Reducing Health Disparities in Persons with Mental Illness by Engaging Patients, Peers
Mobile Technology and Implementation Science
Steve Bartels, MD, MS Herman O. West Professor of Geriatrics, Professor of
Psychiatry and Community & Family Medicine Director, Dartmouth Centers for Health and Aging
Disclosures • Grant Funding:
– NIMH – CDC – HRSA – AHRQ – CMS
• Consultant:
– Substance Abuse and Mental Health Administration – National Council of Behavioral Health Care
Overview
• Serious mental illness as a health disparity • Serious mental illness as a high cost health
condition • The failure of conventional treatment to reduce
early mortality and costs • The challenge of implementation • The promise and potential of peers and technology
Serious Mental Illness: The Nation’s Greatest Hidden
Health Disparity?
The Epidemic of Premature Death in Middle-aged Persons with Mental Illness
For people with major mental illness: The average life expectancy is 53 yrs.
“50 is the New 75”
The average life expectancy in the US has steadily increased to 77.9 years (increasing by almost 5 years since the 90s alone) At the same time……….
The Hidden Health Disparity of Early Mortality for Patients with Major Mental Illness
Mean Years of Potential Life Lost
Year AZ MO OK RI TX UT
1997 26.3 25.1 28.5
1998 27.3 25.1 28.8 29.3
1999 32.2 26.8 26.3 29.3 26.9
2000 31.8 27.9 24.9
Compared with the general population, persons with major mental illness lose 25-30 years of normal life span
Colton CW, Manderscheid RW. Prev Chronic Dis [serial online] 2006 Apr [date cited]. Available at: URL:http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm
Cardiovascular Disease Is Primary Cause of Death in Persons with Mental Illness*
*Average data from 1996-2000. Colton CW, Manderscheid RW. Prev Chronic Dis [serial online] 2006 Apr [date cited]. Available at URL: http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm
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MOMOMOMOMOMOMOMO
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RIRIRIRIRIRIRIRI
TXTXTXTXTXTXTXTX
UTUTUTUTUTUTUTUT
VAVAVAVAVAVAVAVA
Heart Disease
Cancer
Cerebrovascular
Chronic Respiratory
Accidents
Diabetes
Influenza/Pneumonia
Suicide
30
12
4.5
6
5
4.5
4
10
34
10
6
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2.5
4.5
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25
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Sheet1
Heart DiseaseCancerCerebrovascularChronic RespiratoryAccidentsDiabetesInfluenza/PneumoniaSuicide
MO30124.5654.5410
OK34106482.54.510
RI25161084456
TX271055.5115311
UT20665105415
VA453210.50140
• 203 studies including 29 countries over six continents
• mental health disorders 2.22 times higher mortality risk compared to general population or people w/o mental illness.
• average of 10 years of potential life lost • Medical causes 2/3 (67.3%) of deaths,
17.5% “unnatural causes; remaining unknown.
Cardiovascular Disease (CVD) Risk Factors and Major Mental Illness
A Paradigm for High Complexity and Risk
Vancamfort et al., 2013: Meta-analysis of 136 studies
Modifiable Risk Factors Serious Mental Illness
Prevalence Compared to General Population
Abdominal Obesity 4.4 X
Smoking 3-4X
Diabetes 2X
Hypertension 1.4 X
Metabolic Syndrome 2.4X
Hyperlipidemia 2.7X
Factors Contributing to Longevity vs. Premature Death in the General Population
40%
30%
15%
10% 5%
Source: N Engl J Med. 2007 Sep 20;357(12):1221-8.
Chart1
Health Behaviors
Genetic Predisposition
Social Determinants
Environmental Exposure
Health Care
Sales
0.4
0.3
0.15
0.05
0.1
Sheet1
Sales
Health Behaviors40%
Genetic Predisposition30%
Social Determinants15%
Environmental Exposure5%
Health Care10%
To update the chart, enter data into this table. The data is automatically saved in the chart.
The 2007 National “10 By 10” National Campaign
Aim: To Increase the Life Expectancy of People with Mental Illness by 10 Years in 10 Years SAMHSA, HRSA, CDC, Healthy People 2020, and Numerous Organizations and Advocacy Groups A Decade Later there has been no change in life expectancy
Health Care Costs of Mental Illness
• Mental illness and substance abuse account for 29% of all hospital days and 22% of hospital costs in the US.
