A complication is defined as a patient condition caused by the Type 2 diabetes of the patient. 2 diabetes. Complications of Type 2 diabetes include, but …
Texas Business Group on Health
TBGH
2008 TEXAS
TYPE
2
DIABETES REPORT
Featuring Demographic, Charges, Utilization, and Pharmacotherapy Data
Tex as B us ines s Group o n Hea lth
Presented by
in conjunction with Texas Business Group on Health
2008 TEXAS TYPE 2 DIABETES REPORT
CONTENTS
Introduction and Patient Universe Count 2 Texas Nation 34 Texas MSA Comparisons 57 National MSA Comparisons: Use of Services 89 Hospital Charges 1011 Austin 1213 Dallas 1415 El Paso 1617 Ft Worth/Arlington 1819 Houston 2021 San Antonio 2223 Data Methodology 24
Introduction
The Texas Business Group on Health TBGH is pleased to present the Texas Type 2 Diabetes Report for 2008, an overview of demographic, financial, utilization and pharmacotherapy measures for Type 2 diabetes patients in key local markets in the state of Texas The report, intended to help providers and employers identify better opportunities to serve the needs of their patients, organizes Type 2 diabetes benchmarks into six local Texas markets and across Texas as a whole All data are drawn from the Managed Care
Digest Series The 2008 Texas Type 2 Diabetes Report helps TBGH fulfill its mission to help Texas employers play an active and enthusiastic role in collaboration with health plans, providers and purchasers; and be a catalyst in promoting costeffective delivery of quality health care to the benefit of the community
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TBGH Members: Bexar County Brundage Management Co City of Amarillo City of Odessa H-E-B Grocery Houston Metropolitan Transit Authority Research and Planning Consultants Weatherford International Westlake Chemical Corporation Dallas-Fort Worth Business Group on Health 131 Members
This third edition features examples of the kinds of patient-level, diseasespecific data on Type 2 diabetes that can be provided by TBGH using the Managed Care Digest Series as a resource Its focus on Texas locales allows for heightened scrutiny of community progress with Type 2 diabetes patient populations TBGH chose Type 2 diabetes high blood glucose levels caused by either a lack of insulin or the bodys inability to use insulin efficiently as the focus of this resource because the Centers for Disease Control estimate that 90 to 95 of all Americans with diabetes–translating to 57 of
the US population–have the Type 2 variety The data in this report covering 2005 through 2007 were gathered by Verispan LLC, Yardley, Pa, a recognized leader in the health care information industry The data provides employers with independent, third-party information against which they can benchmark their own data Please see the back page for information on the data methodology
Marianne Fazen, PhD fazen@dfwbghorg 214-382-3036
President CEO Texas Business Group on Health
Jean Berg
720-922-9451
A1: TOTAL NUMBER OF TYPE 2 DIABETES PATIENT CLAIMS, BY MSA
jeanberg@sanofi-aventisus Employer National Account Manager, sanofi-aventis US LLC
Dana McCormack
danamccormack@sanofi-aventisus Regional Account Manager, sanofi-aventis US LLC
128,000
118,734 119,924
2006
2007
Kevin Womble
Total Number of Patient Claims kevinwomble@sanofi-aventisus Regional Account Manager, sanofi-aventis US LLC 96,000
82,083 75,575
Jim Listak
jimlistak@sanofi-aventisus Regional Account Manager, sanofi-aventis US LLC
64,000
49,809 52,612 45,598
60,185
Managed Care Digest Series 2008
wwwmanagedcaredigestcom
Provided by sanofi-aventis US LLC Bridgewater, NJ Developed and produced by Forte Information
Resources LLC Denver, CO wwwforteinformationcom Data provided by Verispan LLC, Yardley, PA
Cover photo courtesy of the Texas Twist Ranch, wwwtxrangercom
32,000
27,206 27,617
4,067
5,037
0 Austin Dallas El Paso Ft Worth/ Arlington Houston San Antonio
Data source: Verispan LLC 2008
2
TEXAS TYPE 2 DIABETES REPORT 2008
MANAGED CARE DIGEST SERIES
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TEXAS AND NATION
B1: DEMOGRAPHICS: AGE AND GENDER1
Percentage of Patients Texas AGE GROUP 017 1835 3664 6579 80 GENDER Male Female 2005 05 47 600 275 73 2006 05 47 579 288 81 2007 04 44 560 302 90 2005 05 38 520 325 113 Nation 2006 04 36 506 333 121 2007 04 34 495 341 127 COMORBIDITIES 0 1 2 2 COMPLICATIONS 0 1 2 2 2005 310 246 334 110 588 288 95 30 Texas 2006 359 240 310 91 616 274 84 26
B2: DEMOGRAPHICS: COMORBIDITIES AND COMPLICATIONS 2, 3
Percentage of Patients 2007 375 236 299 90 591 283 96 30 2005 416 255 266 63 627 282 72 20 Nation 2006 454 240 250 56 642 275 67 17 2007 467 234 243 55 625 282 73 20
409 591
401 599
401 600
455 545
451 549
449 551
B3: HOSPITAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, COMMERCIAL INSURANCE PAYERS 4, 5 INPATIENT
Avg Annual Charges/Patient Avg Annual Charges/Patient
2006
2007
43,606
OUTPATIENT
2006
4,488
EMERGENCY ROOM
2007
Avg Annual Charges/Patient
2006
2007
1,331 1,037
50,000 42,500 35,000 27,500 20,000
40,050
47,290
5,200 4,450
3,688
1,450 1,175 900 625 350
1,004
1,347
36,468
4,030 3,277
3,700 2,950 2,200 Texas
Texas
Nation
Nation
Texas
Nation
B4: PROFESSIONAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, COMMERCIAL INSURANCE PAYERS 5, 6
Avg Annual Charges per Patient
5,600
4,662 4,916 Texas Nation
4,200 2,800 1,400 0
2,466 2,795 2,229 1,655 1,797 635 581 2,454
Office/ Clinic
Hospital Inpatient
Hospital Outpatient
Ambulatory Surgery Center
Emergency Room
NO COMPLICATIONS TEXAS PATIENT SHARE DECLINES The share of patients across the state of Texas who were diagnosed with Type 2 diabetes and had no complications from the disease dropped moderately in 2007, to 591 from 616 in 2006 As a consequence, the percentage gap between the Texas share and the corresponding national rate 625 rose to 34 percentage points Meanwhile, the share of Texas patients diagnosed with Type 2 diabetes and more than two complications from the disease increased to 30, notably higher than the corresponding national rate 20
Data source: Verispan
LLC 2008 all pages, the percentages are representative of the universe of Type 2 diabetes patients on whom claims data have been collected in a given year 2 A complication is defined as a patient condition caused by the Type 2 diabetes of the patient These conditions are a direct result of having Type 2 diabetes Complications of Type 2 diabetes include, but are not limited to, coronary artery disease, hypoglycemia, nephropathy, neuropathy and retinopathy 3 A comorbidity is a condition a Type 2 diabetes patient may also have, which is not directly related to the diabetes Comorbidities were narrowed down to a subset of conditions which are typically present in patients with Type 2 diabetes Comorbidities of Type 2 diabetes include, but are not limited to, congestive heart failure, coronary artery disease, dysmetabolic syndrome, hyperlipidemia, hypertension and obesity 4 Figures reflect the charges generated for Type 2 diabetes patients by the facilities that delivered care 5 Includes commercial insurance companies, Blue Cross/Blue Shield, HMOs, PPOs, point-of-service plans and exclusive provider organizations 6 Professional charges are those generated by the providers delivering care
to Type 2 diabetes patients in various settings
1 On
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MANAGED CARE DIGEST SERIES
TEXAS TYPE 2 DIABETES REPORT 2008
3
TEXAS AND NATION
Avg Annual Payments per Patient
TEXAS UTILIZATION MEASURES LAG BEHIND THE NATION Patients diagnosed with Type 2 diabetes in Texas reported lower shares than their national counterparts in all six utilization categories profiled in 2007 see graph B5 For example, just 632 of these Texas patients underwent urine microalbumin testing in 2007, notably lower than the 711 share of patients nationally The Texas patient share for blood glucose testing 840 was likewise lower than the national percentage 866 in 2007 TEXAS INSULIN AND NON-INSULIN PATIENT SHARES ARE LOWER In 2007, the shares of Texas Type 2 diabetes patients using insulin and noninsulin therapies alike were smaller than the national shares in each of the four insulin an non-insulin categories profiled Of Texas Type 2 diabetes patients, 344 used any insulin product, for example, compared with 356 nationally Similarly, the share of Texas Type 2 diabetes patients using any non-insulin antidiabetic product was 835 in 2007, slightly less that the national average of 848
