Blue Cross Blue Shield, The Health of America Report is a collaboration between the Blue Cross Blue Shield Association and Blue Health Intelligence that uses advanced analytics to report on key trends in healthcare to support improved quality and affordability for all Americans.
May 19, 2016
Blue Cross Blue Shield Association Examines the Growing Costs of Specialty Pharmacy
A new study by the Blue Cross Blue Shield Association (BCBSA) and HealthCore, Inc. shows that per member specialty pharmacy spending increased 26 percent from 2013 to 2014.
The report, “The Growth in Specialty Drug Spending from 2013 to 2014,” represents a comprehensive, in-depth study of costs for both medical and pharmacy claims. Approximately half of specialty drug spending is funded by each benefit. Examining medical benefit data allows for a thorough analysis of changes in the cost of medication administered at hospitals and other clinical settings. For example, more than 80 percent of cancer medication costs are billed through the medical benefit. Comparing specialty pharmacy spending in 2013 and 2014, this study found that:
- There was an $87 annual per member increase in specialty pharmacy spending from 2013 to 2014.
- The increasing costs of specialty drug treatments were the main driver of the growth in spending. Treatment costs include the price and selection of drugs. Increased utilization had a smaller effect on the growth in spending.
- In 2014, annual specialty drug spending was 17 percent higher per member in the individual market compared to the employer market. While cost of treatment was similar between employer-based and individual members, there were differences in utilization rates by condition. Utilization was significantly higher for individual members for cancer, human immunodeficiency virus and hepatitis, but slightly lower for inflammatory conditions (such as rheumatoid arthritis) or multiple sclerosis.
March 30, 2016
Blue Cross Blue Shield Association Examines the Health Conditions and Costs of Caring for Newly Enrolled Individual Members in 2014 and 2015
OVERVIEW: Data show newly enrolled individuals received significantly more medical care
The report, “Newly Enrolled Members in the Individual Health Insurance Market After Health Care Reform: The Experience from 2014 and 2015,” represents a comprehensive, in-depth study of actual medical claims among those enrolled in individual coverage before and after the ACA took effect. The study also compares this group to those who receive insurance through their employers.
KEY FINDINGS: Comparing health status and use of medical services among these three groups, the study finds that:
- Members who newly enrolled in BCBS individual health plans in 2014 and 2015 have higher rates of certain diseases such as hypertension, diabetes, depression, coronary artery disease, human immunodeficiency virus (HIV) and Hepatitis C than individuals who had BCBS individual coverage prior to health-care reform.
- Consumers who newly enrolled in BCBS individual health plans in 2014 and 2015 received significantly more medical care, on average, than those with BCBS individual plans prior to 2014 who maintained BCBS individual health coverage into 2015, as well as those with BCBS employer-based group health insurance.
- The new enrollees used more medical services across all sites of care—including inpatient admissions, outpatient visits, medical professional services, prescriptions filled and emergency room visits.
- Medical costs of care for the new individual market members were, on average, 19 percent higher than employer-based group members in 2014 and 22 percent higher in 2015. For example, the average monthly medical spending per member was $559 for individual enrollees versus $457 for group members in 2015.
February 24, 2016
Blue Cross Blue Shield Association Study Shows How Consumers Save with Shift to Outpatient Care
OVERVIEW: Data show significant savings for consumers and payers
A new study by the Blue Cross Blue Shield Association (BCBSA) demonstrates how much consumers and payers save when medical procedures shift from an inpatient to an outpatient setting.
The study, “How Consumers Are Saving with the Shift to Outpatient Care,” examines four common shoppable procedures – hysterectomy, lumbar/spine surgery, angioplasty and gallbladder removal – from 2010 to 2014. These four procedures cost Blue Cross and Blue Shield companies, their members and employers nationwide an estimated $11 billion in 2014.
KEY FINDINGS: Patients who utilized outpatient procedures saved money in 2014:
- $320 on average for lumbar/spine surgeries
- $483 for hysterectomies
- $924 for gallbladder removals
- $1,062 for angioplasties
For appropriate patients, outpatient surgery has been shown to be safe and effective, achieving similar or better outcomes as inpatient procedures while allowing patients to spend less time in a medical facility, recover faster and incur less pain. Spine surgery and angioplasty have been shown to be safe and are associated with similar or better outcomes in the outpatient setting. Additionally, outpatient hysterectomy was found to have fewer 30-day complications, lower risk of perioperative morbidity, less risk of wound complications and other medical complications compared to inpatient, even after adjusting for demographic and operative differences between the two groups.
