.8%
13.0% 13.3%14.4% 14.5% 14.0%
8.2%7.8%8.5%8.2% 7.7%
$75,000+
$50,000 - $74,999
$25,000 - $49,999
8/3/2019 Healthcare Trends in America
16/101
Improving Access to Health Coverage
14HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
WA
OR
CA
NV
AZ
UT CO
NM
MT
WYID
SD
ND
NE
KS
OK
TXLA
AR
MO
IA
MN
WI
ILID
MI
KY
TN
MS ALGA
FL
SC
NC
VA
WV
OHPA
NY
VTNH
ME
MACT
RI
NJ
DE
MD
HI
AK
17.5% or higher
15.5% to 17.4%
12.4% to 15.4%
12.3% or lower
Percentage of Uninsured by State
In 2008, 17 states had a higher uninsured rate than the national level of 15.4 percent.
Source: Health Insurance Coverage of the Total Population, states (2007-2008), U.S. (2008), statehealthfacts.org, The Henry J. Kaiser Family Foundation, 2009This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation is a non-prot private operating foundation, based inMenlo Park, California, dedicated to producing and communicating the best possible analysis and information on health issues. Reprinted with permission of the Urban Institute.
The Uninsured
8/3/2019 Healthcare Trends in America
17/101
15 Blue Cross and Blue Shield Association
Improving Access to Health Coverage
2008 Uninsured: 46.3M
65 and
Older
1%Under 18
16%
25 - 34
23%
35 - 44
17% 45 - 64
24%
18 - 24
18%
By Age By Ethnicity
Non-Hispanic
White
46%
Asian
5%
Hispanic
31%
Black
16%
By Citizenship Status
American Citizens
73%
Not a Citizen
21%
Naturalized
Citizens
6%
Breakdown of the Uninsured
Young adults aged 18-34 comprise the largest portion of the uninsured; nearly one-third of the uninsured are Hispanic.
Note: Figures may not add up to 100 percent due to rounding. Segments per U.S. Census Bureau.Source: Census Bureau (2009) I ncome, Poverty, and Health Insurance Coverage in the United States: 2008.
The Uninsured
8/3/2019 Healthcare Trends in America
18/101
16HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
8/3/2019 Healthcare Trends in America
19/101
17 Blue Cross and Blue Shield Association
Keeping Healthcare AffordableKeeping Healthcare Affordable
Section
2ComponentsofGrossDomesticProduct(GDP).......................................................19
Healthc areSpendinginBi llions.................................................................................19
Internat ionalHealt hcareSpend ingasaPercent ageofGDP...................................20
GrowthRatesofHealthcareSpending,WagesandSalaries,
andtheCPI....................................................................................................................21
TheNationsHea lthcareD ollar...................................................................................21PercentageSpentonHealthcarebySourceofFunds.............................................22
ChangeBetween2004and2007inTotalCostsforHospitalStays........................22
PercentageChangeinHealthcareUtilizationandCosts.........................................23
PhysicianO fceV isits................................................................................................. 24
HospitalEmployeesinMillionsandPercentageofHospitals
withPhys icianAf liationsbyOr ganizatio n..............................................................25
AnnualGrow thinDrugSpen ding..............................................................................26
GenericPrescriptionsasaPercentageofTotalScripts,2006-2008.....................27
AverageConsumerPharmacyCopaymentsbyTier................................................27
GenericDrugApprovals..............................................................................................28
AverageAnnualPremiumforFamilyCoverage......................................................29
HospitalPayment-to-CostRatiosforMedicare,Medicaid
andPrivatePayers.......................................................................................................30
PercentageofMembersOut-of-PocketCostSharingbyProductLine,
2006-2008....................................................................................................................30
ActionsOrganizationsAreTakingRegardingTheirHealthcare
ProgramsG ivenRecentEven tsinEconom y............................................................. 31
PrivateHealthPlanAdministrativeExpensesasaPercentage
ofPremiums..................................................................................................................32
SavingsandRec overiesfro mFraudInvest igationsinMil lions..............................32
17
Keeping Healthcare Affordable
8/3/2019 Healthcare Trends in America
20/101
Keeping Healthcare Affordable
1818HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Summary
Comprising 17.3 percent of the nations Gross Domestic Product,
healthcare spending represents a signicant portion of the U.S.
economy. The current healthcare spend represents more than$8,000 annually for every man, woman and child in the nation
a far greater per-capita spend than any other country.
Government programs fund almost half of the nations total
healthcare expenses, while private insurance funds one-third.
The remainder is largely covered by consumer out-of-pocket
payments.
Two-thirds of the total healthcare spend is devoted to hospitalcare, physician and clinical services, and prescription drugs.
Major trends in these three largest components show:
The cost of hospital stays are increasing, even though length
of hospital stays are on the decline.
While the total number of physician visits has remained
relatively at with the majority of visits to general/family
practitioners and internists the trend shows a rapidly
growing number of visits to specialists.
Growth in total and specialty drug spending has risen,driven largely by higher unit costs.
Health insurance premiums have risen, reecting the impact
of overall rising healthcare costs. Private payers continue to
pay hospitals more than Medicare and Medicaid as hospitals
apply higher charges to private payers to compensate for
a widening gap in payments from government programs.
Recognizing the value of offering coverage to their employees,
employers continue to cover nearly 75 percent of annualemployee premiums.
Facing a projected growth rate of 3.9 percent, stemming the
rise in healthcare costs is a top national priority. Finding ways
to improve healthcare quality and safety, while keeping health-
care affordable remains a major challenge.
8/3/2019 Healthcare Trends in America
21/101
19 Blue Cross and Blue Shield Association
Keeping Healthcare Affordable
Components of Gross Domestic Product (GDP) Healthcare Spending in Billions
The whole healthcare sector represents a signicant portionof the U.S. economy.
Healthcare is projected to be almost 18 percent of GDPby 2015.
*Annual gure for 2009 projected by Centers for Medicare and Medicaid Services. Other data pointsare as of Q4 2009.Note: Healthcare costs reect National Health Expenditure (NHE) which measures the total amountspent in the U.S. to purchase healthcare goods and services during the year. The amount invested inmedical sector structures and equipment and in non-commercial research in the U.S. is also included.
Source: Bureau of Economic Analysis (2010); Centers for Medicare and Medicaid Services (2010).
*Projected by Centers for Medicare and Medicaid Services.Source: Centers for Medicare and Medicaid Services (2010).
Healthcare Spending Healthcare Spending
Motor
Vehiclesand Parts
Gasoline
and OtherEnergy Goods
FoodNational
Defense
Housing
and Utilities
Healthcare*
13.1%
5.5% 5.5%
2.5% 2.2%
17.3%
NHE
2015(p)*2010(p)*2009(p)*200820072006
$2,113 $2,240$2,339
$2,472 $2,570
$3,442
NHE as a Percentage of GDP
15.8% 15.9% 16.2%17.3% 17.3% 17.7%
$7, 07 1 $ 7, 42 3 $ 7, 68 1 $ 8, 047 $ 8,2 90 $10 ,63 1
PerCapita
8/3/2019 Healthcare Trends in America
22/101
Keeping Healthcare Affordable
20HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
International Healthcare Spending as a Percentage of GDP
The U.S. spends a higher proportion of GDP on healthcare than any other country, four percentage points ormore above all others.