NOTE: A1c
tests measure how much glucose has been in the blood during the past 34 months Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in a given year
B5: UTILIZATION: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY SERVICE, 2007
90
840 866 838 799 761 711 632 631 692 833 Texas Nation
Percentage of Patients
80
738 699
70 60 50
A1c Test
Blood Glucose Test
Serum Cholesterol Test
Urine Urine Ophthalmologic Glucose Test Microalbumin Test Examination
B6: PHARMACOTHERAPY: AVERAGE ANNUAL PAYMENTS, BY TYPE OF DRUG THERAPY, 2007
1,200 950 700
465 Any Insulin Product Any Non-Insulin Antidiabetic Product 1,004 855
567
450 200
Texas
Nation
B7: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENT USING INSULIN THERAPIES, 2007
Any Insulin Product IntermediateActing Insulin LongActing Insulin ShortActing Insulin Mixed Insulin
of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs Texas Nation 344 356 855 1,004 39 47 321 364 171 191 589 646 129 152 561 654 87 89 660 761
B8: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENT USING NON-INSULIN THERAPIES, 2007
Any Non-Insulin Antidiabetic Product of Pat Texas Nation 835
848 Avg Costs 465 567 Biguanides of Pat 461 525 Avg Costs 92 110 Sulfonylureas of Pat 331 395 Avg Costs 85 100 Insulin Sensitizing Agents of Pat 225 260 Avg Costs 851 985
Data source: Verispan LLC 2008 Biguanides Improve insulin sensitivity; reduce the production of glucose by the liver, decrease intestinal absorption of glucose, and increase the peripheral uptake and use of circulating glucose Sulfonylureas Stimulate the release of insulin in the pancreas Insulin Sensitizing Agents Improve response to insulin in liver, adipose tissue, and skeletal muscle, resulting in decreased production of glucose by the liver and increased peripheral uptake and use of circulating glucose
4
TEXAS TYPE 2 DIABETES REPORT 2008
MANAGED CARE DIGEST SERIES
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TEXAS MSA COMPARISONS
C1: HOSPITAL INPATIENT CHARGES PER YEAR FOR TYPE 2 DIABETES
Average Annual Charges per Patient 70,000
2006 54,061 2007 57,434 46,483
PATIENTS 1, 2
62,971 55,531 48,238 57,224 49,907 56,765
55,000 40,000
47,658
25,000 10,000
Dallas
Ft Worth/ Arlington
Houston
San Antonio
Texas
C2: PROFESSIONAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS2, 3
Hospital Inpatient MARKET Austin Dallas Ft Worth/
Arlington Houston San Antonio Texas NATION
2006 2007
HOUSTON HOSPITAL INPATIENT CHARGES DECREASE IN 2007 After averaging the highest profiled annual hospital inpatient charges for Type 2 diabetes patients in 2006 62,971, the Houston MSA saw such charges fall notably in 2007, to 55,531 see table C1 The other three Texas MSAs profiled in this table each saw such charges increase, most notably Ft Worth/Arlington, in which hospital inpatient charges rose to 57,434 in 2007 from 46,483 in 2006 EMERGENCY ROOM CHARGES ARE HIGH THROUGHOUT TEXAS Of the four Texas MSAs reporting average annual professional charges for emergency room ER care for Type 2 diabetes patients in 2007, three observed charges well above the national average of 647 Most notable of these was Dallas, with average ER professional charges of 905, substantially higher than the national average In contrast, patients diagnosed with Type 2 diabetes in San Antonio paid an average of 596 for ER care in 2007, lowest of the markets listed
1
Hospital Outpatient
2006 2007
Ambulatory Surgery Center
2006 2007
Emergency Room
2006 2007 2006
Office/ Clinic
2007
2,503 4,327 5,913 4,954 4,244 4,573 5,653
2,335 4,750 5,282 7,434
4,293 5,276 6,070
958 1,949 1,966 3,361 946 1,737 1,814
1,285 2,325 1,998 2,668 1,094 1,856 1,919
3,195 2,757 1,586 7,175 3,055 3,247 2,791
3,145 2,998 1,362 4,779 4,251 3,272 3,055
589 879 747 669 514 698 575
– 905 818 732 596 741 647
1,408 5,191 950 1,806 784 2,724 2,630
1,452 6,750 1,022 1,751 1,298 3,198 2,818
C3: PHARMACOTHERAPY: AVERAGE ANNUAL PAYMENTS, BY TYPE OF DRUG THERAPY, 20074
Average Annual Payments per Patient
Any Insulin Product Any Non-Insulin Antidiabetic Product
1,200 900 600 300 0
1,019 833 722 546 455 448 473 465 904 798 838 855
411
435
Austin
Dallas
El Paso
Ft Worth/ Arlington
Houston
San Antonio
Texas
Data source: Verispan LLC 2008
NOTE: Facility and professional charges data were unavailable for the El Paso and Austin MSAs
Hospital charges reflect the charges generated for Type 2 diabetes patients by the facilities that delivered care 2 Includes commercial insurance companies, Blue Cross/Blue Shield, HMOs, PPOs, point-of-service plans and exclusive provider organizations 3 Professional charges are those generated by the providers delivering care to Type 2 diabetes patients in various settings 4 Figures reflect the per-patient yearly
payments for Type 2 diabetes patients receiving a particular type of therapy
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MANAGED CARE DIGEST SERIES
TEXAS TYPE 2 DIABETES REPORT 2008
5
TEXAS MSA COMPARISONS: A1C LEVELS
SHARE OF EL PASO PATIENTS WITH POOR A1C RESULTS IS HIGH Of patients diagnosed with Type 2 diabetes in the El Paso MSA, a noteworthy 145 had A1c test results greater than 90, highest of the eight markets listed L1 By comparison, the share of such patients across the state of Texas who had A1c test results in that range was 118 The share of Type 2 diabetes patients in the Dallas MSA with A1c test results in this highest range was 110, lowest of the Texas markets LOW A1C RESULTS SHARE IS HIGHER IN TEXAS THAN NATION In 2007, the share of patients diagnosed with Type 2 diabetes who had A1c test results of 70 or less was slightly higher in the state of Texas 637 than nationally 611 Such patients diagnosed with Type 2 diabetes in the Dallas MSA were most likely, by Texas market, to be in that lowest A1c test results range 649, while patients in the El Paso MSA were least likely 603
L1: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY A1C LEVEL RANGE
70 MARKET Austin Dallas El Paso Ft Worth/ Arlington
Houston San Antonio Texas NATION
2006 2007
7179
2006 2007
8090
2006 2007 2006
90
2007
605 618 616 615 614 572 607 583
639 649 603 634 640 610 637 611
157 164 158 168 161 176 167 186
144 154 153 159 148 155 155 174
104 98 107 102 100 116 103 109
91 87 98 90 90 99 91 98
134 119 119 115 125 137 124 122
126 110 145 117 122 136 118 117
L2: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY A1C LEVEL RANGE, AUSTIN
72
605
639
2006
2007
Percentage of Patients
54 36 18 0
157 144 134 91 126
104
70
7179
8090
90
L3: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY A1C LEVEL RANGE, DALLAS
72
618
649
2006
2007
Percentage of Patients
54 36 18 0
164 154 98 87
119
110
NOTE: A1c tests measure how much glucose has been in the blood during the past 34 months Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in a given year
70
7179
8090
90 Data source: Verispan LLC 2008
6
TEXAS TYPE 2 DIABETES REPORT 2008
MANAGED CARE DIGEST SERIES
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TEXAS MSA COMPARISONS: A1C LEVELS
L4: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY A1C LEVEL RANGE, EL PASO
72
616 603 2006 2007
54 36 18 0
158 153 107 98 145
119
70
7179
8090
90
L5:
PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY A1C LEVEL RANGE, FT WORTH/ARLINGTON
72
615 634 2006 2007
Percentage of Patients
EL PASO PATIENTS HAVE HIGHEST A1C TEST RESULTS SHARE In 2007, the share of patients diagnosed with Type 2 diabetes who had A1c test results greater than 80 was highest, at 243 up from 226 in 2006, in the El Paso MSA L4 The percentage of Type 2 diabetes patients across the state of Texas with A1c test results in that range was a comparatively small 209 down moderately from 227 the previous year HOUSTON PATIENT SHARE WITH LOW A1C TEST RESULTS RISES Of patients with Type 2 diabetes who were diagnosed in the Houston MSA in 2007, 640 had A1c test results in the 70 or less range, up from 614 in 2006 Of the Texas markets profiled, only the El Paso MSA accounted for an annual decrease to 603 from 616 the previous year in the share of Type 2 diabetes patients with A1c test results in this lowest range In the state of Texas, the Type 2 diabetes patient share in this range rose to 611 from 583 in 2006