• Direct cost of care for mental illness estimated at $100 billion per year, indirect costs estimated at an additional $193 billion.
• Hospitalization and emergency service costs (>25%) account for much of the excess in health care costs for people with SMI.
Co-Morbid Mental Illness also Doubles or Triples Health Care Costs
Bartels, Clark et al, 2003
Medical Costs 2-3 x Greater for Beneficiaries with Co-morbid mental Health or substance Use Disorders = $293 Billion in US Effective integrated Care estimated to result in savings of 9-16%
Milliman Report, Economic Impact of integrated medical-behavioral health care, 2014
$0
$10,000
$20,000
$30,000
$40,000
$50,000
19 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85+
Schizophrenia Depression Dementia Medical Diagnoses Only
$0
$10,000
$20,000
$30,000
$40,000
$50,000
19 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 to 84 85+
Schizophrenia Depression Dementia Medical Diagnoses Only
_1300599516.xls
Chart4
19 to 3419 to 3419 to 3419 to 34
35 to 4435 to 4435 to 4435 to 44
45 to 5445 to 5445 to 5445 to 54
55 to 6455 to 6455 to 6455 to 64
65 to 7465 to 7465 to 7465 to 74
75 to 8475 to 8475 to 8475 to 84
85+85+85+85+
Schizophrenia
Depression
Dementia
Medical Diagnoses Only
24566.0662921348
15596.5740340909
9052.0657711443
26025.9595859213
19950.8740944882
14449.7655
30026.875753012
19258.5632368421
45744.24
12973.3059504132
34646.872125
23892.382972973
44001.4315151515
13610.6818699187
39153.8775555556
27850.0210793651
39586.7133742331
10897.6294650952
40995.6021505376
32030.3488888889
33978.3776382661
15715.8237293087
48921.110952381
33933.1798230088
33111.0779906103
23072.6042894057
KSINK Graphs
SchizophreniaMajor DepressionAlzheimer'sAll Other Non-Psych DiagnosesSchizophreniaMajor DepressionAlzheimer'sMedical Diagnoses OnlySchizophreniaMajor DepressionAlzheimer'sMedical Diagnoses Only
Total InpatientTotal OutpatientTotal PhysicianTotal Nursing HomeTotal Home HealthTotal DrugTotal Other CostsTotal MedicareTotal MedicaidTotal Costs19 to 3417817620119 to 34$24,566.07$15,596.57$9,052.0719 to 340.00%0.57%2.99%
19 to 34Schizophrenia$3,955.98$11,142.71$1,362.23$0.00$3,586.92$4,480.02$38.2135 to 4448338130035 to 44$26,025.96$19,950.87$14,449.7735 to 441.24%2.62%3.67%
Major Depression$4,237.02$4,692.98$1,899.34$307.01$1,398.36$2,810.86$251.0245 to 543323801236345 to 54$30,026.88$19,258.56$45,744.24$12,973.3145 to 540.90%5.00%58.33%7.99%
Alzheimer's55 to 641602593349255 to 64$34,646.87$23,892.38$44,001.43$13,610.6855 to 649.38%13.51%72.73%9.96%
All Other Non-Psych Diagnoses$1,318.31$1,564.26$768.19$1,385.68$2,003.07$1,479.86$532.69$3,120.32$5,931.75$9,052.0765 to 741353151631,10365 to 74$39,153.88$27,850.02$39,586.71$10,897.6365 to 7440.00%32.38%93.87%14.14%
35 to 44Schizophrenia$3,591.99$10,667.57$1,535.96$434.98$4,399.87$5,352.89$42.7075 to 84933696691,02775 to 84$40,995.60$32,030.35$33,978.38$15,715.8275 to 8476.34%65.85%93.27%32.23%
Major Depression$5,084.94$4,498.75$2,389.33$918.73$2,850.42$3,961.19$247.5185+423391,06577485+$48,921.11$33,933.18$33,111.08$23,072.6085+95.24%89.09%98.59%67.96%
Alzheimer's