Source: World Health Organization (2009); Centers for Medicare and Medicaid Services (2010)
Healthcare Spending
Less than or equal to 3
3.1 - 5
5.1 - 8
8.1 - 10
10.1 - 13
>13
Data not available
Global GDP Spendingon Healthcare
U.S.spendsthemostonhealthcare:17.3%
Germany,FranceandSwitzerland:10.1%-13.0%
Canada,theUnitedKingdomandJapan:8.1%-10.0%
Russia,MexicoandBrazil:5.1%-8.0%
China,IndiaandSaudiArabia:3.1%-5.0%
8/3/2019 Healthcare Trends in America
23/101
21 Blue Cross and Blue Shield Association
Keeping Healthcare Affordable
Growth Rates of Healthcare Spending, Wages and Salaries,and the CPI
The Nations Healthcare Dollar
Healthcare spending in 2010 is expected to grow 3.9 percent,twice as much as CPI but less than wages and salaries.
Nearly two-thirds of annual healthcare spend is for hospitalcare, physician and clinical services and prescription drugs.
*Projected by Centers for Medicare and Medicaid Services.Source: Centers for Medicare and Medicaid Services (2010); Congressional Budget Ofce (2010).
*Figures do not add to 100 percent due to rounding.**Other spending includes dental services, other professional services, durable medical products,other non-durable medical products, public health activities, structures and equipment, otherpersonal healthcare and research.Note: Figures are from year-end 2008.
Source: Centers for Medicare and Medicaid Services (2010).
Healthcare Spending Healthcare Spending
Consumer Price Index (CPI)Wages and SalariesNHE
2010(p)*2009(p)*200820072006
6.6% 6.0%
5.7% 5.9%
3.9%
6.3%
5.6% 4.4%
4.0% 4.0%
1.7%
3.8%
2.8%3.2%
-1.0%
Federal
35%
State &
Local12%
Private
Insurance
34%
Out of
Pocket12%
OtherPrivate
7%
Where it Came From Where it Went*
Hospital
Care
31%Other
Spending**23% Physician
& Clinical
Services
21%PrescriptionDrugs 10%
Nursing Home
Care 6%
Government
Administration andNet Cost of Private
Health Insurance7%
HomeHealthcare
3%
8/3/2019 Healthcare Trends in America
24/101
Keeping Healthcare Affordable
22HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Percentage Spent on Healthcare by Source of Funds
Hospitals, physician and clinical services, and prescriptiondrugs account for 77 percent of private health insurance
spending, 61 percent of public spending and 43 percent of
out-of-pocket spending.
*Other spending includes nursing home, home health, dental services, other professional services,durable medical products, other non-durable medical products, public health activities, research,structures and equipment, government administration and net costs of private health insurance,and other personal healthcare. Figures are from year-end 2008.**Figures do not add to 100 percent due to rounding.Source: Centers for Medicare and Medicaid Services (2010).
Healthcare Spending
Other*Prescription DrugsPhysician and
Clinical Services
Hospital
Out-of-Pocket**Public**Private Health Insurance
23%
13%
31%
33%
40%
8%
16%
37%
56%
17%
18%
8%
Change Between 2004 and 2007 in Total Costs for Hospital Stays
Hospital costs are on the rise; between 2004 and 2007, costsfor all hospital stays increased $344 billion.
Source: Agency for Healthcare Research and Quality, Center for Delivery, Organization, and Markets,Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2004 and 2007.
Hospital and Physician Expenditures
Hospital Stays withProcedure Performed
All Hospital Stays
$344B
$296B
6.3% 7.2%
PercentageChange
8/3/2019 Healthcare Trends in America
25/101
23 Blue Cross and Blue Shield Association
Keeping Healthcare Affordable
Percentage Change in Healthcare Utilization and Costs
Inpatient healthcare utilization declined between 2007 and 2008, but outpatient care and professional visits rose.Costs associated with healthcare services increased in the same time frame.
Note: Data include commercially insured individuals below age 65.Source: BHI (2009)BHI is a registered trademark of the Blue Cross and Blue Shield Association. The information contained herein is proprietary and was derived from claims informationsubmitted by Member Plans of the Blue Cross and Blue Shield Association.2009 BHI All Rights Reserved. No reproduction without permission.
Hospital and Physician Expenditures
Pharmacy
Scripts per
Member
Professional
Office Services
per Member
Outpatient
Services per
Member
Inpatient Days
per 1,000
-0.4%
1.7%1.7%
-3.9%
Percentage Change in Healthcare
Utilization Between 2007 and 2008
Percentage Change in Healthcare
Costs Between 2007 and 2008
Allowed
Amount per
Script
Professional
Office Allowed
Amount per
Service
Outpatient
Allowed
Amount per
Service
Inpatient
Allowed
Amount per
Day
7.7%
4.4%
2.5%
2.9%
8/3/2019 Healthcare Trends in America
26/101
Keeping Healthcare Affordable
24HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Physician Ofce Visits
The total number of physician visits has remained relatively stable. Over half of visits are for primary care.
Source: Centers for Disease Control and Prevention. Health, United States, 2006-2009, Centers of Disease Control and Prevention (2008) National Health Statistics Reports, Number 3.
Hospital and Physician Expenditures
20072006200520042003
317 315
329
307
336
General andFamily Medicine
23%
InternalMedicine
14%
Obstetrics andGynecology
8%
Opthalmology
6%
Orthopedic
Surgery5%
Oncology
2%
Pediatrics14%
All Others
28%
Physician Office Visits per 100 People Office Visits by Physician Specialty
K i H l h Aff d bl
8/3/2019 Healthcare Trends in America
27/101
25 Blue Cross and Blue Shield Association
Keeping Healthcare Affordable
Hospital Employees in Millions and Percentage of Hospitals with Physician Afliations by Organization
Hospitals are employing more staff and reducing external afliations.
Source: Adapted from the American Hospital Association and Avalere Chartbook 2009: Trends Affecting Hospitals and Health Systems.
Hospital and Physician Expenditures
Group Practice without Walls
Management Service Organization
Independent Practice Organization
Physician-Hospital Organization
Hospital Full-time Equivalents
20072003
4.1
4.5
21%
16%
13%
10%9%
4%
3%
19%
8/3/2019 Healthcare Trends in America
28/101
Keeping Healthcare Affordable
26HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Annual Growth in Drug Spending
After several years of declining trend, the rate of growth in specialty and overall drug spending rose between 2007 and 2008,driven by increased unit costs.
Note: Medicare utilization is included in Medcos overall trend as of January 1, 2006.Source: Drug Trend Report: The Great Healthcare Debates. 2009 Medco Health Solutions, Inc.; Drug Trend Report: Predictions. 2008 Medco Health Solutions,Inc.; Drug Trend Report: Humanomics. 2007 Medco Health Solutions, Inc.; Drug Trend Report: Personalizing Healthcare. 2006 Medco Health Solutions, Inc.