Percentage of Patients
54 36 18 0
168 159 102 90
115
117
70
7179
8090
90
L6: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY A1C LEVEL RANGE, HOUSTON
72
614 640 2006
2007
Percentage of Patients
54 36 18 0
161 148 100 90 125 122
70
7179
8090
90
L7: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY A1C LEVEL RANGE, SAN ANTONIO
72 Percentage of Patients
572 610 2006 2007
54 36
176
18 0
155 116 99
137
136
NOTE: A1c tests measure how much glucose has been in the blood during the past 34 months Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in a given year
70
7179
8090
90
Data source: Verispan LLC 2008
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MANAGED CARE DIGEST SERIES
TEXAS TYPE 2 DIABETES REPORT 2008
7
NATIONAL MSA COMPARISONS: USE OF SERVICES
DALLAS UTILIZATION SHARES ARE LOW ACROSS THE BOARD For each of the four services profiled in the report, Type 2 diabetes patients in the Dallas MSA had the lowest percentages of use among the various MSAs profiled see table D1 For example, just 626 of such patients in Dallas had at least one urine microalbumin test in 2007, down from 629 in 2006, lowest by far of the listed MSAs Meanwhile, Denver had the second lowest urine microalbumin patient share in 2007, at 714, still nearly nine percentage points higher than the patient share in Dallas DALLAS TYPE 2 DIABETES EYE
EXAM PATIENT SHARE RISES In 2007, 629 of diabetes patients diagnosed with Type 2 diabetes in the Dallas MSA had an ophthalmologic examination, up from 621 in 2006, and the only utilization measure listed with an annual increase By comparison, this percentage decreased in Minneapolis/ St Paul, to 778 from 781 in 2006, still the highest share of the profiled markets Overall, 692 of Type 2 diabetes patients nationally had at least one ophthalmologic examinations in 2007
D1: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY SERVICE
A1c Test Serum Cholesterol Test Ophthalmologic Exam Urine Microalbumin Test
MARKET Dallas Denver Minneapolis/ St Paul Boston Seattle NATION
2006
2007
2006
2007
2006
2007
2006
2007
684 779 861 752 816 739
675 787 859 752 817 738
790 833 877 892 836 837
785 837 883 892 844 838
621 684 781 747 700 688
629 698 778 753 700 692
629 723 816 816 758 708
626 714 825 825 755 711
D2: PERCENTAGE OF TYPE 2 DIABETES PATIENTS RECEIVING A1C TESTS
90 Percentage of Patients 80 70 60 50 Dallas Denver Minneapolis/ St Paul Boston Seattle Nation
684 675 2006 2007 861 859 816 817 779 787 752 752 739 738
D3: PERCENTAGE OF TYPE 2 DIABETES PATIENTS RECEIVING
OPHTHALMOLOGIC EXAMS
90
2006 2007
Percentage of Patients
80 70
621 629 684 698
781 778
747 753 700 700 688 692
60 50 Dallas Denver Minneapolis/ St Paul Boston Seattle Nation
A1c tests measure how much glucose has been in the blood during the past 34 months Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in a given year NOTE: The Seattle MSA also includes Bellevue and Everett, WA
Data source: Verispan LLC 2008
8
TEXAS TYPE 2 DIABETES REPORT 2008
MANAGED CARE DIGEST SERIES
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NATIONAL MSA COMPARISONS: USE OF SERVICES
D4: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY A1C LEVEL RANGE
70 MARKET Dallas Denver Minneapolis/ St Paul Boston Seattle NATION
2006 2007
7179
2006 2007
8090
2006 2007 2006
90
2007
618 613 640 638 639 583
649 634 678 663 666 611
164 177 156 155 156 186
154 165 135 146 146 174
98 100 91 92 91 109
87 96 84 83 81 98
119 110 114 114 114 122
110 105 103 109 107 117
D5: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY A1C LEVEL RANGE, 2007
70 7179 8090 634 90 678
72 Percentage of Patients 54 36 18 0
649
SHARE OF DALLAS PATIENTS WITH LOW A1C LEVELS GROWS In 2007, 649 of patients in Dallas
diagnosed with Type 2 diabetes had A1c test levels at or below 70, up from 618 in 2006 see table D4 This share was well above the national percentage of 611 Of the remaining four MSAs listed, only Denver 634 reported a lower Type 2 diabetes patient share for this measure than that of Dallas DALLAS PATIENT SHARE WITH HIGHEST A1C LEVELS SHRINKS The share of Dallas Type 2 diabetes patients with A1c levels above 90 fell to 110 in 2007 from 119 in 2006 In spite of this decrease, Dallas Type 2 diabetes patients were most likely, by MSA, to fall within this highest A1c level range Minneapolis/ St Pauls share of Type 2 diabetes patients with very high A1c levels was 103, down from 114 the year before, lowest of the five MSAs profiled Each of the MSAs reported shares lower than the 2007 national share of 117
154 87
165 110 96 105
135 84
103
Dallas
Denver
Minneapolis/St Paul
D6: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY A1C LEVEL RANGE, 2007
70 7179 8090 666 611 90
72 Percentage of Patients 54 36 18 0
663
146 83
109
146 81
174 107 98 117
Boston
Seattle
Nation
Data source: Verispan LLC 2008
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MANAGED CARE DIGEST SERIES
TEXAS TYPE 2 DIABETES REPORT
2008
9
NATIONAL MSA COMPARISONS: HOSPITAL CHARGES
DALLAS ER CHARGES ARE BELOW THE NATIONAL AVERAGE Hospital charges per year for emergency room care delivered to Type 2 diabetes patients in 2007 were 1,448 in the Dallas MSA, up 175 from 1,232 in 2006 see table E1 Despite the increase, such charges were 123 lower than average charges for the nation 1,651 in 2007 OUTPATIENT CHARGES ARE HIGH AT DALLAS HOSPITALS IN 2007 Dallas patients diagnosed with Type 2 diabetes paid an average of 5,406 in hospital outpatient charges in 2007, up nearly 1,000 from 4,440 in 2006 and the highest of the markets profiled In contrast, such charges were just 3,350 in Denver in 2007, the lowest of all the listed markets HOSPITAL INPATIENT CHARGES INCREASE ACROSS THE BOARD Average hospital inpatient charges per year for Type 2 diabetes patients increased between 2006 and 2007 for each of the four markets reporting data for both years For example, Dallass average annual hospital inpatient charges grew more than 10, to 54,061 in 2007 from 47,658 in 2006
Figures reflect the charges generated for Type 2 diabetes patients by the facilities that delivered care
E1: HOSPITAL CHARGES PER YEAR FOR TYPE 2
DIABETES PATIENTS
Emergency Room
Hospital Inpatient
Hospital Outpatient
MARKET Dallas Denver Minneapolis/ St Paul Seattle NATION
2006
2007
2006
2007
2006
2007
1,232 1,433 1,614 2,013 1,299
1,448 951 1,958 2,398 1,651
47,658 55,533 53,028 30,312 41,381
54,061 — 57,175 37,314 49,870
4,440 2,597 4,491 3,244 3,901
5,406 3,350 5,034 4,053 4,673
E2: HOSPITAL INPATIENT CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS
2006 54,061 55,533 53,028 49,870 47,658 41,381 37,314 30,312 57,175 2007
62,000
Average Charges
52,000
42,000
32,000 — 22,000 Dallas Denver Minneapolis/ St Paul
Seattle
Nation
E3: HOSPITAL OUTPATIENT CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS
6,000
4,440 2006 5,406 5,034 4,491 4,053 3,350 3,244 3,901 4,673 2007
Average Charges
4,500
3,000
2,597
1,500
0 Dallas Denver Minneapolis/ St Paul Seattle Nation
NOTE: Hospital charge data were unavailable for the Boston MSA
Data source: Verispan LLC 2008
10
TEXAS TYPE 2 DIABETES REPORT 2008
MANAGED CARE DIGEST SERIES
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NATIONAL MSA COMPARISONS: HOSPITAL CHARGES
E4: HOSPITAL INPATIENT CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, BY PAYER
Commercial
Insurance
Medicaid
Medicare
MARKET Dallas Denver Minneapolis/ St Paul Seattle NATION
2006
2007
2006
2007
2006
2007
37,462 32,025 43,095 25,554 36,468
42,746 — 48,666 32,530 43,606
40,027 — 48,259 31,639 37,917
55,165 — 60,267 42,124 47,039
52,483 34,651 58,182 32,134 41,689
58,997 — 58,665 37,292 48,839
E5: HOSPITAL OUTPATIENT CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, BY PAYER
Commercial Insurance
Medicaid
Medicare
MARKET Dallas Denver Minneapolis/ St Paul Seattle NATION
2006
2007
2006
2007
2006
2007
3,367 2,119 3,896 2,585 3,277
4,162 2,667 4,590 3,305 4,030
4,247 2,684 3,476 3,657 3,735
4,449 — 3,894 4,911 4,317
5,561 3,174 4,737 4,137 4,347
7,169 — 5,270 5,004 5,103