January 13, 2016
BCBS Blue Cross Blue Shield Association Study Shows Consumer Choices in the Affordable Care Act Marketplace
OVERVIEW: Data shows that product choices vary across the country
With the third enrollment season now upon us, the Affordable Care Act marketplaces are evolving as insurers gain a better understanding of how to design coverage options that meet the needs of consumers while managing risk for health insurers. To get the most complete understanding of the marketplaces as a whole, Blue Cross Blue Shield Association compiled and analyzed an extensive database of every health insurer and product sold across the country. The findings are revealed in “The Evolving Affordable Care Act Marketplaces: The 2015 to 2016 Transition,” the fourth report in the ongoing Blue Cross Blue Shield, The Health of America Report series. The analysis shows that in 2016, consumers in most regions of the country still have multiple options from which to select a health insurance plan, but the types of health plans being offered are changing to meet the needs of customers and manage risk for health insurers.
September 29, 2015
BCBS Health of America Report on Women’s Heart Health
OVERVIEW: Disparities Identified in Post Heart Attack Treatment Between Women and Men
BCBS data reveals that women are receiving less aggressive treatments after a heart attack than men. Following a heart attack, women are 27 percent less likely than men to receive angioplasties to open clogged arteries. The same data shows that women are 38 percent less likely than men to undergo coronary bypass surgery and nearly 5 percent less likely to receive coronary angiography, a diagnostic procedure that involves an X-ray examination of blood vessels. While heart disease and heart attacks are more prevalent in men, women who experience heart attacks have worse outcomes – they are more likely than men to die within one year of a heart attack, to have another heart attack within six years, and to be disabled because of heart failure within six years. In fact, heart disease far surpasses breast cancer and other recognized causes of death among U.S. women.
This is the fourth edition of “Blue Cross Blue Shield, The Health of America Report,” a collaboration between the Blue Cross Blue Shield Association and Blue Health Intelligence, which uses a market-leading claims database to uncover key trends and insights into healthcare affordability and access to care.
July 16, 2015
Cost Variations in Cardiac Care: Overview
A Study of Cost Variation for Percutaneous Coronary Interventions (Angioplasties) in the U.S.
The cost of angioplasties — among the most common treatments for heart disease — varies widely in markets across the country, with significant variations emerging even within the same market area. A new report by the Blue Cross Blue Shield Association (BCBSA) and Blue Health Intelligence (BHI) shows that prices for angioplasties or Percutaneous Coronary Interventions (PCIs) can cost more than five times as much depending on which hospital a patient chooses within a market. The analysis is based on independent Blue Cross and Blue Shield (BCBS) companies’ claims data. While many angioplasty procedures are performed while a patient is experiencing a heart attack, the procedures studied in this report are not performed on such an urgent basis, making it possible for some individuals to consider both quality and cost as they choose the best facility for their care
June 3, 2015
BCBS Health of America Snapshot: Cost Variations in Specialty Drugs
Specialty drugs driving growth in Rx spend Recent analysis of data from Blue Cross Blue Shield (BCBS) companies, the largest commercial claims database in healthcare, confirms that prescription drug (Rx) per-member per-month (PMPM) spend increased by 9.3 percent from 2013 to 2014. The driving factor behind the Rx cost trend is the cost of specialty drugs. Data confirm that in 2014, specialty drug unit costs jumped 20.1 percent, compared to 5.7 percent for non-specialty drugs. Utilization for specialty drugs also rose by 7.3 percent in 2014.
Within the specialty pharmaceutical portfolio, the top 10 drugs contribute to 61 percent of overall spend. New Hepatitis C and Multiple Sclerosis drugs have contributed significantly to the trend (e.g., Sovaldi®, a Hepatitis C treatment introduced in October 2014 priced at $84,000 for 12 week treatment, and Tecfidera® for Multiple Sclerosis priced at $55,000 for 1 year treatment).
January 21, 2015
The Extreme Cost Variation in Healthcare
Blue Cross Blue Shield Association Study Reveals Extreme Cost Variations for Knee and Hip Replacement Surgeries
The cost of knee and hip replacement surgeries—among the fastest growing medical treatments in the U.S.—varies widely in markets across the country, with extreme variations emerging even within the same market area, according to a report by the Blue Cross Blue Shield Association (BCBSA) and Blue Health Intelligence (BHI).
The report, based on independent Blue Cross and Blue Shield (BCBS) companies’ claims data, shows that prices for identical procedures can quadruple in cost depending on which hospital a patient chooses within a market.
Cost Variations for Knee Replacement
Cost Variations for Hip Replacement
About the Blue Cross Blue Shield Association
The Blue Cross Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 106 million members — one in three Americans.
About Blue Health Intelligence
Health Intelligence Company is the nation’s premier health intelligence resource, delivering data-driven insights about healthcare trends and best practices, resulting in healthier lives and more affordable access to safe and effective care. HIC accesses healthcare claims data from more than 140 million individuals nationwide, collected over nine years, in a safe, HIPAA compliant and secure database. The resulting conformed, reliable data set has the broadest, deepest pool of integrated medical and pharmacy claims, reflecting medical utilization in every ZIP code. Health Intelligence Company, LLC operates under the trade name Blue Health Intelligence (BHI) and is an Independent Licensee of the Blue Cross and Blue Shield Association. For more information, visit http://www.bluehealthintelligence.com.