All Other Non-Psych Diagnoses$2,303.13$2,217.13$1,107.08$704.94$4,909.19$2,421.30$787.00$5,667.37$8,782.39$14,449.77
45 to 54Schizophrenia$3,354.72$12,242.48$1,436.49$356.72$7,322.65$5,233.92$79.90
Major Depression$4,468.48$4,121.66$2,268.75$1,791.32$2,173.61$4,060.84$373.89
Alzheimer's$5,328.48$4,773.27$2,370.63$16,880.03$12,690.70$2,724.91$976.22$10,630.15$35,114.09$45,744.24
All Other Non-Psych Diagnoses$2,786.38$1,741.27$1,169.75$2,462.46$2,299.72$2,158.51$355.22$5,514.76$7,458.55$12,973.31
55 to 64Schizophrenia$3,896.87$12,894.85$1,682.01$4,041.64$7,656.54$4,416.99$57.98
Major Depression$5,971.03$4,372.34$2,729.57$3,907.00$2,910.11$3,588.97$413.38
Alzheimer's$5,070.66$4,585.98$1,538.26$20,177.54$9,868.66$2,603.02$157.31$7,497.63$36,503.80$44,001.43
All Other Non-Psych Diagnoses$3,209.87$2,078.66$1,410.38$1,713.63$2,547.16$2,291.09$359.89$6,505.09$7,105.59$13,610.68
65 to 74Schizophrenia$6,390.05$7,583.66$1,565.87$16,273.23$3,699.80$3,571.45$69.82
Major Depression$6,363.75$2,875.37$2,452.58$8,749.52$3,573.84$3,261.38$573.58
Alzheimer's$5,565.00$1,062.80$1,657.13$27,192.72$1,376.70$2,378.12$354.25$10,082.18$29,504.53$39,586.71
All Other Non-Psych Diagnoses$2,398.52$1,215.02$1,154.49$2,828.97$1,406.51$1,642.42$251.71$5,038.66$5,858.97$10,897.63
75 to 84Schizophrenia$4,696.77$2,473.44$1,334.68$27,842.46$1,724.98$2,792.27$131.00
Major Depression$6,058.55$1,489.29$2,038.40$17,524.19$1,679.50$2,773.13$467.28
Alzheimer's$3,256.95$936.22$1,307.83$25,341.83$741.30$2,079.81$314.45$6,973.57$27,004.81$33,978.38
All Other Non-Psych Diagnoses$3,150.54$1,229.60$1,419.27$6,277.56$1,644.93$1,685.86$308.06$6,571.40$9,144.42$15,715.82
85 +Schizophrenia$8,817.75$1,459.44$2,054.54$32,806.26$1,217.84$2,356.30$208.98
Major Depression$2,608.29$1,030.13$1,468.56$24,676.21$1,018.38$2,668.18$463.43
Alzheimer's$2,194.01$576.86$1,048.86$27,125.32$195.53$1,707.56$262.93$5,335.94$27,775.13$33,111.08
All Other Non-Psych Diagnoses$1,843.53$788.93$1,048.65$16,012.15$1,430.40$1,651.67$297.26$4,866.88$18,205.72$23,072.60
KSINK Graphs
Total Inpatient
Total Outpatient
Total Physician
Total Nursing Home
Total Home Health
Total Drug
Total Other Costs
Total Costs: 1999
MEDICARE MEDICAID GRAPHS
Schizophrenia
Major Depression
Alzheimer's
Medical Diagnoses Only
Figure 1: 1999 Per Member Per Year Costs of Dual Eligible People
Schizophrenia
Schizophrenia
Major Depression
Alzheimer's
All Other Non-Psych Diagnoses
1999 Number of Dual Eligible People
Major Depression Costs
Schizophrenia
Major Depression
Alzheimer's
Medical Diagnoses Only
Figure 3: Proportion of Duals in Nursing Homes
ALZHEIMERS
SchizophreniaMajor DepressionCardiovascular
Total MedicareTotal MedicaidTotal MedicareTotal MedicaidTotal MedicareTotal Medicaid
19 to 34Schizophrenia$5,257.80$19,308.26$24,566.07
Major Depression$6,879.19$8,717.39$15,596.57
Alzheimer's
All Other Non-Psych Diagnoses$3,120.32$5,931.75$9,052.07
35 to 44Schizophrenia$5,680.88$20,345.08$26,025.96
Major Depression$8,405.12$11,545.76$19,950.87
Alzheimer's
All Other Non-Psych Diagnoses$5,667.37$8,782.39$14,449.77
45 to 54Schizophrenia$5,110.57$24,916.30$30,026.88
Major Depression$8,425.80$10,832.76$19,258.56
Alzheimer's$10,630.15$35,114.09$45,744.24