INPATIENT CHARGES RISE SHARPLY FOR MEDICAID PATIENTS Between 2006 and 2007, average hospital inpatient charges generated by Type 2 patients with Medicaid coverage in the Dallas MSA jumped, to 55,165 per year from 40,027 Nationwide, inpatient charges for Medicaid recipients increased 241 during this time, to 47,039 from 37,917 Meanwhile, average hospital outpatient charges generated by Dallas Type 2 diabetes patients with Medicaid coverage grew by a comparatively slight 48,
to 4,449 from 4,247 the previous year ER CHARGES IN DALLAS AREA TRAIL NATIONAL AVERAGES In 2007, ER charges per Type 2 diabetes patient in the Dallas MSA were lower than the national averages, regardless of payer type For such patients covered by a commercial health plan, for example, such charges were significantly lower in Dallas 1,097 than nationally 1,331 For Medicaid recipients, charges for ER care in Dallas 1,545 were 155 lower than the national average 1,828 in 2007
Figures reflect the charges generated for Type 2 diabetes patients by the facilities that delivered care Includes commercial insurance companies, Blue Cross/Blue Shield, HMOs, PPOs, point-ofservice plans and exclusive provider organizations
E6: HOSPITAL EMERGENCY ROOM CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, BY PAYER, 2007
3,200
Commercial Insurance Medicaid Medicare 2,824 2,240 2,254 1,756 1,748 1,526 1,331 1,097 871 924 1,828 1,799
Average Charges
2,400
1,545
1,600
800
0 Dallas Denver Minneapolis/ St Paul Seattle Nation
Data source: Verispan LLC 2008
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MANAGED CARE DIGEST SERIES
TEXAS TYPE 2 DIABETES REPORT 2008
11
AUSTIN
F1: DEMOGRAPHICS: AGE AND GENDER1
Percentage of
Patients
F2: DEMOGRAPHICS: COMORBIDITIES AND COMPLICATIONS2, 3
Percentage of Patients Texas 2007 04 44 560 302 90 COMORBIDITIES 0 1 2 2 COMPLICATIONS 0 1 2 2 2005 236 273 378 113 624 267 84 25 Austin 2006 273 271 363 92 651 255 73 22 2007 288 267 352 93 627 265 83 25 Texas 2007 375 236 299 90 591 283 96 30
AGE GROUP 017 1835 3664 6579 80 GENDER Male Female
2005 04 66 709 184 38
Austin 2006 05 65 714 179 37
2007 03 61 689 203 45
384 616
374 626
369 631
401 600
GROWING SHARE OF PATIENTS HAS NO COMORBIDITIES The percentage of Austinarea Type 2 diabetes patients who had no comorbidities edged up to 288 in 2007 from 273 in 2006 In spite of this rise, the Austin patient share remained 10 percentage points less than the overall Texas share of patients with no comorbidities 375 PROFESSIONAL CHARGES REMAIN LOW IN AUSTIN MSA In 2007, average professional charges for care delivered to Type 2 patients with commercial health plan coverage were sharply lower in Austin than statewide across all facility types profiled For example, 2007 average professional charges for office/clinic services for such patients were 40 lower in Austin 1,458 than in Texas 2,466
NOTE: Hospital charge data
were unavailable for the Austin MSA in 2006 and 2007
F3: DEMOGRAPHICS: COMORBIDITIES3
Austin 2006 Austin 2007 Texas 2007
68 Percentage of Patients
544 555
611 455 445 389
51 34 17 0
1 Comorbidity or fewer
2 or more Comorbidities
F4: PROFESSIONAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, COMMERCIAL INSURANCE PAYERS 5, 7
Average Annual Charges per Patient 5,000 3,750
2,748 2,991 4,662 Austin 2006 Austin 2007 Texas 2007
2,147 2,616 1,655 231 212 635 2,795 2,466 1,458 1,404
2,500 1,250 0
1,340 1,025
Hospital Inpatient
Hospital Outpatient
Ambulatory Surgery Center
Emergency Room
Office/ Clinic
Data source: Verispan LLC 2008 all pages, the percentages are representative of the universe of Type 2 diabetes patients on whom claims data have been collected in a given year 2 A complication is defined as a patient condition caused by the Type 2 diabetes of the patient These conditions are a direct result of having Type 2 diabetes Complications of Type 2 diabetes include, but are not limited to, coronary artery disease, hypoglycemia, nephropathy, neuropathy and retinopathy 3 A comorbidity is a condition a Type 2 diabetes patient may also have, which is not directly related
to the diabetes Comorbidities were narrowed down to a subset of conditions which are typically present in patients with Type 2 diabetes Comorbidities of Type 2 diabetes include, but are not limited to, congestive heart failure, coronary artery disease, dysmetabolic syndrome, hyperlipidemia, hypertension and obesity 4 Includes commercial insurance companies, Blue Cross/Blue Shield, HMOs, PPOs, point-of-service plans and exclusive provider organizations 5 Professional charges are those generated by the providers delivering care to Type 2 diabetes patients in various settings
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AUSTIN
F5: UTILIZATION: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY SERVICE
100
903 895 Austin 2006 865 861 799 737 761 733 Austin 2007 Texas 2007
85 70 55 40
840 803 791 699
657 654 632
585 577
631
A1c Test
Blood Glucose Test
Serum Cholesterol Test
Urine Urine Ophthalmologic Glucose Test Microalbumin Test Examination
SHARE OF AUSTIN PATIENTS RECEIVING A1C TEST DECLINES In 2007, 791 of Type 2 diabetes patients in the Austin MSA were administered an A1c test, down from 803 the year before Despite the moderate
decrease, the Austin A1c rate exceeded the statewide A1c rate 699 by nearly 10 percentage points USE OF LONG-ACTING INSULIN INCREASES The percentage of Type 2 diabetes patients in the Austin MSA who used a long-acting insulin product increased slightly in 2007, to 194 from 181 in 2006 However, overall insulin use among Type 2 diabetes patients in Austin fell in 2007, to 343 of Type 2 patients from 348 in 2006 Statewide, 344 of Type 2 diabetes patients used any insulin product in 2007, and 171 used a long-acting insulin product
NOTE: A1c tests measure how much glucose has been in the blood during the past 34 months Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in a given year Biguanides Improve insulin sensitivity; reduce the production of glucose by the liver, decrease intestinal absorption of glucose, and increase the peripheral uptake and use of circulating glucose Sulfonylureas Stimulate the release of insulin in the pancreas Insulin Sensitizing Agents Improve response to insulin in liver, adipose tissue, and skeletal muscle, resulting in decreased production of glucose by the liver and increased peripheral uptake and use of
circulating glucose
Percentage of Patients
F6: PHARMACOTHERAPY: AVERAGE ANNUAL PAYMENTS, BY TYPE OF DRUG THERAPY
Any Insulin Product Any Non-Insulin Antidiabetic Product 1,019 876 855
Avg Annual Payments per Patient
1,200 900 600 300 0
550
546 465
Austin 2006
Austin 2007
Texas 2007
F7: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENTS USING INSULIN THERAPIES
Any Insulin Product Austin 2006 Austin 2007 Texas 2007 IntermediateActing Insulin LongActing Insulin ShortActing Insulin Mixed Insulin
of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs 348 343 344 876 1,019 855 25 21 39 296 264 321 181 194 171 546 641 589 148 148 129 628 683 561 56 54 87 655 665 660
F8: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENT USING NON-INSULIN THERAPIES
Any Non-Insulin Antidiabetic Product of Pat Austin 2006 Austin 2007 Texas 2007 827 837 835 Avg Costs 550 546 465 Biguanides of Pat 446 447 461 Avg Costs 128 99 92 Sulfonylureas of Pat 289 298 331 Avg Costs 104 87 85 Insulin Sensitizing Agents of Pat 332 262 225 Avg Costs 878 927 851
Data source: Verispan LLC 2008
wwwtbghorg
MANAGED CARE DIGEST SERIES
TEXAS TYPE 2 DIABETES REPORT
2008
13
DALLAS
G1: DEMOGRAPHICS: AGE AND GENDER1
Percentage of Patients
G2: DEMOGRAPHICS: COMORBIDITIES AND COMPLICATIONS 2, 3
Percentage of Patients Texas 2007 04 44 560 302 90 COMORBIDITIES 0 1 2 2 COMPLICATIONS 0 1 2 2 2005 293 241 339 128 571 290 104 36 Dallas 2006 358 236 305 101 603 276 92 29 2007 396 226 280 98 577 284 104 35 Texas 2007 375 236 299 90 591 283 96 30
AGE GROUP 017 1835 3664 6579 80 GENDER Male Female
2005 06 49 598 276 72
Dallas 2006 05 46 568 299 82
2007 04 42 542 318 94
399 601
386 614
385 615
401 600
LARGER SHARE OF DALLAS PATIENTS IS COMORBIDITY-FREE Of all Type 2 diabetes patients in the Dallas MSA, 396 were without a diagnosed comorbidity in 2007, up from 358 in 2006 and from 293 in 2005 see table G2 A higher percentage of Type 2 diabetes patients in Dallas 139 had two or more complications from this disease than did such patients in Texas 126 HOSPITAL INPATIENT CHARGES CLIMB FOR DALLAS PATIENTS Average annual hospital inpatient charges for Type 2 diabetes patients in Dallas with commerical insurance grew 141, to 42,746 
