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Altarum Institute integrates independent research and client-centered consulting to deliver comprehensive, systems-based solutions that improve health and health care. A nonprofit, Altarum serves clients in both the public and private sectors. For more information, visit www.altarum.org Age-Focused Evaluation of Prevalence, Healthcare Costs, and Utilization, by CCS Condition, in the Military Health System Michelle Kloc, Ph.D., MSN, RN November 4, 2013 American Public Health Association 141st APHA Annual Meeting
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2 Research Team Altarum Institute Michelle Kloc, Ph.D., MSN, RN [michelle.kloc@altarum.org] Joe Dorris, MA Charles Roehrig, Ph.D. Department of Defense Office of the Assistant Secretary of Defense (Health Affairs), Defense Health Agency, Defense Health Cost Assessment and Program Evaluation Diana Jeffery, Ph.D.
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3 Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Michelle Kloc “No relationships to disclose”
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4 Disclaimer The opinions expressed herein are those of the authors, and are not necessarily representative of the opinions or policies of the Department of Defense (DOD); or the United States Army, Navy, Air Force, or Coast Guard
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5 Introduction Study builds on interest in determining health care condition prevalence, costs and utilization by various demographics (e.g. enrollment, age, gender, beneficiary category, etc.) and assessing trends over time. A driving research interest related to identification of the ‘chronic’ population and its characteristics in order to appropriately determine Patient Centered Medical Home (PCMH) design, policy and resource allocation.
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6 Methods Population: All unique MHS beneficiaries alive and eligible within the study period, within the U.S. Beneficiaries with death during the study period were flagged All MHS eligibles which represented approximately 10 million people each year, with a focus on those age 18 – 64 Excluded beneficiaries overseas for the full year Time Frame: FY06 through FY11, inclusive Data: Obtained from SADR, SIDR, TED-I/N, PDTS, Ancillary (Laboratory/Radiology), DEERS VM6 PITE representing directly provided and purchased inpatient, ambulatory, pharmacy, and ancillary care linked to enrollment and eligibility records. ** Results present data from 2 studies of the same population conducted from FY06-10 (excludes Alaska) and FY07-11 (includes Alaska and Hawaii).
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7 Methods Classification of Diseases HEDIS-based measures A beneficiary was considered to have a given chronic condition if they had a minimum of: a) 2 outpatient visits within a FY with the same ICD-9; and/or b) 1 inpatient admission for a given ICD-9. Chronic conditions by ICD-9 were defined using AHRQ chronic condition definition set. Individual ICD-9s were grouped into higher level conditions using the Agency for Healthcare Research and Quality's (AHRQ) Clinical Classification Software (CCS) Over 14,000 ICD-9s were grouped into approximately 264 CCS conditions CCS Classification based upon primary ICD-9 DX only To provide greater operational relevance, Clinical Classification Software (CCS) condition categories were further grouped into higher level Medical Conditions based upon the method used by Dr. Charlie Roehrig (Altarum Institute) The approximately 264 CCS were aggregated into approximately 43 Medical Conditions