All Other Non-Psych Diagnoses$5,514.76$7,458.55$12,973.31
55 to 64Schizophrenia$6,504.98$28,141.89$34,646.87
Major Depression$11,356.08$12,536.30$23,892.38
Alzheimer's$7,497.63$36,503.80$44,001.43
All Other Non-Psych Diagnoses$6,505.09$7,105.59$13,610.68
65 to 74Schizophrenia$8,256.01$30,897.87$39,153.88
Major Depression$12,961.43$14,888.59$27,850.02
Alzheimer's$10,082.18$29,504.53$39,586.71
All Other Non-Psych Diagnoses$5,038.66$5,858.97$10,897.63
75 to 84Schizophrenia$7,526.76$33,468.84$40,995.60
Major Depression$12,181.93$19,848.42$32,030.35
Alzheimer's$6,973.57$27,004.81$33,978.38
All Other Non-Psych Diagnoses$6,571.40$9,144.42$15,715.82
85+Schizophrenia$12,716.34$36,204.77$48,921.11
Major Depression$7,311.99$26,621.19$33,933.18
Alzheimer's$5,335.94$27,775.13$33,111.08
All Other Non-Psych Diagnoses$4,866.88$18,205.72$23,072.60
ALZHEIMERS
Total Medicare
Total Medicaid
Total Costs:1999
All Other Diagnoses
Total Medicare
Total Medicaid
Percentage of Total Costs:1999
Cardio Costs
1999 SCHIZOPHRENIA DUAL COSTS1999 SCHIZOPHRENIA DUAL COSTS1999 SCHIZOPHRENIA DUAL COSTS1999 SCHIZOPHRENIA DUAL COSTS
85+Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$343.32$8,474.43$8,817.75$963.96$495.48$1,459.44$88.75$1,965.78$2,054.54$31,996.36$809.90$32,806.26$456.07$761.76$1,217.84$2,126.07$230.24$2,356.30$56.42$152.56$0.00$0.00$208.98$12,716.34$36,204.77$48,921.11
Number of People4242424242424242424242424242424242424242424242424242
Total Cost per Category$14,419.60$355,925.98$370,345.58$40,486.13$20,810.29$61,296.42$3,727.62$82,562.90$86,290.52$1,343,847.10$34,015.89$1,377,862.99$19,155.14$31,993.96$51,149.10$89,294.78$9,670.00$98,964.78$2,369.68$6,407.59$0.00$0.00$8,777.27$534,086.29$1,520,600.37$2,054,686.66
$8,817.75$370,345.58$1,459.44$61,296.42$2,054.54$86,290.52$32,806.26$1,377,862.99$1,217.84$51,149.10$2,356.30$98,964.78$208.98$8,777.27$12,716.34$36,204.77$48,921.11
Number of Non-Zero People111818323740364141406403934042424271008424242
Non-Zero PMPY$1,310.87$19,773.67$20,574.75$1,265.19$562.44$1,532.41$103.55$2,013.73$2,104.65$33,596.18$5,669.32$34,446.57$491.16$10,664.65$1,278.73$2,126.07$230.24$2,356.30$338.53$6,407.59$0.00$0.00$1,097.16$12,716.34$36,204.77$48,921.11
75 to 84Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$134.52$4,562.26$4,696.77$2,111.60$361.84$2,473.44$73.89$1,260.79$1,334.68$26,768.19$1,074.26$27,842.46$1,588.24$136.74$1,724.98$2,574.31$217.96$2,792.27$125.20$5.67$0.13$0.00$131.00$7,526.76$33,468.84$40,995.60
Number of People9393939393939393939393939393939393939393939393939393
Total Cost per Category$12,510.00$424,289.96$436,799.96$196,378.85$33,651.23$230,030.08$6,871.54$117,253.74$124,125.28$2,489,441.95$99,906.51$2,589,348.46$147,706.71$12,716.76$160,423.47$239,411.07$20,270.00$259,681.07$11,643.56$527.12$12.00$0.00$12,182.68$699,988.88$3,112,602.12$3,812,591.00
$4,696.77$436,799.96$2,473.44$230,030.08$1,334.68$124,125.28$27,842.46$2,589,348.46$1,724.98$160,423.47$2,792.27$259,681.07$131.00$12,182.68$7,526.76$33,468.84$40,995.60
Number of Non-Zero People182929787089809292711173878888888881411016939393