from 37,462 in 2006 Still, these charges were notably lower than the statewide average 47,290 in 2007 Average professional
office charges for commercially insured Type 2 diabetes patients were nearly twice as high in Dallas 4,904 as in Texas 2,466
14
G3: HOSPITAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, COMMERCIAL INSURANCE PAYERS 4, 5 INPATIENT
Avg Annual Charges/Patient Avg Annual Charges/Patient 50,000
42,746 47,290 37,462
OUTPATIENT
4,600 3,700 2,800 1,900 1,000 Dallas Dallas 2006 2007 Texas 2007
3,367 4,162 4,488
EMERGENCY ROOM
Avg Annual Charges/Patient 1,500 1,250 1,000 750 500 Dallas Dallas 2006 2007 Texas 2007
885 1,097 1,347
42,500 35,000 27,500 20,000
Dallas Dallas 2006 2007
Texas 2007
G4: PROFESSIONAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, COMMERCIAL INSURANCE PAYERS 5, 6
Average Annual Charges per Patient 6,000
4,662 Dallas 2006 Dallas 2007 Texas 2007 4,904 3,741 2,404 2,795 2,359 2,466
4,500 3,000
4,242 3,837
2,042 1,974 1,655
1,500 0
700 720 635
Hospital Inpatient
Hospital Outpatient
Ambulatory Surgery Centers
Emergency Room
Office/ Clinic
Data source: Verispan LLC 2008 all pages, the percentages are representative of the universe of Type 2 diabetes patients on whom claims data have been collected in a given year 2 A complication is defined as a patient
condition caused by the Type 2 diabetes of the patient These conditions are a direct result of having Type 2 diabetes Complications of Type 2 diabetes include, but are not limited to, coronary artery disease, hypoglycemia, nephropathy, neuropathy and retinopathy 3 A comorbidity is a condition a Type 2 diabetes patient may also have, which is not directly related to the diabetes Comorbidities were narrowed down to a subset of conditions which are typically present in patients with Type 2 diabetes Comorbidities of Type 2 diabetes include, but are not limited to, congestive heart failure, coronary artery disease, dysmetabolic syndrome, hyperlipidemia, hypertension and obesity 4 Figures reflect the charges generated for Type 2 diabetes patients by the facilities that delivered care 5 Includes commercial insurance companies, Blue Cross/Blue Shield, HMOs, PPOs, point-of-service plans and exclusive provider organizations 6 Professional charges are those generated by the providers delivering care to Type 2 diabetes patients in various settings
1 On
TEXAS TYPE 2 DIABETES REPORT 2008
MANAGED CARE DIGEST SERIES
wwwtbghorg
DALLAS
G5: UTILIZATION: PERCENTAGE OF TYPE 2 DIABETES PATIENTS,
BY SERVICE
90
Percentage of Patients
Dallas 2006 840 841 840 785 790 675 699 626 629 632 621 631 629 799 768 768 761 Dallas 2007 Texas 2007
80 70 60 50 A1c Test Blood Glucose Test
684
Serum Cholesterol Test
Urine Urine Ophthalmologic Glucose Test Microalbumin Test Examination
DALLAS A1C PATIENT TEST SHARE TRAILS THE STATE OF TEXAS In 2007, the share of Type 2 diabetes patients in Dallas who received an A1c test was 675, down slightly from 684 in 2006 G5 Statewide, 699 of Type 2 diabetes patients were administered at least one A1c test, down fractionally from 701 the year before NON-INSULIN COSTS DECLINE FOR DALLAS TYPE 2 PATIENTS Average costs per Type 2 diabetes patient per year in the Dallas MSA for any non-insulin antidiabetic product fell slightly in 2007, to 455 from 463 in 2006 During the same period, any insulin product costs for these Type 2 diabetes patients climbed, to 833 from 714 the prior year In spite of this increase, insulin costs remained higher for Type 2 diabetes patients statewide 855 in 2007
G6: PHARMACOTHERAPY: AVERAGE ANNUAL PAYMENTS, BY TYPE OF DRUG THERAPY
Avg Annual Payments per Patient
Any Insulin Product Any Non-Insulin Antidiabetic Product 833 714
855
900 750 600
463
455
465
450 300
Dallas 2006
Dallas 2007
Texas 2007
G7: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENTS USING INSULIN THERAPIES
Any Insulin Product Dallas 2006 Dallas 2007 Texas 2007 330 344 344 714 833 855 IntermediateActing Insulin 48 40 39 296 333 321 LongActing Insulin 134 157 171 512 584 589 ShortActing Insulin 123 131 129 468 535 561 Mixed Insulin 106 101 87 582 670 660
of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs
G8: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENT USING NON-INSULIN THERAPIES
Any Non-Insulin Antidiabetic Product of Pat Dallas 2006 Dallas 2007 Texas 2007 823 823 835 Avg Costs 463 455 465 Biguanides of Pat 471 479 461 Avg Costs 121 93 92 Sulfonylureas of Pat 342 331 331 Avg Costs 102 84 85 Insulin Sensitizing Agents of Pat 278 219 225 Avg Costs 819 845 851
NOTE: A1c tests measure how much glucose has been in the blood during the past 34 months Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in a given year Biguanides Improve insulin sensitivity; reduce the production of glucose by the liver, decrease intestinal absorption of glucose,
and increase the peripheral uptake and use of circulating glucose Sulfonylureas Stimulate the release of insulin in the pancreas Insulin Sensitizing Agents Improve response to insulin in liver, adipose tissue, and skeletal muscle, resulting in decreased production of glucose by the liver and increased peripheral uptake and use of circulating glucose
Data source: Verispan LLC 2008
wwwtbghorg
MANAGED CARE DIGEST SERIES
TEXAS TYPE 2 DIABETES REPORT 2008
15
EL PASO
H1: DEMOGRAPHICS: AGE AND GENDER1
Percentage of Patients
H2: DEMOGRAPHICS: COMORBIDITIES AND COMPLICATIONS 2, 3
Percentage of Patients Texas 2007 04 44 560 302 90 COMORBIDITIES 0 1 2 2 COMPLICATIONS 0 1 2 2 2005 409 250 266 75 653 246 79 22 El Paso 2006 442 252 249 57 698 215 70 17 2007 394 261 277 68 652 249 79 20 Texas 2007 375 236 299 90 591 283 96 30
AGE GROUP 017 1835 3664 6579 80 GENDER Male Female
2005 06 59 588 274 73
El Paso 2006 05 51 539 317 89
2007 06 59 545 295 95
390 610
413 587
418 582
401 600
PATIENT SHARE WITH 2 COMORBIDITIES RISES IN EL PASO The percentage of Type 2 diabetes patients in the El Paso MSA with two or more diagnosed comorbidities grew to 345 in 2007 from 306 in 2006 H3 By
comparison, a moderately larger share of Type 2 diabetes patients in the state of Texas 389 were diagnosed with at least two comorbidities in 2007 OFFICE PROVIDER COSTS ARE LOW FOR EL PASO PATIENTS Average professional office charges for care delivered to Type 2 diabetes patients in El Paso with commercial insurance coverage dropped notably in 2007, to 714 from 1,000 in 2006 Such charges were substantially less than the statewide average of 2,466 in 2007
H3: DEMOGRAPHICS: COMORBIDITIES3
694 El Paso 2006 655 611 El Paso 2007 Texas 2007
72
Percentage of Patients
54 36 18 0
306 345 389
1 Comorbidity or fewer
2 or more Comorbidities
H4: PROFESSIONAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, COMMERCIAL INSURANCE PAYERS 5, 6
Average Annual Charges Per Patient 6,400 4,800 3,200
1,420 El Paso 2006 4,770 5,033 4,662 3,463 2,795 1,655 274 413 — 635 714 1,000 2,466 El Paso 2007 Texas 2007
1,600 0
1,336
Hospital Inpatient
Hospital Outpatient
Ambulatory Surgery Center
Emergency Room
Office/ Clinic
NOTE: Hospital charge data were unavailable for the El Paso MSA in 2006 and 2007
Data source: Verispan LLC 2008 On all pages, the percentages are representative of the universe
of Type 2 diabetes patients on whom claims data have been collected in a given year 2 A complication is defined as a patient condition caused by the Type 2 diabetes of the patient These conditions are a direct result of having Type 2 diabetes Complications of Type 2 diabetes include, but are not limited to, coronary artery disease, hypoglycemia, nephropathy, neuropathy and retinopathy 3 A comorbidity is a condition a Type 2 diabetes patient may also have, which is not directly related to the diabetes Comorbidities were narrowed down to a subset of conditions which are typically present in patients with Type 2 diabetes Comorbidities of Type 2 diabetes include, but are not limited to, congestive heart failure, coronary artery disease, dysmetabolic syndrome, hyperlipidemia, hypertension and obesity 4 Figures reflect the charges generated for Type 2 diabetes patients by the facilities that delivered care 5 Includes commercial insurance companies, Blue Cross/Blue Shield, HMOs, PPOs, point-of-service plans and exclusive provider organizations 6 Professional charges are those generated by the providers delivering care to Type 2 diabetes patients in various settings