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8 Population demographics 20072008 2009 2010 2011 N%N%N%N%N% Gender Sub- PopulationOverall2,595,88546.40%2,639,74246.30%2,692,25146.30%2,725,32946.40%2,737,52546.50% FEMALE Beneficiary Category Active Duty 265,88510.24%267,62910.14%273,74510.17%278,09510.20%274,52410.03% Retired77,3793.00%83,0723.10%88,4113.30%93,9993.40%99,5603.60% Other 2,252,62186.78%2,289,04186.71%2,330,09586.55%2,353,23586.35%2,363,44186.33% Age Group 18-24571,58822.00%582,77722.10%602,78722.40%611,45122.40%608,15922.20% 25-44 950,177 36.60% 964,230 36.53% 983,699 36.54% 998,563 36.64% 1,005,839 36.74% 45-641,074,12041.40%1,092,73541.40%1,105,76541.10%1,115,31540.90%1,123,52741.00% MALE Overall2,996,52653.60%3,056,25053.60%3,115,18653.60%3,151,74953.60%3,147,03353.50% Beneficiary Category Active Duty 1,511,86650.45%1,529,40250.04%1,560,11750.08%1,569,03549.78%1,540,87348.96% Retired1,072,61321.70%1,079,27321.50%1,075,33821.00%1,072,86420.70%1,069,61520.60% Other 412,04713.75%447,57514.64%479,73115.40%509,85016.18%536,54517.05% Age Group 18-24894,70729.90%913,54129.90%936,83930.10%935,69429.70%916,29529.10% 25-44 1,048,694 35.00% 1,070,308 35.02% 1,094,982 35.15% 1,119,850 35.53% 1,129,763 35.90% 45-641,053,12535.10%1,072,40135.10%1,083,36534.80%1,096,20534.80%1,100,97535.00%
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9 Top 5 CCS Conditions, based on Cost, by Age Group, FY2006-2010 Fiscal Year 2006 Fiscal Year 2007 Fiscal Year 2008 Fiscal Year 2009 Fiscal Year 2010 Rank Age GroupCCS Category 1 Age 18-24Exam/eval Age 25-34Exam/eval Age 35-44Back problem Age 45-64Back problem 2 Age 18-24Social adminMood disorders Age 25-34Back problem Age 35-44Exam/eval Age 45-64Coron athero Ot conn tiss 3 Age 18-24Mood disordersSocial adminRehab Adjustment disorders Age 25-34Social admin Mood disorders Age 35-44Ot conn tiss Unclassified Age 45-64Chest pain Ot conn tiss Unclassified 4 Age 18-24SprainRehabSprain Ot preg comp Age 25-34Ot compl birMood disordersRehab Anxiety disorders Age 35-44Unclassified Ot conn tiss Age 45-64Ot conn tiss Chest painUnclassifiedOsteoarthros 5 Age 18-24Ot compl birSprainSocial adminAdjustment disordersOt joint dx Age 25-34Mood disordersOt compl birSocial adminAnxiety disordersOt joint dx Age 35-44Rehab Ot joint dx Age 45-64OsteoarthrosUnclassifiedOsteoarthros Coron athero
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10 Top 5 CCS Conditions, based on Cost, by Age Group, FY2006-2010 Fiscal Year 2006Fiscal Year 2007Fiscal Year 2008Fiscal Year 2009Fiscal Year 2010 Rank Age GroupCCS Category Total Condition Costs (excl Rx)CCS Category Total Condition Costs (excl Rx)CCS Category Total Condition Costs (excl Rx)CCS Category Total Condition Costs (excl Rx)CCS Category Total Condition Costs (excl Rx) 1 Age 18-24Exam/eval$151,481,874Exam/eval$155,510,697Exam/eval$181,356,045Exam/eval$211,894,623Exam/eval$233,611,404 Age 25-34Exam/eval$161,785,718Exam/eval$169,658,498Exam/eval$203,623,217Exam/eval$246,455,282Exam/eval$280,587,201 Age 35-44Back problem$155,056,055Back problem$158,621,205Back problem$174,129,983Back problem$184,942,844Back problem$190,023,678 Age 45-64Back problem$264,341,912Back problem$290,101,874Back problem$315,231,532Back problem$338,503,211Back problem$350,387,954 2 Age 18-24Social admin$78,218,733 Mood disorders$84,312,035 Mood disorders$95,396,491 Mood disorders$110,700,034 Mood disorders$113,948,105 Age 25-34Back problem$99,900,046Back problem$106,466,714Back problem$121,033,702Back problem$142,928,202Back problem$155,628,789 Age 35-44Exam/eval$116,369,228Exam/eval$115,302,036Exam/eval$128,171,859Exam/eval$148,254,259Exam/eval$158,538,877 Age 45-64Coron athero$194,786,538Coron athero$189,640,948Coron athero$176,692,757Coron athero$173,096,562Ot conn tiss$167,200,337 3 Age 18-24 Mood disorders$74,444,363Social admin$82,007,625Rehab$70,817,509Rehab$73,182,522 