Non-Zero PMPY$695.00$14,630.69$15,062.07$2,517.68$480.73$2,584.61$85.89$1,274.50$1,349.19$35,062.56$9,082.41$35,470.53$1,697.78$1,589.60$1,822.99$2,720.58$230.34$2,950.92$831.68$527.12$12.00$0.00$761.42$7,526.76$33,468.84$40,995.60
65 to 74Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$1,128.89$5,261.16$6,390.05$6,797.21$786.45$7,583.66$131.73$1,434.13$1,565.87$15,689.00$584.23$16,273.23$3,577.50$122.31$3,699.80$3,343.80$227.65$3,571.45$60.60$7.14$2.08$0.00$69.82$8,256.01$30,897.87$39,153.88
Number of People135135135135135135135135135135135135135135135135135135135135135135135135135135
Total Cost per Category$152,400.20$710,256.70$862,656.90$917,623.35$106,170.67$1,023,794.02$17,784.09$193,607.95$211,392.04$2,118,015.34$78,870.43$2,196,885.77$482,962.14$16,511.24$499,473.38$451,413.41$30,732.50$482,145.91$8,180.60$963.85$281.00$0.00$9,425.45$1,114,561.44$4,171,212.03$5,285,773.47
$6,390.05$862,656.90$7,583.66$1,023,794.02$1,565.87$211,392.04$16,273.23$2,196,885.77$3,699.80$499,473.38$3,571.45$482,145.91$69.82$9,425.45$8,256.01$30,897.87$39,153.88
Number of Non-Zero People355456128101132118135135541256132121321281281281814022135135135
Non-Zero PMPY$4,354.29$13,152.90$15,404.59$7,168.93$1,051.19$11,414.82$150.71$1,434.13$1,565.87$39,222.51$6,572.54$39,230.10$3,658.80$1,375.94$3,783.89$3,526.67$240.10$3,766.76$454.48$963.85$70.25$0.00$428.43$8,256.01$30,897.87$39,153.88
55 to 64Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$158.03$3,738.84$3,896.87$12,395.94$498.90$12,894.85$94.39$1,587.61$1,682.01$3,514.37$527.27$4,041.64$7,547.58$108.97$7,656.54$4,221.32$195.67$4,416.99$43.39$0.00$14.59$0.00$57.98$6,504.98$28,141.89$34,646.87
Number of People160160160160160160160160160160160160160160160160160160160160160160160160160160
Total Cost per Category$25,284.34$598,214.61$623,498.95$1,983,350.95$79,824.25$2,063,175.20$15,103.17$254,018.29$269,121.46$562,299.62$84,362.81$646,662.43$1,207,612.18$17,434.58$1,225,046.76$675,410.77$31,307.50$706,718.27$6,942.52$0.00$2,333.95$0.00$9,276.47$1,040,797.06$4,502,702.48$5,543,499.54
$3,896.87$623,498.95$12,894.85$2,063,175.20$1,682.01$269,121.46$4,041.64$646,662.43$7,656.54$1,225,046.76$4,416.99$706,718.27$57.98$9,276.47$6,504.98$28,141.89$34,646.87
Number of Non-Zero People2247481571241591391601601511211601616015715715718016034160160160
Non-Zero PMPY$1,149.29$12,727.97$12,989.56$12,632.81$643.74$20,570.99$108.66$1,587.61$1,682.01$37,486.64$7,669.35$30,793.45$7,547.58$1,089.66$7,656.54$4,301.98$199.41$4,501.39$385.70$145.87$272.84$6,504.98$28,141.89$34,646.87
$6,504.98$28,141.89$34,646.87
45 to 54Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$192.79$3,161.94$3,354.72$11,800.75$441.73$12,242.48$61.55$1,374.94$1,436.49$333.02$23.70$356.72$7,284.16$38.49$7,322.65$5,060.15$173.77$5,233.92$69.78$0.00$10.12$0.00$79.90$5,110.57$24,916.30$30,026.88
Number of People332332332332332332332332332332332332332332332332332332332332332332332332332332
Total Cost per Category$64,005.07$1,049,762.78$1,113,767.85$3,917,850.12$146,653.54$4,064,503.66$20,435.58$456,480.50$476,916.08$110,562.00$7,868.41$118,430.41$2,418,341.03$12,777.37$2,431,118.40$1,679,970.30$57,690.00$1,737,660.30$23,167.05$0.00$3,359.00$0.00$26,526.05$1,696,709.65$8,272,213.10$9,968,922.75