1
16
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DIABETES REPORT 2008
MANAGED CARE DIGEST SERIES
wwwtbghorg
EL PASO
H5: UTILIZATION: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY SERVICE
El Paso 2006 El Paso 2007 Texas 2007
85 Percentage of Patients 75 65 55 45 A1c Test
788 779 655 699 649
840 760 799 781 766 761 748
600 604
632 571 556
631
Blood Glucose Test
Serum Cholesterol Test
Urine Urine Ophthalmologic Glucose Test Microalbumin Test Examination
H6: PHARMACOTHERAPY: AVERAGE ANNUAL PAYMENTS, BY TYPE OF DRUG THERAPY
Avg Annual Payments per Patient
900 750
618 Any Insulin Product Any Non-Insulin Antidiabetic Product 855
LARGER SHARE OF EL PASO PATIENTS RECEIVES EYE EYAMS The share of El Paso Type 2 diabetes patients receiving ophthalmologic exams rose moderately in 2007, to 571 from 556 in 2006 H5, but still trailed the statewide average 631 by six percentage points With the exception of urine glucose tests, the shares of Type 2 diabetes patients receiving at least one test per year was lower in El Paso than in Texas in every utilization category profiled PER-PATIENT INSULIN COSTS ARE LOW IN THE EL PASO MSA Insulin treatment costs per Type 2 diabetes patient per year in the El Paso MSA were 722, up notably from
618 in 2006 However, these patients paid considerably less for insulin therapy, on average, than their counterparts across the state of Texas 855, up from 736 the previous year
NOTE: A1c tests measure how much glucose has been in the blood during the past 34 months Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in a given year Biguanides Improve insulin sensitivity; reduce the production of glucose by the liver, decrease intestinal absorption of glucose, and increase the peripheral uptake and use of circulating glucose Sulfonylureas Stimulate the release of insulin in the pancreas Insulin Sensitizing Agents Improve response to insulin in liver, adipose tissue, and skeletal muscle, resulting in decreased production of glucose by the liver and increased peripheral uptake and use of circulating glucose
722
600
448 465
450 300
408
El Paso 2006
El Paso 2007
Texas 2007
H7: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENTS USING INSULIN THERAPIES
Any Insulin Product El Paso 2006 El Paso 2007 Texas 2007 292 291 344 618 722 855 IntermediateActing Insulin 43 27 39 255 254 321 LongActing Insulin 137 162 171 497 512 589 ShortActing Insulin
90 87 129 447 535 561 Mixed Insulin 110 98 87 480 580 660
of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs
H8: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENT USING NON-INSULIN THERAPIES
Any Non-Insulin Antidiabetic Product of Pat El Paso 2006 El Paso 2007 Texas 2007 866 881 835 Avg Costs 408 448 465 Biguanides of Pat 486 493 461 Avg Costs 103 80 92 Sulfonylureas of Pat 350 344 331 Avg Costs 95 82 85 Insulin Sensitizing Agents of Pat 275 244 225 Avg Costs 701 756 851
Data source: Verispan LLC 2008
wwwtbghorg
MANAGED CARE DIGEST SERIES
TEXAS TYPE 2 DIABETES REPORT 2008
17
FT WORTH/ARLINGTON
I1: DEMOGRAPHICS: AGE AND GENDER1
Percentage of Patients 2005 08 51 632 246 63 Ft Worth/Arlington 2006 08 51 604 265 73 2007 04 49 593 275 79 Texas 2007 04 44 560 302 90
I2: DEMOGRAPHICS: COMORBIDITIES AND COMPLICATIONS 2, 3
Percentage of Patients Ft Worth/Arlington 2005 2006 240 248 382 131 548 300 114 38 276 249 365 111 574 288 100 38 2007 292 252 350 107 552 291 115 42 Texas 2007 375 236 299 90 591 283 96 30
AGE GROUP 017 1835 3664 6579 80 GENDER Male Female
COMORBIDITIES 0 1 2 2 COMPLICATIONS 0 1 2 2
414 586
415 585
411 589
401
600
Average Annual Charges per Patient
COMPLICATION-FREE FT WORTH PATIENT SHARE DECREASES The share of patients in the Ft Worth/Arlington MSA diagnosed with Type 2 diabetes and no complications from the disease dropped in 2007, to 552 from 574 in 2006 I2 Conversely, the share of these same Type 2 diabetes patients with two or more diagnosed complications from the disease was 157, notably higher than the Texas mark 126 FT WORTH HOSPITAL INPATIENT CHARGES DECLINE SHARPLY Average professional inpatient charges for Type 2 diabetes patients in the FtWorth/Arlington MSA with commercial insurance decreased in 2007, to 4,888 from 5,371 in 2006 and from 5,572 in 2005 However, these charges continued to exceed the statewide average to 4,662 from 4,448 the previous year by more than 200
I3: HOSPITAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, COMMERCIAL INSURANCE PAYERS 4, 5 INPATIENT
Avg Annual Charges/Patient Avg Annual Charges/Patient 50,000 42,500
34,971 45,603 47,290
OUTPATIENT
Avg Annual Charges/Patient 4,600
3,653 4,488
EMERGENCY ROOM
1,500
1,256 1,347
3,450 2,300 1,150 0
2,784
1,250 1,000 750 500 Ft Worth Ft Worth Texas 2006 2007 2007
928
35,000 27,500 20,000 Ft Worth Ft
Worth Texas 2006 2007 2007
Ft Worth Ft Worth Texas 2006 2007 2007
I4: PROFESSIONAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, COMMERCIAL INSURANCE PAYERS 5, 6
6,400
5,371 Ft Worth/Arlington 2006 4,888 4,662 Ft Worth/Arlington 2007 Texas 2007
4,800 3,200
2,795 2,028 2,164 1,422 1,655 1,501 533 537 635 872 911
2,466
1,600 0
Hospital Inpatient
Hospital Outpatient
Ambulatory Surgery Center
Emergency Room
Office/ Clinic
Data source: Verispan LLC 2008 all pages, the percentages are representative of the universe of Type 2 diabetes patients on whom claims data have been collected in a given year 2 A complication is defined as a patient condition caused by the Type 2 diabetes of the patient These conditions are a direct result of having Type 2 diabetes Complications of Type 2 diabetes include, but are not limited to, coronary artery disease, hypoglycemia, nephropathy, neuropathy and retinopathy 3 A comorbidity is a condition a Type 2 diabetes patient may also have, which is not directly related to the diabetes Comorbidities were narrowed down to a subset of conditions which are typically present in patients with Type 2 diabetes Comorbidities of Type 2 diabetes include, but
are not limited to, congestive heart failure, coronary artery disease, dysmetabolic syndrome, hyperlipidemia, hypertension and obesity 4 Figures reflect the charges generated for Type 2 diabetes patients by the facilities that delivered care 5 Includes commercial insurance companies, Blue Cross/Blue Shield, HMOs, PPOs, point-of-service plans and exclusive provider organizations 6 Professional charges are those generated by the providers delivering care to Type 2 diabetes patients in various settings
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18
TEXAS TYPE 2 DIABETES REPORT 2008
MANAGED CARE DIGEST SERIES
wwwtbghorg
FT WORTH/ARLINGTON
I5: UTILIZATION: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY SERVICE
Ft Worth/Arlington 2006 808 840 775 808 799 776 687 689 699 625 622 632 631 625 613 Ft Worth/Arlington 2007 767 761 762 Texas 2007
85 Percentage of Patients 75 65 55 45 A1c Test
Blood Glucose Test
Serum Cholesterol Test
Urine Urine Ophthalmologic Glucose Test Microalbumin Test Examination
FT WORTH PATIENTS ARE LESS LIKELY TO RECEIVE SERVICES Patients diagnosed with Type 2 diabetes in the Ft Worth/Arlington MSA were less likely than Type 2 diabetes patients across the state of Texas to receive any of six
profiled services I5 For example, 687 of Type 2 diabetes patients in the Ft Worth/Arlington MSA underwent A1c testing in 2007, compared with 699 of such patients statewide PER-PATIENT INSULIN COSTS CLIMB IN FT WORTH/ARLINGTON Type 2 diabetes patients in the Ft Worth/Arlington MSA paid on average 904 per year for insulin therapy in 2007, up considerably from 783 in 2006 Noninsulin costs also increased for Type 2 diabetes patients in FtWorth/Arlington over this period, to 473 from 466 the previous year
I6: PHARMACOTHERAPY: AVERAGE ANNUAL PAYMENTS, BY TYPE OF DRUG THERAPY
Any Insulin Product
Avg Annual Payments per Patient
950
783
Any Non-Insulin Antidiabetic Product 904 855
775 600
466 473 465
425 250
Ft Worth 2006
Ft Worth 2007
Texas 2007
I7: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENTS USING INSULIN THERAPIES
Any Insulin Product Ft Worth 2006 Ft Worth 2007 Texas 2007 IntermediateActing Insulin LongActing Insulin ShortActing Insulin Mixed Insulin