Adjustment disorders$74,814,640 Age 25-34Social admin$82,552,596Social admin$83,955,289 Mood disorders$81,740,508 Mood disorders$97,694,254 Mood disorders$110,657,659 Age 35-44Ot conn tiss$64,970,699Ot conn tiss$67,086,947Ot conn tiss$74,454,011Ot conn tiss$81,000,176Unclassified$88,525,228 Age 45-64Chest pain$138,737,466Chest pain$143,759,774Ot conn tiss$142,854,699Ot conn tiss$159,889,785Unclassified$154,962,062 4 Age 18-24Sprain$63,230,254Rehab$65,328,898Sprain$70,113,025Sprain$71,385,843Ot preg comp$73,850,201 Age 25-34Ot compl bir$70,769,337 Mood disorders$73,173,663Rehab$78,834,719Rehab$82,837,603 Anxiety disorders$93,766,107 Age 35-44Unclassified$52,046,242Unclassified$57,980,090Unclassified$68,400,363Unclassified$78,267,236Ot conn tiss$85,023,515 Age 45-64Ot conn tiss$119,973,898Ot conn tiss$126,903,701Chest pain$142,331,300Unclassified$141,808,421Osteoarthros$149,865,874 5 Age 18-24Ot compl bir$59,772,419Sprain$64,035,536Social admin$67,443,596 Adjustment disorders$71,219,825Ot joint dx$70,888,173 Age 25-34 Mood disorders$68,936,159Ot compl bir$69,177,966Social admin$71,566,136 Anxiety disorders$78,532,444Ot joint dx$88,143,761 Age 35-44Rehab$51,229,381Rehab$54,725,950Ot joint dx$59,935,295Ot joint dx$65,432,216Ot joint dx$72,250,378 Age 45-64Osteoarthros$105,639,710Unclassified$115,302,988Osteoarthros$129,184,659Osteoarthros$141,118,225Coron athero$143,819,288
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11 Utilization for Top 5 CCS Conditions, based on Cost, by Age Group, FY2006-2010 Fiscal Year 2006Fiscal Year 2007Fiscal Year 2008Fiscal Year 2009Fiscal Year 2010 Rank Age GroupCCS Category Total VisitsCCS Category Total VisitsCCS Category Total VisitsCCS Category Total VisitsCCS Category Total Visits 1 Age 18-24Exam/eval1,102,061Exam/eval1,188,717Exam/eval1,342,777Exam/eval1,532,823Exam/eval1,624,210 Age 25-34Exam/eval1,026,876Exam/eval1,103,407Exam/eval1,291,221Exam/eval1,556,096Exam/eval1,718,700 Age 35-44Back problem553,584Back problem612,064Back problem685,472Back problem771,033Back problem883,593 Age 45-64Back problem1,208,341Back problem1,399,546Back problem1,590,656Back problem1,824,139Back problem2,083,374 2 Age 18-24Social admin590,118Mood disorders220,885Mood disorders239,948Mood disorders275,141Mood disorders288,890 Age 25-34Back problem381,983Back problem434,106Back problem507,955Back problem614,913Back problem748,331 Age 35-44Exam/eval681,238Exam/eval700,254Exam/eval765,555Exam/eval891,500Exam/eval931,108 Age 45-64Coron athero90,415Coron athero87,017Coron athero80,417Coron athero72,216Ot conn tiss1,412,643 3 Age 18-24Mood disorders207,086Social admin692,409Rehab352,835Rehab381,016 Adjustment disorders206,467 Age 25-34Social admin656,550Social admin732,119Mood disorders298,284Mood disorders345,525Mood disorders385,162 Age 35-44Ot conn tiss330,850Ot conn tiss360,584Ot conn tiss393,514Ot conn tiss438,066Unclassified181,200 Age 45-64Chest pain125,457Chest pain123,592Ot conn tiss1,174,233Ot conn tiss1,297,108Unclassified341,194 4 Age 18-24Sprain254,779Rehab357,115Sprain273,245Sprain278,037Ot preg comp104,122 Age 25-34Ot compl bir83,557Mood disorders282,237Rehab431,197Rehab474,525Anxiety disorders320,463 Age 35-44Unclassified97,646Unclassified101,719Unclassified123,129Unclassified153,835Ot conn tiss482,912 Age 45-64Ot conn tiss938,066Ot conn tiss1,050,044Chest pain123,358Unclassified309,675Osteoarthros458,034 5 Age 18-24Ot compl bir57,217Sprain255,143Social admin598,608 Adjustment disorders192,926Ot joint dx459,038 Age 25-34Mood disorders269,114Ot compl bir88,806Social admin689,253Anxiety disorders269,191Ot joint dx582,676 Age 35-44Rehab352,273Rehab363,831Ot joint dx417,900Ot joint dx501,445Ot joint dx587,228 Age 45-64Osteoarthros305,309Unclassified245,256Osteoarthros389,506Osteoarthros428,558Coron athero69,000