Prescription Expenditures
Unit CostUtilization
Total
Drug
Specialty
Drug
Total
Drug
Specialty
Drug
Total
Drug
Specialty
Drug
Total
Drug
Specialty
Drug
Total
Drug
Specialty
Drug
20.4%
4.5%
15.9%
8.5%
3.1%
16.9%16.1%
5.4%
2.8%
12.4%
2.0%
3.3%
15.8%
6.6%
2.7%
8.8%
1.8%
8.4%
11.5%
0.4% 4.4%
10.3%
2.7%
7.3%
1.0% 1.6%3.9% 4.3%
-1.1%
5.4%
2004 2005 2006 2007 2008
Specialty Pharmaceutical
Specialtydrugsaccountedfor
12.8%oftotalpharmacyspend
in2008.Thetoptherapeutic
classescontributingtospecialty
drugpharmacyspending
includeautoimmuneconditions,
multiplesclerosisandcancer,
togethercomprising60percent
ofspecialtydrugspend.
K i H lth Aff d bl
8/3/2019 Healthcare Trends in America
29/101
27 Blue Cross and Blue Shield Association
Keeping Healthcare Affordable
200820072006
53.4%56.1%
58.8%
Generic Prescriptions as a Percentage of Total Scripts, 2006 - 2008 Average Consumer Pharmacy Copayments by Tier
As a percentage of all scripts, generic scripts are on the rise,up 5.4 percentage points between 2006 and 2008. While average copayments for generic prescriptions remain at$10, copayments for other prescriptions continue to rise.
Note: Data include commercially insured individuals below age 65.Source: BHI (2009)BHI is a registered trademark of the Blue Cross and Blue Shield Association. The informationcontained herein is proprietary and was derived from claims information submitted by Member Plansof the Blue Cross and Blue Shield Association.2009 BHI All Rights Reserved. No reproduction without permission.
*Fourth-tier drugs are drug products, such as lifestyle or injectable drugs, that are paid for using new types ofcost-sharing arrangements that typically have higher copayments or coinsurance. The average copayment forfourth-tier drugs is calculated using information from only those plans that have a fourth-tier copayment amount.Source: Employer Health Benets 2009 Annual Survey, (#7936), The Henry J. Kaiser Family Foundation andHRET, September 2009. This information was reprinted with permission from the Henry J. Kaiser Family Founda-tion. The Kaiser Family Foundation is a non-prot private operating foundation, based in Menlo Park, Calif., dedi-cated to producing and communicating the best possible information, research and analysis on health issues.
Prescription Expenditures Prescription Expenditures
20092005
Other(Tier 4)*Non-PreferredDrugs(Tier 3)
PreferredDrugs(Tier 2)
Generic Drugs(Tier 1)
$10 $10
$23$27
$40
$46
$74
$85
8/3/2019 Healthcare Trends in America
30/101
Keeping Healthcare Affordable
28HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Generic Drug Approvals
Each year about 100 rst-time generics are introduced. Patent expirations of several blockbuster drugs in the next two yearswill open almost $18 billion to generic competition.
Note: First-time generics are those drug products that have never been approved before as generic drug products and are new generic products to the marketplace.Source: Center for Drug Evaluation and Research, Food and Drug Administration (2010) www.fda.gov/cder/ogd/approvals/default.htm, Drug Trend Report: The Great Healthcare Debates. 2009 Medco Health Solutions, Inc.
Prescription Expenditures
20092008200720062005
93
10099
91
112
First-Time Generic Drug Approvals
PatentExpiration
DrugBrandName(Manufacturer)
Use/Indication
2008U.S.Sales
(BillionsofDollars)
2010
Flomax(BoehringerIngelheim)
EffexorXR(Wyeth)
BenignProstaticHypertrophy
Depression
$1.3
$2.8
2011
Aricept(Eisai)
Levaquin(Ortho-McNeil)
Actos(Takeda)
Zyprexa(Lilly)
Lipitor(Pzer)
AlzheimersDisease
BacterialInfections
Type2Diabetes
Schizophrenia
HighCholesterol
$1.2
$1.7
$2.6
$1.9
$6.4
Total $17.9
Blockbuster Drugs Going Off-Patent
Keeping Healthcare Affordable
8/3/2019 Healthcare Trends in America
31/101
29 Blue Cross and Blue Shield Association
Keeping Healthcare Affordable
Average Annual Premium for Family Coverage
Due to rising healthcare costs, annual family health insurance premiums have risen 23 percent in the last ve years; employerscontinue to cover nearly three-fourths of those costs.
Note: Coverage is for a family of four.Source: Calculated based on Employer Health Benets 2009 Annual Sur vey, (#7936), The Henry J. Kaiser Family Foundation and HRET, September 2009This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation is a non-prot private operating foundation, based in Menlo Park, Calif., dedicatedto producing and communicating the best possible information, research and analysis on health issues.
Private Health Insurance
75.1% 74.1% 72.9% 73.5% 73.7%
Percentage of Employer Contribution
Employee ContributionEmployer Contribution
20092008200720062005
$10,880
$2,713 $2,973$3,281 $3,354
$3,515
$8,167 $8,508 $8,824 $9,325 $9,860
$11,480$12,160
$12,680
$13,375
8/3/2019 Healthcare Trends in America
32/101
Keeping Healthcare Affordable
30HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Hospital Payment-to-Cost Ratios for Medicare, Medicaidand Private Payers
Hospitals use higher charges to private payers to compensatefor a gap in payments from Medicare and Medicaid.
Note: Payment-to-cost ratios indicate the degree to which payments from each payer covers the costs oftreating that providers patients. Data are for community hospitals and cover all hospital services. Imputedvalues were used for missing data (about 35% of observations). Most Medicaid managed care patientsare included in the private payers category.Source: Adapted from the American Hospital Association and Avalere Health TrendWatch Chartbook 2009:Trends Affecting Hospitals and Health Systems; Avalere Health analysis of American Hospital Association
Annual Survey data, 2008, for community hospitals.
Private Health Insurance
MedicaidMedicarePrivate Payers
20082007200620052004
100%
129% 129% 130%132%
128%
91%91%91%92%92%
90%87% 86%
88% 89%
Break Even (Payment = Cost)
Percentage of Members Out-of-Pocket Cost Sharingby Product Line, 2006 - 2008
Between 2006 and 2008, percentage of members out-of-pocket cost sharing remained relatively at, but actual
member out-of-pocket spending increased.
Note: Data include commercially insured individuals below age 65. TRD is traditional health plan.Source: BHI (2009)BHI is a registered trademark of the Blue Cross and Blue Shield Association. The information con-tained herein is proprietary and was derived from claims information submitted by Member Plansof the Blue Cross and Blue Shield Association.2009 BHI All Rights Reserved. No reproduction without permission.
Private Health Insurance
TRDPOS PPOHMO
200820072006
13.2%13.0% 13.1%
11.6% 11.5%11.1%
9.3%10.4%
10.8%
5.9%5.7%5.6%
AnnualMemberOut-of-PocketSpending
$230 $261 $287
Keeping Healthcare Affordable
8/3/2019 Healthcare Trends in America
33/101
31 Blue Cross and Blue Shield Association
Keeping Healthcare Affordable
2008200720052003
43%
59%
73%
62%
Employers Who are Very Confident that Healthcare Benefits
Will be Offered by Employers for the Next Decade
Actions Organizations Are Taking Regarding Their Healthcare
Programs Given Recent Events in Economy
Actions Organizations Are Taking Regarding Their Healthcare Programs Given Recent Events in Economy
About 60 percent of companies are very condent they will continue to offer healthcare benets in a decade, a decline from 2007.