$3,354.72$1,113,767.85$12,242.48$4,064,503.66$1,436.49$476,916.08$356.72$118,430.41$7,322.65$2,431,118.40$5,233.92$1,737,660.30$79.90$26,526.05$5,110.57$24,916.30$30,026.88
Number of Non-Zero People601011053292513322713313323473311533131831831835028059332332332
Non-Zero PMPY$1,066.75$10,393.69$10,607.31$11,908.36$584.28$19,526.64$75.41$1,379.10$1,436.49$36,854.00$1,967.10$16,918.63$7,306.17$851.82$7,344.77$5,282.93$181.42$5,464.34$661.92$0.00$119.96$0.00$449.59$5,110.57$24,916.30$30,026.88
35 to 44Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$198.74$3,393.24$3,591.99$10,005.51$662.06$10,667.57$92.74$1,443.21$1,535.96$328.97$106.01$434.98$4,342.55$57.31$4,399.87$5,195.05$157.84$5,352.89$19.04$0.00$23.66$0.00$42.70$5,680.88$20,345.08$26,025.96
Number of People483483483483483483483483483483483483483483483483483483483483483483483483483483
Total Cost per Category$95,992.67$1,638,936.53$1,734,929.20$4,832,661.02$319,776.13$5,152,437.15$44,794.59$697,072.39$741,866.98$158,893.50$51,202.32$210,095.82$2,097,452.62$27,682.25$2,125,134.87$2,509,210.59$76,237.50$2,585,448.09$9,197.37$0.00$11,429.00$0.00$20,626.37$2,743,866.99$9,826,671.49$12,570,538.48
$3,591.99$1,734,929.20$10,667.57$5,152,437.15$1,535.96$741,866.98$434.98$210,095.82$4,399.87$2,125,134.87$5,352.89$2,585,448.09$42.70$20,626.37$5,680.88$20,345.08$26,025.96
Number of Non-Zero People76138139475373479376477479671048215482470470470440660104483483483
Non-Zero PMPY$1,263.06$11,876.35$12,481.51$10,174.02$857.31$15,135.47$119.13$1,461.37$1,548.78$26,482.25$7,314.62$21,009.58$4,351.56$1,845.48$4,408.99$5,338.75$162.21$5,500.95$209.03$0.00$173.17$0.00$198.33$5,680.88$20,345.08$26,025.96
$5,680.88$20,345.08$26,025.96
19 to 34Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$326.04$3,629.94$3,955.98$10,818.22$324.49$11,142.71$74.53$1,287.70$1,362.23$0.00$0.00$0.00$3,586.92$0.00$3,586.92$4,353.29$126.73$4,480.02$15.68$0.00$20.26$2.27$38.21$5,257.80$19,308.26$24,566.07
Number of People178178178178178178178178178178178178178178178178178178178178178178178178178178
Total Cost per Category$58,035.83$646,128.73$704,164.56$1,925,642.54$57,759.76$1,983,402.30$13,266.73$229,210.04$242,476.77$0.00$0.00$0.00$638,471.31$0.00$638,471.31$774,885.73$22,557.50$797,443.23$2,790.75$0.00$3,606.00$404.88$6,801.63$935,889.28$3,436,870.52$4,372,759.80
$3,955.98$704,164.56$11,142.71$1,983,402.30$1,362.23$242,476.77$0.00$0.00$3,586.92$638,471.31$4,480.02$797,443.23$38.21$6,801.63$5,257.80$19,308.26$24,566.07
Number of Non-Zero People196061177145178124174175000177017717117117113020133178178178
Non-Zero PMPY$3,054.52$10,768.81$11,543.68$10,879.34$398.34$14,729.63$106.99$1,317.30$1,385.58$0.00$0.00$0.00$3,607.18$0.00$3,607.18$4,531.50$131.92$4,663.41$214.67$0.00$180.30$404.88$206.11$5,257.80$19,308.26$24,566.07
$5,257.80$19,308.26$24,566.07
WS KSINK
1999 MAJOR DEPRESSION DUAL COSTS1999 MAJOR DEPRESSION DUAL COSTS1999 MAJOR DEPRESSION DUAL COSTS1999 MAJOR DEPRESSION DUAL COSTS
85+Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$70.36$2,537.93$2,608.29$484.64$545.49$1,030.13$53.38$1,415.18$1,468.56$22,750.13$1,926.08$24,676.21$594.01$424.37$1,018.38$2,426.04$242.15$2,668.18$107.56$355.38$0.50$0.00$463.43$7,311.99$26,621.19$33,933.18