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12 Top 5 Conditions, based on Cost, for Females by Age Group, FY2007-2011 Rank Age Group FY 2007FY 2008FY 2009FY 2010FY 2011 Condition Category Total Govt Paid Condition Category Total Govt Paid Condition Category Total Govt Paid Condition Category Total Govt Paid Condition Category Total Govt Paid 118-24Maternal$421,649,687Maternal$451,519,004Maternal$489,241,540Maternal$522,106,843Maternal$527,404,993 218-24Screening$101,859,343Gastrointestinal$109,599,437Screening$119,927,009Screening$129,620,094Screening$145,952,668 318-24Gastrointestinal$97,016,478Screening$107,078,861Gastrointestinal$119,009,860Reproductive$124,052,909Reproductive$130,027,109 418-24Reproductive$97,016,189Reproductive$106,321,358Reproductive$116,598,956Gastrointestinal$119,326,142Mental disorders$120,842,476 518-24Mental disorders$75,580,272Mental disorders$85,265,949Mental disorders$97,404,064Mental disorders$108,583,420Gastrointestinal$118,680,440 125-44Maternal$472,298,884Maternal$517,605,599Maternal$571,493,008Maternal$653,663,040Maternal$714,750,380 225-44Reproductive$227,152,279Reproductive$247,073,960Reproductive$279,062,108Reproductive$304,110,787Reproductive$325,138,601 325-44Gastrointestinal$209,406,833Gastrointestinal$229,786,810Gastrointestinal$248,848,584Gastrointestinal$256,016,658Gastrointestinal$263,974,409 425-44Screening$169,472,239Screening$180,828,992Screening$204,882,531Screening$222,929,191Screening$241,682,231 525-44Cancers$132,997,214Cancers$146,267,411Mental disorders$165,724,771Mental disorders$187,117,204Mental disorders$214,138,976 145-64Cancers$338,949,511Cancers$363,867,874Cancers$376,071,218Cancers$377,416,266Cancers$392,998,511 245-64Gastrointestinal$240,975,023Musculoskeletal$259,800,672Musculoskeletal$293,036,365Musculoskeletal$317,467,622Musculoskeletal$349,703,547 345-64Musculoskeletal$226,525,111Gastrointestinal$251,998,953Gastrointestinal$269,734,559Gastrointestinal$271,522,850Gastrointestinal$280,611,854 445-64Heart conditions$141,995,316Back Problems$155,924,288Back Problems$172,014,624Back Problems$183,701,985Back Problems$196,750,417 545-64Back Problems$139,887,171Heart conditions$149,395,828Heart conditions$156,939,787Screening$167,349,582Screening$180,909,347
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13 Top 5 Conditions, based on Cost, for Males by Age Group, FY2007-2011 RankAge Group FY 2007FY 2008FY 2009FY 2010FY 2011 Condition Category Total Govt Paid Condition Category Total Govt Paid Condition Category Total Govt Paid Condition Category Total Govt Paid Condition Category Total Govt Paid 118-24 Trauma/Injury$195,263,268Trauma/Injury$196,248,414Screening$216,166,149Screening$252,615,999Screening$314,163,812 218-24 Screening$170,225,509Screening$186,680,568Trauma/Injury$190,762,494Mental disorders$191,863,020Mental disorders$220,421,011 318-24 Mental disorders$112,340,648Mental disorders$147,904,888Mental disorders$177,501,253Trauma/Injury$187,880,805Trauma/Injury$202,049,334 418-24 Musculoskeletal$86,524,139Musculoskeletal$99,507,616Musculoskeletal$104,988,021Musculoskeletal$114,217,468Musculoskeletal$126,175,074 518-24 Gastrointestinal$82,556,795Gastrointestinal$88,939,530Gastrointestinal$96,357,940Gastrointestinal$98,268,905Rehab$99,284,800 125-44 Screening$247,793,739Screening$274,917,291Screening$330,469,425Screening$384,312,091Screening$435,134,278 225-44 Trauma/Injury$192,321,672Musculoskeletal$217,515,146Musculoskeletal$241,006,037Musculoskeletal$272,202,312Mental disorders$316,573,279 325-44 Musculoskeletal$182,845,814Trauma/Injury$207,973,416Trauma/Injury$209,140,037Mental disorders$247,491,825Musculoskeletal$314,393,246 425-44 Back Problems$145,066,905Back Problems$167,106,297Mental