Source: Towers Watson and NBGH (2009) The Keys to Continued Success: Lessons Learned from Consistent Performers. 14th Annual Employer Surveyon Purchasing Value in Healthcare.
Private Health Insurance
HaveAlreadyTakenAction
ExpecttoTakeAction
NoActionExpected
Delay/CancelPlannedChangesinPlanDesign
6% 7% 87%
Delay/CancelPlannedProgramOfferings
5% 8% 86%
DevelopContingencyPlanforMidyearChanges
1% 13% 86%
IncreaseEmployeeCostSharing
34% 23% 44%
RevampHealthcareStrategy
30% 30% 41%
8/3/2019 Healthcare Trends in America
34/101
Keeping Healthcare Affordable
32HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Private Health Plan Administrative Expenses as a Percentageof Premiums
Savings and Recoveries from Fraud Investigations in Millions
Administrative costs of private health plans represent about9 percent of overall premiums. Additionally, administrative
functions covered by private health plans exceed that
of Medicare.
Blue Cross and Blue Shield Companies anti-fraud efforts arehelping to control costs, yielding savings and recoveries of
nearly $350 million in 2008.
*Medicare may perform these functions in a limited capacity.Source: Douglas B. Sherlock, CFA, Administrative Expenses of Health Plans (2009).
Source: Blue Cross and Blue Shield Association (2009).
Administrative Cost Efciencies Administrative Cost Efciencies
9.2%
Private Health Plans
Administrative Functions
InadditiontotheadministrativefunctionsthatMedicareperforms,privatehealthplansalsoperformthefollowingfunctions:
MedicalManagement/QualityAssurance,includingCareCoordination,DiseaseManagementandWellness
ProviderContracting*
CorporateServices
RecoveriesSavings
200820072006
$187
$128
$114
$150
$59
$134
$197
$248
$347
Investigations Closed
9,817
11,655
16,612
Improving Quality and Safety
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
35/101
33 Blue Cross and Blue Shield Association
Improving Quality and Safety
33 Blue Cross and Blue Shield Association
Improving Quality and Safety
Section
3
Improving Quality and Safety
PotentialSav ingsfromIm provement sinHealthc areQualityan dSafet y.............35
SentinelEven ts............................................................................................................. 36
VariationsinTreatingPat ients....................................................................................37
KneeandHipRepl acementSur geryper10,00 0Membersin2 007byRegion......38
InappropriateUseofAntibiotics................................................................................39
ExamplesofMHAKeystoneCenterCollaborative...................................................40
AHRQ/BostonMedicalCenterProjectRED(Re-EngineeredDischarge)...............41
Percent ageofHosp italPatien tsReceiv ingEvidenc e-Base dCare..........................42
BlueDistinctionCentersDesignations....................................................................43
PatientOutcomesatBlueDistinctionCenters........................................................44
AverageCostofInitialBariatricProcedure...............................................................45
ClinicalQualityInformationNeededWhenSelecting
aPhysician/Facility......................................................................................................46
EffectivePolicyStrategiestoControlCostswhileMaintaining
orImprovingQuality....................................................................................................46
Initiati vesAimedtoIn creaseQuali tyofCare...........................................................47
PaymentPoliciesInvolvingNeverEvents.................................................................48
Pay-for-Pe rform ance(P4P)P rograms........................................................................49
Componen tsinProvid erMeasurem entforP4PPr ograms.....................................50
Percent ageofP4PProgr amsRepor tingImprove ment............................................51
CMSHospit alP4PDemons trationAver ageCompos iteQualit yScore..................52
8/3/2019 Healthcare Trends in America
36/101
HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Improving Quality and Safety
34
Improving patient safety and care by delivering consistent,
high-quality care is critical to achieving a better healthcaresystem. Inconsistencies in the quality of care can lead to prevent-
able illness, injury, unnecessary hospitalization or even death.
Promoting and adhering to proven, evidence-based treatments
and procedures will help save lives and lower healthcare costs.
The impact of treatment variations and inconsistencies is
signicant, with some estimates indicating that better quality
and safety could save nearly 90,000 lives and as much as $400
billion a year. There are positive signs as payers are no longerreimbursing claims related to never events serious medical
errors that should not happen. In fact, all 39 Blue Cross and
Blue Shield companies have adopted payment policies that
prohibit reimbursement to contracted acute care hospitals for
12 preventable events identied by the Centers for Medicare &
Medicaid Services.
Collaborating with leading medical organizations across the
country, Blue Cross and Blue Shield companies have morethan 1,600 Blue Distinction programs in 46 states and the
District of Columbia committed to improved quality and
safety standards in the areas of cardiac care, bariatric surgery,
complex and rare cancers, transplants, spine surgery and
knee/hip replacement. In order to receive a Blue Distinction
designation, facilities must meet stringent evidence-based,
quality-focused selection criteria developed with the help of
expert physicians and medical organizations.
Efforts by the Blues and others to reward higher quality care
will improve health outcomes and patient medical experiences,
and is a cornerstone for maintaining healthcare affordability.
Summary
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
37/101
35 Blue Cross and Blue Shield Association
Improving Quality and Safety
Potential Savings from Improvements in Healthcare Quality and Safety
Quality and safety initiatives can help reduce unnecessary medical spending, estimated at more than $400 billion annually or 16percent of healthcare spending.
Source: PricewaterhouseCoopers Health Research Institute (2009) The Price of Excess: Identifying Waste in Healthcare Spending.
TOTALDefensiveMedicine
Non-Adherence
PreventableHospital
Re-admissions
PoorlyManagedDiabetes
MedicalErrors
UnnecessaryER Visits
TreatmentVariations
HospitalAcquiredInfections
Over-prescribingAntibiotics
$1B $3B $10B$14B
$17B
$22B
$25B
$100B
$210B
$402B
I i Q lit d S f t
8/3/2019 Healthcare Trends in America
38/101
Improving Quality and Safety
36HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Sentinel Events
Sentinel or never events situations that should not happen continue to be a problem nationwide.
*Cumulative as of Q3 2009.Note: A sentinel or never event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specically includes loss of limb or function.The phrase or the risk thereof includes any process variation for which a recurrence would carry a signicant chance of a serious adverse outcome. Such events are called sentinel because they signalthe need for immediate investigation and response.Source: Joint Commission (2009) Sentinel Event Statistics as of Sept. 30, 2009.
2009*2008200720062005
367344
450
510 507
Self-Reported Sentinel Events
33
12
12
15
19
12 21
23
18
3332
8
16
19
15
17
1816
11
16
14
21
22
25 17
14
21
25
15 14 22
17
16
19
1815
1419
16
5710
13
23
14
241643
26
29
34
DC: 96
JCAHO Reviewed Sentinel Events per Million by State
PR: 12
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
39/101
37 Blue Cross and Blue Shield Association
p g y y
Variations in Treating Patients
There is considerable variation by region in the quality of care delivered for treating diabetes and cardiovascular disease.
Note: Measures include only commercially insured members and exclude Medicare and Medicaid members.Source: National Committee for Quality Assurance. The State of Healthcare Quality Report, 2007-2009.