Number of People339339339339339339339339339339339339339339339339339339339339339339339339339339
Total Cost per Category$23,852.41$860,358.08$884,210.49$164,293.07$184,921.08$349,214.15$18,094.70$479,746.02$497,840.72$7,712,292.66$652,941.79$8,365,234.45$201,367.88$143,862.32$345,230.20$822,426.19$82,087.50$904,513.69$36,462.33$120,473.93$168.00$0.00$157,104.26$2,478,765.55$9,024,582.41$11,503,347.96
$2,608.29$884,210.49$1,030.13$349,214.15$1,468.56$497,840.72$24,676.21$8,365,234.45$1,018.38$345,230.20$2,668.18$904,513.69$463.43$157,104.26$7,311.99$26,621.19$33,933.18
Number of Non-Zero People329899227271315217337337302743152684928232932932959162072339339339
Non-Zero PMPY$745.39$8,779.16$8,931.42$723.76$682.37$1,747.88$83.39$1,423.58$1,477.27$25,537.39$8,823.54$26,556.30$751.37$2,935.97$1,224.22$2,499.78$249.51$2,749.28$618.01$7,529.62$84.00$0.00$2,182.00$7,311.99$26,621.19$33,933.18
75 to 84Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$191.49$5,867.06$6,058.55$695.08$794.21$1,489.29$104.29$1,934.10$2,038.40$15,053.99$2,470.21$17,524.19$1,028.82$650.68$1,679.50$2,559.66$213.47$2,773.13$215.37$250.30$1.62$0.00$467.28$12,181.93$19,848.42$32,030.35
Number of People369369369369369369369369369369369369369369369369369369369369369369369369369369
Total Cost per Category$70,660.69$2,164,945.99$2,235,606.68$256,483.71$293,064.61$549,548.32$38,484.84$713,683.11$752,167.95$5,554,920.55$911,506.18$6,466,426.73$379,636.11$240,100.94$619,737.05$944,515.45$78,770.00$1,023,285.45$79,471.37$92,359.19$596.00$0.00$172,426.56$4,495,131.39$7,324,067.35$11,819,198.74
$6,058.55$2,235,606.68$1,489.29$549,548.32$2,038.40$752,167.95$17,524.19$6,466,426.73$1,679.50$619,737.05$2,773.13$1,023,285.45$467.28$172,426.56$12,181.93$19,848.42$32,030.35
Number of Non-Zero People6114815029631935126636936924396270333843433373373371261140135369369369
Non-Zero PMPY$1,158.37$14,628.01$14,904.04$866.50$918.70$2,647.25$144.68$1,934.10$2,038.40$22,859.76$9,494.86$23,949.73$1,140.05$2,858.34$1,806.81$2,802.72$233.74$3,036.46$630.73$8,396.29$149.00$1,277.23$12,181.93$19,848.42$32,030.35
65 to 74Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$321.86$6,041.90$6,363.75$1,806.92$1,068.45$2,875.37$158.05$2,294.53$2,452.58$7,061.14$1,688.38$8,749.52$2,274.45$1,299.39$3,573.84$3,053.02$208.36$3,261.38$494.39$74.40$4.79$0.00$573.58$12,961.43$14,888.59$27,850.02
Number of People315315315315315315315315315315315315315315315315315315315315315315315315315315
Total Cost per Category$101,385.79$1,903,197.00$2,004,582.79$569,180.36$336,560.64$905,741.00$49,784.74$722,777.52$772,562.26$2,224,258.19$531,840.54$2,756,098.73$716,452.13$409,306.52$1,125,758.65$961,702.05$65,632.50$1,027,334.55$155,732.53$23,436.13$1,510.00$0.00$180,678.66$4,082,850.88$4,689,905.76$8,772,756.64
$6,363.75$2,004,582.79$2,875.37$905,741.00$2,452.58$772,562.26$8,749.52$2,756,098.73$3,573.84$1,125,758.65$3,261.38$1,027,334.55$573.58$180,678.66$12,961.43$14,888.59$27,850.02
Number of Non-Zero People9714715027927030327631331510270130300107305299299299143360149315315315