disorders$198,021,182Trauma/Injury$228,255,512Trauma/Injury$248,674,212 525-44 Gastrointestinal$145,007,112Gastrointestinal$157,154,059Back Problems$195,288,578Back Problems$212,343,242Back Problems$246,061,569 145-64 Cancers$285,799,124Cancers$311,599,022Cancers$313,927,189Cancers$322,223,032Cancers$339,275,041 245-64 Gastrointestinal$182,121,915Gastrointestinal$192,503,302Gastrointestinal$208,838,705Musculoskeletal$230,642,624Musculoskeletal$254,233,643 345-64 Heart conditions$171,456,424Heart conditions$183,425,920Musculoskeletal$206,903,161Gastrointestinal$219,398,411Gastrointestinal$227,255,478 445-64 Musculoskeletal$149,335,832Musculoskeletal$178,379,810Heart conditions$192,292,343Heart conditions$189,444,043Heart conditions$196,389,823 545-64 Coron athero$127,330,094Back Problems$129,033,807Back Problems$145,688,038Back Problems$157,848,035Back Problems$175,154,752
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14 Top 5 Medical Conditions, by Unique Diagnosis, Females Ages 18-44 Status FY 2007FY 2008FY 2009FY 2010FY 2011 Condition Unique DiagnosisCondition Unique DiagnosisCondition Unique DiagnosisCondition Unique DiagnosisCondition Unique Diagnosis Active Duty Screening214,485Screening218,604Screening227,967Screening234,210Screening232,502 Reproductive103,260Reproductive105,082Reproductive109,366Reproductive113,720Reproductive114,315 Immunization90,361Immunization101,534Immunization105,067Immunization110,104Immunization107,103 Acute bronchitis and URI83,771 Musculoskele tal84,407 Musculoskele tal89,029 Musculoskele tal93,664 Musculoskele tal95,625 Musculoskele tal82,675 Acute bronchitis and URI83,647 Acute bronchitis and URI88,463 Acute bronchitis and URI91,158 Acute bronchitis and URI84,742 Retirees Screening7,919Screening7,696Screening7,858Screening7,800Screening7,741 Reproductive4,391Reproductive4,374Reproductive4,568Reproductive4,492Reproductive4,602 Musculoskele tal3,895 Musculoskele tal4,000 Musculoskele tal4,124 Musculoskele tal4,196 Musculoskele tal4,453 Acute bronchitis and URI3,649 Acute bronchitis and URI3,826 Acute bronchitis and URI3,702 Acute bronchitis and URI3,918 Acute bronchitis and URI3,982 Gastrointestin al2,934 Neurologic Disorder3,012 Gastrointestin al3,133 Gastrointestin al3,262 Neurologic Disorder3,385
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15 Top 5 Medical Conditions, by Unique Diagnosis, Males Ages 18-44 Status FY 2007FY 2008FY 2009FY 2010FY 2011 Condition Unique DiagnosisCondition Unique DiagnosisCondition Unique DiagnosisCondition Unique DiagnosisCondition Unique Diagnosis Active Duty Screening987,296Screening1,045,683Screening1,121,441Screening1,171,335Screening1,178,540 Immunization410,121Immunization475,533Immunization483,709Immunization498,772Immunization488,112 Trauma/Injur y321,183 Trauma/Injur y325,598 Musculoskelet al340,530 Musculoskele tal358,883 Musculoskele tal370,785 Musculoskele tal310,219 Musculoskele tal322,310Trauma/Injury328,376 Trauma/Injur y332,317 Trauma/Injur y322,669 Eye problems310,172 Acute bronchitis and URI292,050 Acute bronchitis and URI307,822 Ear, Nose, Throat310,844 Ear, Nose, Throat303,468 Retirees Screening31,704Screening31,365Screening31,738Screening31,313Screening30,410 Musculoskele tal21,490 Musculoskele tal21,939 Musculoskelet al22,042 Musculoskele tal21,891 Musculoskele tal21,744 Acute bronchitis and URI19,392 Acute bronchitis and URI20,358 Acute bronchitis and URI19,531 All Other Categories20,141 All Other Categories20,892 Cardiovascula r17,398 All Other Categories17,625 All Other Categories19,144 Acute bronchitis and URI18,866 Acute bronchitis and URI17,994 Gastrointestin al17,358 Cardiovascula r17,428 Cardiovascula r17,198 Gastrointestin al16,476 Gastrointestin al16,035