NewEngland
+5.6MidAtlantic:
+0.5
South
Atlantic:-1.7
SouthCentral:
-5.3
West North
Central:
+1.3
Mountain:
-0.8
Pacific:
+1.2East North
Central+1.8
Variation in the Quality of Care for Diabetes
New
England+5.3Mid
Atlantic:
+2.3
South
Atlantic:
-1.5
SouthCentral:-4.9
West NorthCentral:
-0.7
Mountain:-1.5
Pacific:
-0.5East North
Central+2.0
Variation in the Quality of Care for Cardiovascular Disease
-2.5% or more -1.0% to -2.5% Within 1.0% of mean +1.0 to 2.5% +2.5 or more
Difference From National Average
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
40/101
Improving Quality and Safety
38HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Knee and Hip Replacement Surgery per 10,000 Members in 2007 by Region
There also is variation in procedures, for example, the rate of hip and knee replacement surgeries nationwide.
Note: Data include commerically insured individuals below age 65.Source: BHI (2009).BHI is a registered trademark of the Blue Cross and Blue Shield Association. The information contained herein is proprietary and was derived from claims information submittedby Member Plans of the Blue Cross and Blue Shield Association.2009 BHI All Rights Reserved. No reproduction without permission.
New
England14.0
Mid
Atlantic:
13.6
SouthAtlantic:
16.1West South
Central:17.2
EastSouth
Central:
17.5
West NorthCentral:
21.5Mountain:
20.9
Pacific:13.6 East North
Central
18.2
Knee Replacements
National Average: 17.4Hip Replacements
National Average: 8.5
New
England
9.4
MidAtlantic:
8.7
SouthAtlantic:
8.3West SouthCentral:
6.7
East
SouthCentral:
7.6
West NorthCentral:
10.2Mountain:
10.3
Pacific:
8.3 East NorthCentral
9.8
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
41/101
39 Blue Cross and Blue Shield Association
Inappropriate Use of Antibiotics
There is inconsistency in the appropriate use of antibiotics.
Note: Measures include only commercially insured members and exclude Medicare and Medicaid members unless stated.Source: National Committee for Quality Assurance. The State of Healthcare Quality Report, 2007-2009.
200820072006
Measure:
Percentage of people aged 18 to 64 diagnosed with acute
bronchitis and given an antibiotic prescription.
71.3%74.6%
75.4%
Use of Antibiotics for Acute Bronchitis
Acutebronchitisisarespiratoryinfectioncharacterizedbyacoughthatlastsuptothreeweeksandiscausedbyabacteriainonlyoneinevery10cases,suggestingthatantibiotictreatmentisrarelywarranted.
Prescriptionofantibioticsforviralinfectionsareineffectiveandresultinwastedexpenditure.
Overprescriptionof
antibioticscanpotentiallyleadtoresistanceandincreasedcosts.
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
42/101
Improving Quality and Safety
40HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Examples of MHA Keystone Center Collaborative
Quality initiatives, such as the use of checklists, have resulted in lives saved, shorter hospital stays and reduced costs.
Note: MHA is the Michigan Health and Hospital Association.Source: MHA Keystone Center for Patient Safety and Quality (2009) Setting the Healthcare Agenda. 2009 Annual Report.
Quality Initiatives
IntensiveCareUnite(ICU) Hospital-AssociatedInfection(HAI)
Initiative
LaunchedinOctober2003withresultsfrom74hospitalsasofMarch2009 Reducecentralline-associatedbloodstreaminfections(CLABSIs)and
ventilator-associatedpneumonia(VAP)inintensivecareunit(ICU)patients
Launchedin2007withinitialresultsfrom16hospitals EliminateHAIs
Interventions Setupateamthatincludeshospitaladministrator,directors,nurses
andphysicians Utilizeachecklisttoensureadherencetoinfectioncontrolpractices
Focusonappropriatehandhygiene,reducingcatheter-associatedurinarytractinfections(CA-UTI)andavoidingCLABSIs
Collectdata,sharendingsandtweakinterventionaccordingly
Results
Lives Saved AvoidedHospital Days
HealthcareDollars Saved
1,830140,700
$271M
Jul 08Jan 08
Patients
withCA-UTIs
AvoidedHospital Days
HealthcareCosts Saved
32K29K
1,000 $1M
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
43/101
41 Blue Cross and Blue Shield Association
AHRQ/Boston Medical Center Project RED (Re-Engineered Discharge)
A well-dened hospital discharge protocol leads to better patient outcomes and reduced costs.
Quality Initiatives
*Hospital visits include initial visit plus readmission when applicable.Source: Agency for Healthcare Research and Quality ( 2009) Project RED (Re-Engineered Discharge) Toolkit.
$412,544
$21,389
$11,825
$8,906
$12,617
$1,203
$791
$268,942
Cost for:
Hospital Visits* ER Visits PCP Visits Per DischargedPatient
Non-Intervention Patients Intervention Patients
Overview
Focusoneducatingpatientsaboutpost-hospitalcare
1.Denerolesandresponsibilitiesofeachstaffmember
2.Educatepatientsthroughouthospitalization
3.Useawrittendischargetofacilitateowofinformationbetweenpatientsdoctorand
hospitalteam
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
44/101
Improving Quality and Safety
42HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Percentage of Hospital Patients Receiving Evidence-Based Care
There has been a dramatic increase in the percentage of patients receiving evidence-based care for heart failure, pneumoniaand heart attacks.
Note: All improvements in performance are statistically signicant. Composite measures combine the results of all individual measures into a single percentage rating calculated by adding, or rolling up, the numberof times recommended care was provided to patients and dividing this sum by the total number of opportunities to provide this care.Source: The Joint Commission (2009) I mproving Americas Hospitals: The Joint Commissions Annual Report on Quality and Safety.
Quality Initiatives
20082002
Heart Attack Care
Composite
Pneumonia Care
Composite
Heart Failure
Composite
59.7%
91.6%
72.3%
92.9%
86.9%
96.7%
ImprovementSinceInceptionofMetric
HeartFailureCareComposite 31.9%
PneumoniaCareComposite 20.6%
HeartAttackCareComposite 9.8%
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
45/101
43 Blue Cross and Blue Shield Association
Blue Distinction Centers Designations
The Blues
promote quality care with more than 1,600 programs designated as Blue Distinction Centers
(BDCs) across 46 statesin the U.S.
Note: Designation as Blue Distinction Centers means these facilities overall experience and aggregate data met objective criteria established in collaboration with expert clinicians and leading professionalorganizations recommendations. Individual outcomes may vary. To nd out which services are covered under your policy at any facilities, please call your local Blue Cross and/or Blue Shield Plan.Source: Blue Cross and Blue Shield Association (2010).
Quality Initiatives
WA
OR
CA
NV
AZ
UT CO
NM
MT
WYID
SD
ND
NE
KS
OK
TXLA
AR
MO
IA
MN
WI
IL ID
MI
KY
TN
MS AL GA
FL
SC
NC
VAWV
OH
NY
VT
NH
ME
MACT
RINJ
DEMD
HI
AK
PA
Blue Distinction Centers
for Bariatric Surgery
Blue Distinction Centersfor Cardiac Care
Blue Distinction Centers
for Complex and Rare Cancers
Blue Distinction Centers
for Knee and Hip ReplacementSM
Blue Distinction Centersfor Spine SurgerySM
Blue Distinction Centers
for Transplants
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
46/101
Improving Quality and Safety
44HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Patient Outcomes at Blue Distinction Centers
Blue Distinction Centers (BDCs) deliver signicantly better overall quality outcomes.