of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs 331 333 344 783 904 855 38 32 39 292 327 321 157 173 171 548 628 589 130 136 129 543 612 561 86 75 87 590 662 660 NOTE: A1c tests
measure how much glucose has been in the blood during the past 34 months Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in a given year Biguanides Improve insulin sensitivity; reduce the production of glucose by the liver, decrease intestinal absorption of glucose, and increase the peripheral uptake and use of circulating glucose Sulfonylureas Stimulate the release of insulin in the pancreas Insulin Sensitizing Agents Improve response to insulin in liver, adipose tissue, and skeletal muscle, resulting in decreased production of glucose by the liver and increased peripheral uptake and use of circulating glucose
I8: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENT USING NON-INSULIN THERAPIES
Any Non-Insulin Antidiabetic Product of Pat Ft Worth 2006 Ft Worth 2007 Texas 2007 831 833 835 Avg Costs 466 473 465 Biguanides of Pat 478 472 461 Avg Costs 118 91 92 Sulfonylureas of Pat 343 323 331 Avg Costs 98 84 85 Insulin Sensitizing Agents of Pat 285 222 225 Avg Costs 830 887 851
Data source: Verispan LLC 2008
wwwtbghorg
MANAGED CARE DIGEST SERIES
TEXAS TYPE 2 DIABETES REPORT 2008
19
HOUSTON
J1: DEMOGRAPHICS: AGE AND
GENDER1
Percentage of Patients
J2: DEMOGRAPHICS: COMORBIDITIES AND COMPLICATIONS 2, 3
Percentage of Patients Texas 2007 04 44 560 302 90 COMORBIDITIES 0 1 2 2 COMPLICATIONS 0 1 2 2 2005 299 239 338 124 574 298 98 31 Houston 2006 366 231 301 102 600 282 90 27 2007 382 233 286 100 575 293 102 31 Texas 2007 375 236 299 90 591 283 96 30
AGE GROUP 017 1835 3664 6579 80 GENDER Male Female
2005 04 53 664 223 55
Houston 2006 04 55 638 240 63
2007 04 50 596 266 85
392 608
373 627
376 625
401 600
Avg Annual Charges per Patient
HOUSTON WORKING AGE TYPE 2 DIABETES PATIENT SHARE FALLS The share of patients diagnosed with Type 2 diabetes in the Houston MSA who were between 18 and 64 years of age declined in 2007, to 646 from 693 in 2006, yet still exceeded the corresponding rate across the state of Texas 604 J1 Meanwhile, the share of Houston Type 2 diabetes patients with two or more complications from the disease likewise exceeded the statewide average 133 vs 126 PROFESSIONAL OFFICE CHARGES ARE HIGHEST IN HOUSTON With the exception of office visits, professional charges are higher in Houston than in Texas for commercially insured type 2 diabetes patients in every patient setting
profiled in 2007 For example, hospital charges per Type 2 diabetes patient per year were higher in Houston than Dallas for inpatient and outpatient hospital settings alike
20
J3: HOSPITAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, COMMERCIAL INSURANCE PAYERS 4, 5 INPATIENT
Avg Annual Charges/Patient Avg Annual Charges/Patient
52,000 39,000 26,000 13,000 0 Houston Houston Texas 2006 2007 2007
49,370 51,726 47,290
OUTPATIENT
5,200 4,500 3,800 3,100 2,400 Houston Houston Texas 2006 2007 2007
4,349
EMERGENCY ROOM
Avg Annual Charges/Patient
1,600 1,200 800 400 0 Houston Houston Texas 2006 2007 2007
917 1,502 1,347 4,488
5,018
J4: PROFESSIONAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, COMMERCIAL INSURANCE PAYERS 5, 6
7,200 5,400 3,600 1,800 0
2,028 1,655 624 654 635 — 5,230 5,424 4,662 3,607 2,795 1,425 2,466 1,519 Houston 2006 4,963 Houston 2007 Texas 2007
Hospital Inpatient
Hospital Outpatient
Ambulatory Surgery Center
Emergency Room
Office/ Clinic
Data source: Verispan LLC 2008 the percentages are representative of the universe of Type 2 diabetes patients on whom claims data have been collected in a given year 2 A complication is defined as a patient condition
caused by the Type 2 diabetes of the patient These conditions are a direct result of having Type 2 diabetes Complications of Type 2 diabetes include, but are not limited to, coronary artery disease, hypoglycemia, nephropathy, neuropathy and retinopathy 3 A comorbidity is a condition a Type 2 diabetes patient may also have, which is not directly related to the diabetes Comorbidities were narrowed down to a subset of conditions which are typically present in patients with Type 2 diabetes Comorbidities of Type 2 diabetes include, but are not limited to, congestive heart failure, coronary artery disease, dysmetabolic syndrome, hyperlipidemia, hypertension and obesity 4 Figures reflect the charges generated for Type 2 diabetes patients by the facilities that delivered care 5 Includes commercial insurance companies, Blue Cross/Blue Shield, HMOs, PPOs, point-of-service plans and exclusive provider organizations 6 Professional charges are those generated by the providers delivering care to Type 2 diabetes patients in various settings
1 On all pages,
TEXAS TYPE 2 DIABETES REPORT 2008
MANAGED CARE DIGEST SERIES
wwwtbghorg
HOUSTON
J5: UTILIZATION: PERCENTAGE OF TYPE 2 DIABETES
PATIENTS, BY SERVICE
803 840 787 Houston 2006 761 760 799 765 761 761 Houston 2007 Texas 2007
85
75 65 55 45
656 699 649 610 605 632 631 611 601
A1c Test
Blood Glucose Test
Serum Cholesterol Test
Urine Urine Ophthalmologic Glucose Test Microalbumin Test Examination
HOUSTON DIABETES SERVICES SHARES TRAIL STATE AVERAGE The shares of patients diagnosed with Type 2 diabetes who received various services for the disease in 2007 were lower in the Houston MSA than across the state of Texas for every service profiled, with one exception: State and Houston averages for patients receiving at least one urine glucose test were both at 761 J5 TEXAS PER-PATIENT INSULIN PAYMENTS TOP HOUSTON RATES Although average annual payments per Houston Type 2 diabetes patient per year for any insulin product rose, to 798 from 670 in 2006, the ratio still trailed the statewide average for this measure 855 J6 Type 2 diabetes patients across the state of Texas likewise had higher non-insulin antidiabetic product payments than than their Houston counterparts 465 vs 411
NOTE: A1c tests measure how much glucose has been in the blood during the past 34 months Figures reflect the percentage of Type 2
diabetes patients who have had at least one A1c test in a given year Biguanides Improve insulin sensitivity; reduce the production of glucose by the liver, decrease intestinal absorption of glucose, and increase the peripheral uptake and use of circulating glucose Sulfonylureas Stimulate the release of insulin in the pancreas Insulin Sensitizing Agents Improve response to insulin in liver, adipose tissue, and skeletal muscle, resulting in decreased production of glucose by the liver and increased peripheral uptake and use of circulating glucose
Percentage of Patients
J6: PHARMACOTHERAPY: AVERAGE ANNUAL PAYMENTS, BY TYPE OF DRUG THERAPY
Avg Annual Payments per Patient
950 750 550
418 411 Any Insulin Product Any Non-Insulin Antidiabetic Product 855 798 670
465
350 150
Houston 2006
Houston 2007
Texas 2007
J7: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENTS USING INSULIN THERAPIES
Any Insulin Product Houston 2006 Houston 2007 Texas 2007 IntermediateActing Insulin LongActing Insulin ShortActing Insulin Mixed Insulin
of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs 318 331 344 670 798 855 45 42 39 272 276 321 152 166 171 472 553 589 113
118 129 501 567 561 72 71 87 525 579 660
J8: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENT USING NON-INSULIN THERAPIES
Any Non-Insulin Antidiabetic Product of Pat Houston 2006 Houston 2007 Texas 2007 842 844 835 Avg Costs 418 411 465 Biguanides of Pat 461 474 461 Avg Costs 118 94 92 Sulfonylureas of Pat 344 333 331 Avg Costs 96 81 85 Insulin Sensitizing Agents of Pat 271 203 225 Avg Costs 710 759 851
Data source: Verispan LLC 2008
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MANAGED CARE DIGEST SERIES
TEXAS TYPE 2 DIABETES REPORT 2008
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SAN ANTONIO
K1: DEMOGRAPHICS: AGE AND GENDER1
Percentage of Patients
K2: DEMOGRAPHICS: COMORBIDITIES AND COMPLICATIONS 2, 3
Percentage of Patients Texas 2007 04 44 560 302 90 COMORBIDITIES 0 1 2 2 COMPLICATIONS 0 1 2 2 2005 323 235 330 113 550 311 105 34 San Antonio 2006 366 229 312 94 563 305 103 30 2007 387 237 290 86 545 309 113 33 Texas 2007 375 236 299 90 591 283 96 30
AGE GROUP 017 1835 3664 6579 80 GENDER Male Female
2005 05 44 561 301 88