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16 Top 5 Medical Conditions, by Unique Diagnosis, Females Ages 45-64 Status FY 2007FY 2008FY 2009FY 2010FY 2011 Condition Unique DiagnosisCondition Unique DiagnosisCondition Unique DiagnosisCondition Unique DiagnosisCondition Unique Diagnosis Active Duty Screening10,808Screening11,213Screening11,950Screening12,601Screening12,626 Eye problems5,959 Musculoskel etal6,240 Musculoskel etal6,660 Musculoskel etal7,397 Musculoskele tal7,556 Musculoskeleta l5,924Eye problems5,822Eye problems5,849Eye problems6,015Eye problems5,639 Reproductive3,967Reproductive3,992 Immunizatio n4,493 Immunizatio n4,985Reproductive4,718 Rehab3,676 Immunizatio n3,945Reproductive4,368Reproductive4,577 All Other Categories4,504 Retirees Screening26,682Screening30,168Screening34,361Screening37,213Screening39,693 Musculoskeleta l15,494 Musculoskel etal17,926 Musculoskel etal20,320 Musculoskel etal22,681 Musculoskele tal24,839 Reproductive11,464Eye problems12,696Eye problems14,181Eye problems15,911Eye problems17,303 Eye problems11,162Reproductive12,693Reproductive14,127 Acute bronchitis and URI15,039 Acute bronchitis and URI16,365 Acute bronchitis and URI10,661 Acute bronchitis and URI12,403 Acute bronchitis and URI13,749Reproductive14,951Reproductive15,959
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17 Top 5 Medical Conditions, by Unique Diagnosis, Males Ages 45-64 Status FY 2007FY 2008FY 2009FY 2010FY 2011 Condition Unique DiagnosisCondition Unique DiagnosisCondition Unique DiagnosisCondition Unique DiagnosisCondition Unique Diagnosis Active Duty Screening50,659Screening52,561Screening57,562Screening62,130Screening62,373 Eye problems25,841Eye problems24,606 Musculoskelet al26,605 Musculoskelet al29,542 Musculoskele tal31,488 Musculoskele tal22,876 Musculoskele tal24,371Eye problems24,529Eye problems24,498 All Other Categories23,690 Immunization17,346Immunization19,641Immunization21,703Immunization24,198Eye problems22,986 Rehab14,143 All Other Categories15,023 All Other Categories17,819 All Other Categories20,935Immunization22,121 Retirees Screening228,688Screening244,619Screening265,808Screening279,348Screening292,595 Cardiovascula r176,679 Cardiovascula r185,199Cardiovascular193,091Cardiovascular199,752 Cardiovascula r201,702 HTN165,646HTN176,181 Musculoskelet al184,649 Musculoskelet al193,613 Musculoskele tal201,452 Musculoskele tal163,279 Musculoskele tal173,980HTN183,772HTN189,547HTN189,253 Gastrointestin al134,705 All Other Categories140,208 All Other Categories153,201 All Other Categories163,780 All Other Categories174,574
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18 Summary Back Problems is the highest cost and utilization CCS condition for the 35- 44 and 45-64 age groups. This condition is the 2 nd highest cost condition for ages 25-34. Other Musculoskeletal-related CCS conditions also rank in the top 5 CCS conditions across age groups (Other Connective Tissue condition, Other Joint diagnosis, Sprain, Osteoarthritis). Cost for Back Problems, in terms of Government Paid amounts, increase with age almost doubling in cost from age 35-44 to 45-64. Costs increase, within age groups, over the 5 year period. Back Problems, Musculoskeletal, GI, Maternal, Reproductive and Cancers are within the top 5 most costly Medical Conditions for females. Back Problems, Musculoskeletal, GI, Trauma/Injury, Mental Disorders and Cancers are within the top 5 most costly Medical Conditions for males. Musculoskeletal is consistently the 2 nd -4 th most diagnosed condition for males and females, Active Duty and Retired. It is the most costly condition for Retirees (males and females) and within the top 5 for other age groups. Results suggest that musculoskeletal conditions acquired while on Active Duty persist into retirement.