Note: Results shown are mean values. Mortality rates for bypass surgery and heart transplant are risk-adjusted.Source: Blue Cross and Blue Shield Association (2010) BCBSA Analysis of 2005-06 Hospital RFI Data. Bone marrow transplant data based on 2009 actuarial analysis of RFI data.Heart transplant data include facility results abstracted from the Scientic Registry for Transplant Recipients.
Quality Initiatives
OtherBDC
Bariatric Surgery
(30 days post)
Heart Transplant
(1 year post)
Adult Allogeneic
Stem Cell Transplant
(1 year post)
Bypass Surgery
Statistically significant difference
2% 3%
39%
54%
11%
19%
5%8%
Mortality Rates Complication Rates
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
47/101
45 Blue Cross and Blue Shield Association
Average Cost of Initial Bariatric Procedure
Blue Distinction Centers (BDCs) demonstrate a statistically signicant cost advantage while demonstrating quality expected from
BDCs robust designation requirements
Note: BDC signicantly different than non-BDC with p
8/3/2019 Healthcare Trends in America
48/101
p g y y
46HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Clinical Quality Information Needed When Selectinga Physician/Facility
Effective Policy Strategies to Control Costs while Maintaining orImproving Quality
Consumers indicate that physician participation in andrecognition by quality programs inuences selection of
physician or facility.
Leading health experts believe aligning incentives is a way to
control costs and improve quality.
Source: Blues Cross and Blue Shield Association (2009) Transparency Survey. Base: Opinion leaders in health pol icy and innovators in healthcare del ivery andnance within the U.S., as identied and nominated by peers. Figure captures responseof very or extremely effective.Source: Commonwealth Fund Healthcare Opinion Leaders Survey, April 2009.
Quality Initiatives Aligning Incentives
Physician
recognized by
quality assessmentorganization
Physician follows
early disease
detectionguidelines
Physician follows
prescription
medicationguidelines
Hospital
participates
in medicalerrors program
68%
53% 53%49%
More consumer cost-sharing
Malpractice liability reform
Reporting information on provider
quality and efficiency
Incentives for patients who choose
high-quality providers
All-payer rate setting
P4P with rewards to
high-quality providers
Provider payment reform, moving away
from FFS toward bundled payment 70%
45%
40%
35%
30%
24%
19%
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
49/101
47 Blue Cross and Blue Shield Association
Initiatives Aimed to Increase Quality of Care
Several quality improvement initiatives are focused on aligning incentives with performance.
Source: Blue Cross and Blue Shield Association (2009).
Aligning Incentives
Efforts Organizations Tactics
Provider Performance Measurementand Recognition
FederalandStateGovernmentMedicareandMedicaidPrograms
TheJointCommissionontheAccreditationofHealthcareOrganizations(JCAHO)
TheLeapfrogGroup
PrivatePayers
Measureproviderperformanceforvariousmetricsrelatedtodiagnosis,treatmentandmanagementofdiseasetoprovideabaselineforprovidersandgaininsightaboutpossibleareasofimprovement.
Promoteadherencetoevidence-basedcare.
Makeinformationavailabletoconsumerstoincreasetransparencyandaidindecisionmaking.
Alignnancialincentivesamongproviderstocreateasystemofjointclinicalandnancialaccountability.
Notpayingforneverevents.
Possiblyprovidedisincentivesfortheprovisionoflowerqualityhealthcare.
Createmechanismstoreviewandmonitorinformationtoidentifypotentialerrorsandrisks.
Shared Accountability
Incentive Programs
Employers
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
50/101
48HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Payment Policies Involving Never Events
Payers are not reimbursing hospitals for never events, which encourages quality of care.
*2008 survey results are based on 1,282 acute care hospitals in 44 states.Source: Centers for Medicare and Medicaid Services (2009); The Leapfrog Group, Leapfrog Hospital Survey Report, 2009; Lembitz, A et al. (2009) Clarifying Never Events and Introducing Always Events.Patient Safety in Surgery. December 2009; Blue Cross and Blue Shield Association (2010); Dallas Business Journal ( 2008) Medicare, Insurers to Stop Reimbursing for Errors. October 17, 2008.
Aligning Incentives
20082007
53%
65%
Percentage of Hospitals Agreeing to ImplementLeapfrogs Never Event Policy*
Never Events Overview
In2002,theNationalQualityForum(NQF)established27neverevents
(currentlythereare28),adverseeventsthatwereserious,largelypreventable.Exampleincludeswrong-sitesurgery.
In2006,TheLeapfrogGroupissuedanevereventpolicybasedontheNQFlistthat\askshospitalstowaiveincrementalcostsassociatedwithneverevent.
OnJanuary15,2009,theCentersforMedicareandMedicaidServices(CMS)nolongercoveredasurgicalorinvasiveprocedurecostofoperatingroom,hospitalizationsandotherservicesrelatedtoapractitionererroneouslyperformingadifferentprocedure,thecorrectprocedurebutonthewrongbodypart;orthecorrectprocedurebutonthewrongpatient.
Privatepayersarenotpayingforneverevents
All39independentBlueCrossandBlueShieldcompanieshaveestablishedapaymentpolicythatprohibitsreimbursementtocontractedacutecarehospitalsforneverevents
Aetna,CIGNAandUnitedHealthcareareincorporatingnevereventslanguageintotheircontracts
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
51/101
49 Blue Cross and Blue Shield Association
Pay-for-Performance (P4P) Programs
Pay-for-performance (P4P) programs are expanding and many are leading to improvements in both quality and cost.
*Data are specic to physician P4P programs only and does not include hospital P4P.Note: Fifty-two plans responded to the survey in 2006 and 62 plans reported to the survey in 2008.Source: Med-Vantage, Inc., The Leapfrog Group and Integrated Healthcare Association (IHA). 2008 Surveys of P4P and Transparency Programs. All rights reserved.
Aligning Incentives
52
62
6.8%
1.9%
7.3%
2.5%
CostQuality
20082006
43%
10%
52%
21%
HospitalPhysician
20082006
Average P4P Incentives as aPercentage of Total Compensation
Percentage of Programs ReportingImprovements in Performance*
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
52/101
50HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Components in Provider Measurement for P4P Programs
Clinical quality, safety and efciency are common features in the Various P4P programs offered by individual Blue Cross and
Blue Shield Plans.
*Figures do not add up to 100% due to rounding.**Not part of hospital-based survey.***Not part of physician-based survey.Note: Each BCBS Plan, acting as an independent entity, makes its own determination on all issues involving benets, claims, coverage, accounts, and provider contracting (including but not limited toand P4P features).Source: Med-Vantage 2009 National P4P Survey - BlueCross BlueShield Plan Responses.
Aligning Incentives
Other (Administrative, Clinical HIT Adoption, Member Access**, and Utilization***)
Patient satisfactionEfficiency or cost of care
Patient safety or medical error reductionClinical quality
58%21%
9%
5%7%
Hospitals Physicians*
51%
27%
5%
16%
2%
Clinical quality accountsfor at least 50 percent
of P4P metrics
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
53/101
51 Blue Cross and Blue Shield Association
Percentage of P4P Programs Reporting Improvement
Of the Blue Cross and Blue Shield Plans that analyzed the impact of P4P programs, more than 80 percent report improvements
in physician and hospital clinical measures after implementing P4P.