San Antonio 2006 05 46 570 318 110
2007 05 41 513 329 113
390 610
389 611
390 611
401 600
SHARE OF OLDEST PATIENTS IN SAN ANTONIO INCREASES The share of all patients diagnosed with Type 2 diabetes in the San
Antonio MSA who were 65 years of age or older rose in 2007, to 442 from 428 in 2006, higher than their counterparts statewide 392 See table K1 Of the seven Texas markets listed, this San Antonio oldest Type 2 diabetes patient share was the highest HIGH COMPLICATION PATIENT SHARE FALLS IN SAN ANTONIO Between 2006 and 2007, the share of patients diagnosed with Type 2 diabetes in San Antonio who had two or more comorbidities declined to 376 from 406 Conversely, the share of Type 2 diabetes patients in this MSA who had two or more complications from the disease increased during this period to 146 from 133, notably exceeding the statewide share 126
22
K3: HOSPITAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, COMMERCIAL INSURANCE PAYERS 4, 5 INPATIENT
Avg Annual Charges/Patient Avg Annual Charges/Patient 50,000 45,000 40,000
35,214 46,568 47,290
OUTPATIENT
6,000
4,773 5,837 4,488
EMERGENCY ROOM
Avg Annual Charges/Patient
2,000 1,500 1,000 500 0
San Antonio San Antonio Texas 2006 2007 2007 1,265 1,900 1,347
4,750 3,500 2,250 1,000
35,000 30,000
San Antonio San Antonio Texas 2006 2007 2007
San Antonio San Antonio Texas 2006 2007 2007
K4: PROFESSIONAL CHARGES PER YEAR FOR TYPE 2
DIABETES PATIENTS, COMMERCIAL INSURANCE PAYERS 5,6
Avg Annual Charges per Patient 5,200
4,326 4,590 4,662 San Antonio 2006 4,034 2,978 San Antonio 2006 Texas 2007
3,900
2,795 2,466 1,655 1,334 635 460 521 698
2,600 1,300 0
1,186 980
Hospital Inpatient
Hospital Outpatient
Ambulatory Surgery Center
Emergency Room
Office/ Clinic
1 On
Data source: Verispan LLC 2008 all pages, the percentages are representative of the universe of Type 2 diabetes patients on whom claims data have been collected in a given year 2 A complication is defined as a patient condition caused by the Type 2 diabetes of the patient These conditions are a direct result of having Type 2 diabetes Complications of Type 2 diabetes include, but are not limited to, coronary artery disease, hypoglycemia, nephropathy, neuropathy and retinopathy 3 A comorbidity is a condition a Type 2 diabetes patient may also have, which is not directly related to the diabetes Comorbidities were narrowed down to a subset of conditions which are typically present in patients with Type 2 diabetes Comorbidities of Type 2 diabetes include, but are not limited to, congestive heart failure, coronary artery disease, dysmetabolic
syndrome, hyperlipidemia, hypertension and obesity 4 Figures reflect the charges generated for Type 2 diabetes patients by the facilities that delivered care 5 Includes commercial insurance companies, Blue Cross/Blue Shield, HMOs, PPOs, point-of-service plans and exclusive provider organizations 6 Professional charges are those generated by the providers delivering care to Type 2 diabetes patients in various settings
TEXAS TYPE 2 DIABETES REPORT 2008
MANAGED CARE DIGEST SERIES
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SAN ANTONIO
K5: UTILIZATION: PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY SERVICE
San Antonio 2006 San Antonio 2007 Texas 2007
90
828
819 840 787 799 799 742 756 761 625 658 638 631 632 641
80 70 60 50 A1c Test Blood Glucose Test Serum Cholesterol Test
671 699 692
Urine Urine Ophthalmologic Glucose Test Microalbumin Test Examination
A1C TYPE 2 DIABETES PATIENT SHARE DROPS IN SAN ANTONIO MSA The share of San Antonio Type 2 diabetes patients who received at least one A1c test in 2007 declined, to 671 from 692 in 2006, more than two percentage points beneath the statewide average 699 K5 In 2007, the San Antonio patient share exceeded the statewide average in only one of six services
profiled: ophthalmologic examinations 658 vs 631 SAN ANTONIO MSA PER-PATIENT INSULIN PAYMENT INCREASES San Antonio per-Type 2 diabetes patient payments per year for any insulin product jumped, to 838 from 663 in 2006, yet still lagged behind the statewide average for this measure 855 The San Antonio per-Type 2 diabetes patient average payment for any non-insulin antidiabetic product also trailed the state average 435 vs 465
NOTE: A1c tests measure how much glucose has been in the blood during the past 34 months Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in a given year Biguanides Improve insulin sensitivity; reduce the production of glucose by the liver, decrease intestinal absorption of glucose, and increase the peripheral uptake and use of circulating glucose Sulfonylureas Stimulate the release of insulin in the pancreas Insulin Sensitizing Agents Improve response to insulin in liver, adipose tissue, and skeletal muscle, resulting in decreased production of glucose by the liver and increased peripheral uptake and use of circulating glucose
Percentage of Patients
K6: PHARMACOTHERAPY: AVERAGE ANNUAL PAYMENTS, BY TYPE OF DRUG
THERAPY
Any Insulin Product Any Non-Insulin Antidiabetic Product 838 663 855
Avg Annual Payments per Patient
900 675 450 225 0
437
435
465
San Antonio 2006
San Antonio 2007
Texas 2007
K7: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENTS USING INSULIN THERAPIES
Any Insulin Product SA 2006 SA 2007 Texas 2007 IntermediateActing Insulin LongActing Insulin ShortActing Insulin Mixed Insulin
of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs of Pat Avg Costs 323 346 344 663 838 855 45 45 39 246 302 321 158 188 171 443 577 589 111 131 129 504 553 561 88 86 87 563 664 660
K8: OF AND AVG PAYMENTS FOR TYPE 2 DIABETES PATIENT USING NON-INSULIN THERAPIES
Any Non-Insulin Antidiabetic Product of Pat SA 2006 SA 2007 Texas 2007 837 839 835 Avg Costs 437 435 465 Biguanides of Pat 462 473 461 Avg Costs 128 96 92 Sulfonylureas of Pat 365 359 331 Avg Costs 96 78 85 Insulin Sensitizing Agents of Pat 279 241 225 Avg Costs 745 802 851
Data source: Verispan LLC 2008
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MANAGED CARE DIGEST SERIES
TEXAS TYPE 2 DIABETES REPORT 2008
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Texas Business Group on Health 11520 North Central Expy Suite 201 Dallas, TX 75243
Data Methodology
Verispan generates
data for this Managed Care Digest Series newsletter using health care professional 837p and institutional 837i insurance claims, representing more than 55 million unique patients nationally in 2007 with a range of Type 2 diabetes diagnoses 2500025092 Data from physicians of all specialties and from all hospital types are included Verispan also gathers data on prescription activity from the National Council for Prescription Drug Programs NCPDP Data for all disease states collected account for some 8 billion prescription claims annually, or more than 50 of the prescription universe These prescription data represent the sampling of prescription activity from a variety of sources, including retail chains, mass merchandisers and pharmacy benefit managers, and come from a near census of more than 59,000 pharmacies in the US Cash, mail-order, Medicaid, and third-party transactions are tracked
DATA INTEGRITY Data arriving into Verispan are put through a rigorous process to ensure that data elements match to valid references, such as product codes, ICD-9 diagnosis and CPT-4 procedure codes, and provider and facility data Claims undergo a careful de-duplication process to ensure that when
multiple, voided, or adjusted claims are assigned to a patient encounter, they are applied to the database, but only for a single, unique patient Through its patient encryption methods, Verispan creates a unique, random numerical identifier for every patient, and then strips away all patient-specific health information that is protected under the Health Insurance Portability and Accountability Act HIPAA The identifier allows Verispan to track disease-specific diagnosis and procedure activity across the various settings where patient care is provided hospital inpatient, hospital outpatient, emergency rooms, clinics, doctors offices and pharmacies, while protecting the privacy of each patient
2008 sanofi-aventis US LLC USNMH0805101
TEXAS TYPE 2 DIABETES REPORT 2008
MANAGED CARE DIGEST SERIES
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Source:dfwbgh.org