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Altarum Institute integrates independent research and client-centered consulting to deliver comprehensive, systems-based solutions that improve health and health care. A nonprofit, Altarum serves clients in both the public and private sectors. For more information, visit www.altarum.org Back-Up Slides
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20 CCS Assignments, Example Tuberculosis ICD-9: 010.0-018.9 (010) Primary tuberculous infection (010.0) Primary tuberculous infection (010.1) Tuberculous pleurisy in primary progressive tuberculosis (010.8) Other primary progressive tuberculosis (010.9) Primary Tuberculous infection, Unspecifed (011) Pulmonary tuberculosis (011.0) Tuberculosis of lung, Infiltrative ……. CCS: Tuberculosis There are 9 3-digit ICD-9’s and an additional 18 ‘sub- diagnoses’ (4-digit ICD-9s) for Tuberculosis-related conditions. CCS groups all relevant ICD-9s into specific conditions or condition groups. Ex.: Cancer of head and neck Septicemia (except in labor) HIV infection Hepatitis Viral infection
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21 Medical Condition, Example 264 CCS Condition Groups 14,900+ ICD-9 Codes (140-149) Malignant neoplasm of lip, oral cavity, and pharynx (150-159) Malignant neoplasm of digestive organs and peritoneum (160-169) Malignant neoplasm of respiratory and intrathoracic organs (170-175) Malignant neoplasm of bone, connective tissue, skin, and breast (176) Kaposi's sarcoma Roll-up to 024 : Cancer of breast 167 : Nonmalignant breast conditions 019 : Cancer of bronchus; lung 125 : Acute bronchitis 240 : Burns 43 Medical Condition Groups Acute bronchitis and URI ADD All Other Categories Asthma Back Problems Birth Blood Cancers Cardiovascular Cerebrovascular disease Roll-up to Medical Condition groups were based on ICD- 9 chapters (e.g. Neoplasms, Respiratory, Musculoskeletal), but allowed for separation of specific diseases (e.g. ADD, Asthma, ‘Birth’)
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22 Methods Cost Calculation Laboratory/Radiology costs based upon primary diagnosis associated with the claim for purchased care. Lab/Rad costs taken directly from SIDR/SADR for direct care. Focus on total government paid amounts/government costs. People with OHI identified to allow for OHI cost impact analysis. Costs in constant year dollars (standardized to FY10 based on DoD Green Book). Utilization Based upon primary diagnosis associated with the visit/stay Prevalence Person-level data de-duplicated to provide a count of unique patients per condition within each fiscal years data
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23 Top 5 Medical Conditions, by Total Government Paid, Females Ages 18-44 StatusCondition20072008200920102011 Active Duty Maternal$174,778,325$185,738,844$201,608,600$218,922,969$223,590,554 Screening$116,022,533$125,945,686$146,505,395$163,125,598$188,228,921 Mental disorders$72,638,721$87,612,183$103,884,533$124,244,995$151,357,977 Musculoskeletal (including Back Problems)$98,658,076$103,534,573$109,323,907$114,202,550$122,019,911 Reproductive$73,817,232$80,038,114$88,135,107$92,493,485$100,014,841 Retirees Musculoskeletal (including Back Problems)$5,180,198$5,617,256$5,968,605$5,948,990$6,233,799 Cancers$4,700,212$4,827,885$4,547,007$3,565,399$3,596,190 Gastrointestinal$3,658,659$3,916,540$4,284,858$3,921,194$4,658,034 Reproductive$3,089,842$3,337,879$3,848,042$3,894,424$4,036,285 Neurologic Disorder$2,670,510$3,342,239$3,293,703$3,186,830$3,519,714
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24 Top 5 Medical Conditions, by Total Government Paid, Males Ages 18-44 StatusCondition20072008200920102011 Active Duty Screening$389,974,713$429,826,695$507,928,138$591,319,425$703,393,409 Musculoskeletal (including Back Problems)$388,212,303$410,927,615$441,636,103$459,924,887$495,762,396 Trauma/Injury$342,443,176$353,358,521$342,811,123$358,883,036$389,947,956 Mental disorders$195,157,918$270,854,537$343,224,535$400,973,830$493,059,209 Gastrointestinal$181,393,677$194,014,244$211,677,526$215,600,361$226,221,211 Retirees Musculoskeletal (including Back Problems)$28,198,371$30,373,920$31,849,632$32,536,320$31,474,018 Gastrointestinal$21,859,088$22,477,235$22,672,819$22,524,966$23,069,872 Cancers$15,657,668$14,742,891$15,353,852$12,099,145$10,325,602 Trauma/Injury$11,869,087$11,835,450$12,677,898$11,241,667$12,291,620 Heart conditions$12,727,597$12,377,684$12,640,148$11,025,530$9,326,675
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