Source: Med-Vantage 2009 National P4P Survey - BlueCross BlueShield Plan Responses.
Aligning Incentives
HospitalPhysician
Too early to tellCost performance
has improved
Performance on
patient surveys
has improved
Providers have
invested in QI or
electronic systems
Performance on
clinical measures
has improved
82%88%
64%
25%
55%
13%
27% 25%
18%13%
Improving Quality and Safety
8/3/2019 Healthcare Trends in America
54/101
52HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
CMS Hospital P4P Demonstration Average Composite Quality Score
CMS P4P demonstration program has resulted in the delivery of higher quality care.
Source: Centers for Medicare and Medicaid Services (2008) Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Fee-for-Service Program.
Aligning Incentives
Year 3Year 1
AMIHip and Knee
Replacement
CABGPnuemoniaHeart Failure
64.5%
88.7%
69.3%
90.5%84.8%
97.4%
84.6%
96.9%
87.5%
96.1%
Hospital P4P:Premier Demonstration Overview
DemonstrationstartedinOctober2003
250hospitalsin38states
CMSP4Pcoveredveclinicalareas:
AcuteMyocardialInfarction(AMI)
CoronaryArteryBypassGraft(CABG)
HeartFailure Pneumonia
HipandKneeReplacement
24.2% 21.2% 12.6% 12.3% 8.6%
ImprovementBetweenYear1andYear3
Promoting Quality and Safety
Improving Consumer Health
8/3/2019 Healthcare Trends in America
55/101
LeadingCaus esofDeathinT housands.................................................................... 55
DirectandIndirectCostsRelatedtoDiseaseandPoorLifestyle
ChoicesinBilli ons........................................................................................................ 56
IncreaseinV isitingPhy siciansAnn uallyBetw een2006and20 08........................57
EmployerStra tegiesforP romotingP rimaryCar e.................................................... 57
AdultsAge18andOverwithCardiovascularDiseaseinMillions..........................58
Hospit alDischar gesforCard iovascularDis ease...................................................... 59
ManagingCardiovascularDisease.............................................................................60
Screeningf orandManagingCar diovascularD isease.............................................61
Prevalenceo fCancer..................................................................................................62
Impacto fCancerScr eening........................................................................................63
PreventiveSc reeningforC ancer................................................................................64
PhysicalActivityLevelsinChildrenandAdults......................................................65
ChildrenandAdultsConsideredOverweight...........................................................66
Prevalenceo fObesit yAmongU.S.Adul tsbyStat e................................................67
IncreaseinAdultPerCapitaMedicalSpendingAttributabletoObesity,ByInsuranceStatusandTypeofService,2006(in2008Dollars)..........................68
UtilizationRatesandMedicalExpendituresforChildren
withPrivateInsurance.................................................................................................68
ScreeningandManagingObesityandPromotingPhysicalActivity.....................69
Obesit yandDiabetes .................................................................................................. 70
PrevalanceofD iabetesA mongChildre nandAdults.............................................. 71
Preventingan dManagingDiab etes...........................................................................72
Screeningf or,Monitoringand ManagingDiab etes.................................................73
PrevalanceofSm okingAmo ngHighScho olStudent sandAdult s....................... 74
Impactof Smoking.......................................................................................................75
Monitorin gandAdvisin gAgainstSmo king.............................................................. 76
53 Blue Cross and Blue Shield Association
Section
4Improving Consumer Health
Improving Consumer Health
8/3/2019 Healthcare Trends in America
56/101
HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition) 54
Improving the health of Americans represents a major
challenge. By some estimates, nearly half of our total national
health expenditures are spent on treating heart disease, cancer,
diabetes (three of the top ve leading causes of death in the
U.S.) and poor lifestyle choices such as smoking, sedentary
behavior and over-eating.
Obesity and sedentary behavior are linked to the onset of diabetes
and are risk factors for several other conditions. Obese adults
spend $1,400 more on healthcare services and prescription drugs
annually than adults with normal weight. Overweight children
are also more likely to need physician visits, be hospitalized or
need treatment for mental or physical conditions.
Regular exercise and maintaining a healthy weight help prevent
diabetes. Today, two-thirds of adults and one in six children
aged six-19 are overweight. Fewer than half of all children meet
physical activity guidelines, and only 31 percent of adults report
having regular exercise, while nearly 40 percent of adults report
being inactive. In addition, the rate of children and adults
diagnosed with diabetes is on the rise even though in many
cases the onset of diabetes can be prevented.
Prevention can help alleviate the impact of other diseases as well.
Early screening for cancer can reduce the number of people who
die from colorectal cancer by at least 60 percent while blood
pressure control reduces the risk of heart disease and stroke
among people with diabetes by as much as 50 percent.
Blue Cross and Blue Shield companies are teaming up with
employers and other key stakeholders to provide educationmaterials and health information to improve the health of the
communities they serve. Most recently, Blue Cross and Blue
Shield companies produced a diabetes toolkit for healthcare
physicians and patients to help them prevent, treat and manage
diabetes in children and adults.
Summary
National Healthcare Trends
Improving Consumer Health
8/3/2019 Healthcare Trends in America
57/101
55 Blue Cross and Blue Shield Association
Leading Causes of Death in Thousands
Preventable and controllable illnesses, such as cardiovascular disease, diabetes and stroke, are among the leading causes
of death in the U.S.
Source: Centers for Disease Control and Prevention. (2009) Health, United States, 2003 and 2008.
Burden of Disease
200620052000
DiabetesChronic Lower
Respiratory Disease
Cerebrovascular
Disease (Stroke)
Malignant
Neoplasms (Cancer)
Heart Disease
711
652632
553 559 560
168144 137
122 131 125
69 75 72
Improving Consumer Health
8/3/2019 Healthcare Trends in America
58/101
56HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Direct and Indirect Costs Related to Disease and Poor Lifestyle Choices in Billions
The estimated costs related to three major conditions cardiovascular disease, cancer and diabetes and poor lifestyle choices
have been rising.
Source: National Institutes of Health, National Heart, Lung and Blood Institute Fact Book, Fiscal Year 2003, 2007 and 2008, PricewaterhouseCoopers Health Research Institute (2009)The Price of Excess: Identifying Waste in Healthcare Spending.
Burden of Disease
Indirect CostsDirect Costs
200920042009200420092004
$368.4
$141.7
$161.5
$120.4
$144.4
$23.8
$30.3
$226.7
$313.3
$69.4
$99.0
$61.5 $85.6
$474.8
$189.8
$243.4
$85.3
$115.9
Cardiovascular
Disease
Cancer Endocrine, Nutritional
and Metabolic
Poor Lifestyle Choices
Obesity/Overweight
$200billion
Smoking
Upto$191billion
National Healthcare Trends
Improving Consumer Health
8/3/2019 Healthcare Trends in America
59/101
57 Blue Cross and Blue Shield Association
Increase in Visiting Physicians Annually Between 2006 and 2008
Primary care, such as annual visits with a members
physician, can identify at-risk individuals early. More
people are seeing their physician on an annual basis,
but there is room for improvement.
Note: Data include commercially insured individuals below age 65.Source: BHI (2009).BHI is a registered trademark of the Blue Cross and Blue Shield Association. The informationcontained herein is proprietary and was derived from claims information submitted by Member Plansof the Blue Cross and Blue Shield Association.2009 BHI All Rights Reserved. No reproduction without permission.
Primary Care
14%
25%
Males, Age 20-64, with an
Annual Physician Visit
Females, Age 20-64, with
an Annual Physician Visit
Employer Strategies for Promoting Primary Care*
Employers are promoting the use of primary care through
educational materials and incentives.
*Percentage of employers with better healthcare cost trends implementing strategies relative tothose with worse cost trends.Source: Towers Watson and NBGH (2009) The Keys to Continued Success: Lessons Learned fromConsistent Performers. 14th Annual Employer Survey on Purchasing Value in Healthcare.
Primary Care
Planned for 2010In place now
Provide general education material
to employees and dependents
Designate in the networkprovider directory
Waive/reduce copays for
primary care office visits
Steerage at times of interaction
with health management programs
Incent selection/use of
primary care physicians
Provide online messages to
support primary care utilization
Participate in community-based
pilot programs
56%
40%
24%
21%
16%
9%
4%
6%
4%
5%
2%
2%
1%
62%
41%
26%
25%
19%
14%
6%
3%
Improving Consumer Health
8/3/2019 Healthcare Trends in America
60/101
58HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Adults Age 18 and Over with Cardiovascular Disease in Millions
In 2008, more than 33 million Americans had cardiovascular disease an increase of about 3 million in the last ve years.
Source: Centers for Disease Control and Prevention (2009) National Health Interview Survey 2004-2008.
Cardiovascular Disease
StrokeHeart Disease
20082007200620052004
30.2 30.8 29.7 30.5
33.1
5.5 5.2 5.6 5.4
6.5
24.7 25.6 24.1 25.1 26.6
National Healthcare Trends
Improving Consumer Health
8/3/2019 Healthcare Trends in America
61/101
59 Blue Cross and Blue Shield Association
Hospital Discharges for Cardiovascular Disease
More people are hospitalized as a result of cardiovascular disease than any other condition.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics (2009),National Heart, Lung and Blood Institute (2009).
Cardiovascular Disease
Neoplasms
Endocrine System
Respiratory System
Digestive System
Obstetrical
Cardiovascular 6.2
4.1
3.5
3.5
1.7
1.6
Hospital Discharges in Millions
for the Leading Diagnostic Groups
Hospital Discharges Associated with
Cardiovascular Disease in Thousands
20062004200220001990
5,161
6,3636,3736,294 6,161
Improving Consumer Health
8/3/2019 Healthcare Trends in America
62/101
60HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Managing Cardiovascular Disease
Reducing blood pressure and cholesterol levels signicantly lowers the risk of cardiovascular disease.
Source: Centers for Disease Control and Prevention (2009) Chronic Disease Prevention and Health Promotions.
Cardiovascular Disease
Stroke
Cardiovascular
Disease
Coronary Heart
Disease
Overall
Deaths
13%
21%
25%
37%
StrokeHeart Attacks
30% 30%
Reducingsystolicbloodpressure12-13mmHgoverfour
yearscanreduce:Reducingserumcholesterollevelsby10percent
canreduce:
National Healthcare Trends
Improving Consumer Health
8/3/2019 Healthcare Trends in America
63/101
61 Blue Cross and Blue Shield Association
Screening for and Managing Cardiovascular Disease
Among those with cardiovascular disease, 89 percent receive proper cholesterol screening, while only 63 percent of those at risk
have reduced their blood pressure to recommended levels.
*Specic to patients with cardiovascular conditions.Note: Measures include only commercially insured members and exclude Medicare and Medicaid members unless stated. LDL-C is low density lipoprotein cholesterol.Source: National Committee for Quality Assurance. The State of Healthcare Quality Report, 2007-2009.
Cardiovascular Disease
Cholesterol Screening* High Blood Pressure Management
200820072006
87.5% 88.2% 88.9%
59.7%63.4%62.2%
200820072006
Percentage of:Membersaged18to75whoweredischargedforaheartcondition
whoreceivedanLDL-Cscreening
Hypertensivemembersage18to85whosebloodpressurewas
controlledtolessthan140/90mmHgduringthepastyear
Improving Consumer Health
8/3/2019 Healthcare Trends in America
64/101
62HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Prevalence of Cancer
Cancer is the number two leading cause of death in the U.S. The prevalence of cancer has gradually declined.
Source: Centers for Disease Control and Prevention (2009) Health, United States, 2008.
Cancer
Overall Prevalence ofCancer per 100,000 Prevalence of Cancer byOrigin per 100,000
20062005200420032002
469.3 456.9 456.0447.5 439.9
Cervical (Female)Breast (Female)
Prostate (Male)Colorectal (Male)
20062005200420032002
176.0
163.1 163.3
148.6155.1
131.6122.6 122.7 121.9 119.6
59.5 57.7 55.8 53.2 51.1
8.3 8.1 7.7 7.7 7.3
National Healthcare Trends
Improving Consumer Health
8/3/2019 Healthcare Trends in America
65/101
63 Blue Cross and Blue Shield Association
Impact of Cancer Screening
Routine cancer screening can reduce cancer mortality rates by up to 60 percent.
Source: Centers for Disease Control and Prevention (2009).
Cancer
60% 25%
20%
20%
60%During a
10-year period
Routinecolorectalcancer
screeningcanreducethenumberofpeoplewhodie
fromcolorectalcancersby:
Gettingamammogramevery
1-2yearsforwomenage40andovercanreducemortality
ratesby:
Afterimplementationof
screeningprogram,ratesofcervicalcancerdropped
upto:
Improving Consumer Health
8/3/2019 Healthcare Trends in America
66/101
64HealthcareTrendsinAmerica:AReferenceGuidefromBCBSA(2010Edition)
Preventive Screening for Cancer
Although more people are getting the necessary screening for cancer, there is room for improvement.
Note: Measures include only commercially insured members and exclude Medicare and Medicaid members unless stated.Source: National Committee for Quality Assurance. The State of Healthcare Quality Report, 2007-2009.
Cancer
Breast Cancer Cervical Cancer
69.9% 69.1% 70.2%
200820072006 200820072006
81.0% 81.7% 80.0%
200820072006
Colorectal Cancer
54.5%58.7%
55.6%
Measure
Percentage of:Womenaged40to69whohadatleastone
mammograminthepasttwoyears
Womenaged21to64whohadatleastonePap
testinthepastthreeyears
Adultsaged50to80whohadappropriate
screeningforcolorectalcancer
National Healthcare Trends
Improving Consumer Health
8/3/2019 Healthcare Trends in America
67/101
65 Blue Cross and Blue Shield Association
Physical Activity Levels in Children and Adults
Children and adults are not getting enough exercise.
Note: Those that are classied as inactive report no sessions of light/moderate or vigorous leisure-time activity of at least 10 minutes duration, while those who are classiedas performing regular activity report three or more sessions per week of vigorous activity lasting at least 20 minutes or ve or more sessions per week of light/moderate activitylasting at least 30 minutes in duration. Figures do not add up to 100 percent, the balance remaining are those individuals who report engaging in some physical activity.Source: Troiano R, Berrigan D, Dodd K, et al., Medicine & Science in Sports & Exercise (2008); Centers for Disease Control and Prevention (2009) Health, United States, 2008.
Inactivity and Obesity
Percentage