Non-Zero PMPY$1,045.21$12,946.92$13,363.89$2,040.07$1,246.52$5,353.77$180.38$2,309.19$2,452.58$21,806.45$7,597.72$21,200.76$2,388.17$3,825.29$3,691.01$3,216.39$219.51$3,435.90$1,089.04$7,812.04$251.67$1,212.61$12,961.43$14,888.59$27,850.02
55 to 64Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$262.69$5,708.34$5,971.03$3,213.99$1,158.35$4,372.34$226.25$2,503.32$2,729.57$3,043.75$863.25$3,907.00$2,190.27$719.84$2,910.11$3,391.41$197.56$3,588.97$394.73$8.26$10.38$0.00$413.38$11,356.08$12,536.30$23,892.38
Number of People259259259259259259259259259259259259259259259259259259259259259259259259259259
Total Cost per Category$68,037.29$1,478,458.77$1,546,496.06$832,424.10$300,011.81$1,132,435.91$58,598.29$648,359.97$706,958.26$788,331.43$223,581.46$1,011,912.89$567,279.99$186,437.63$753,717.62$878,374.61$51,167.50$929,542.11$102,236.02$2,140.32$2,688.00$0.00$107,064.34$2,941,225.98$3,246,901.21$6,188,127.19
$5,971.03$1,546,496.06$4,372.34$1,132,435.91$2,729.57$706,958.26$3,907.00$1,011,912.89$2,910.11$753,717.62$3,588.97$929,542.11$413.38$107,064.34$11,356.08$12,536.30$23,892.38
Number of Non-Zero People669510024523125524425925935234525656256245245245971150107259259259
Non-Zero PMPY$1,030.87$15,562.72$15,464.96$3,397.65$1,298.75$6,665.55$240.16$2,503.32$2,729.57$22,523.76$9,720.93$22,486.95$2,215.94$3,329.24$2,944.21$3,585.20$208.85$3,794.05$1,053.98$2,140.32$179.20$1,000.60$11,356.08$12,536.30$23,892.38
$11,356.08$12,536.30$23,892.38
45 to 54Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$278.89$4,189.60$4,468.48$3,121.27$1,000.39$4,121.66$186.20$2,082.55$2,268.75$1,474.36$316.96$1,791.32$1,694.08$479.53$2,173.61$3,875.58$185.26$4,060.84$285.04$71.75$17.11$0.00$373.89$8,425.80$10,832.76$19,258.56
Number of People380380380380380380380380380380380380380380380380380380380380380380380380380380
Total Cost per Category$105,976.39$1,592,047.27$1,698,023.66$1,186,084.22$380,147.96$1,566,232.18$70,756.66$791,369.03$862,125.69$560,257.98$120,444.07$680,702.05$643,752.13$182,220.13$825,972.26$1,472,720.72$70,397.50$1,543,118.22$108,313.35$27,263.62$6,503.00$0.00$142,079.97$3,201,805.43$4,116,448.60$7,318,254.03
$4,468.48$1,698,023.66$4,121.66$1,566,232.18$2,268.75$862,125.69$1,791.32$680,702.05$2,173.61$825,972.26$4,060.84$1,543,118.22$373.89$142,079.97$8,425.80$10,832.76$19,258.56
Number of Non-Zero People71128134368346377346379380191932376553763583573581333320152380380380
Non-Zero PMPY$1,492.63$12,437.87$12,671.82$3,223.05$1,098.69$5,862.03$204.50$2,088.04$2,268.75$29,487.26$6,339.16$21,271.94$1,712.11$3,313.09$2,196.73$4,113.75$197.19$4,310.39$814.39$9,087.87$203.22$934.74$8,425.80$10,832.76$19,258.56
35 to 44Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$353.62$4,731.33$5,084.94$3,580.20$918.55$4,498.75$348.31$2,041.02$2,389.33$844.25$74.47$918.73$2,434.07$416.35$2,850.42$3,810.73$150.47$3,961.19$223.40$0.00$19.86$4.25$247.51$8,405.12$11,545.76$19,950.87
Number of People381381381381381381381381381381381381381381381381381381381381381381381381381381
Total Cost per Category$134,728.55$1,802,635.41$1,937,363.96$1,364,056.60$349,966.02$1,714,022.62$132,705.91$777,629.55$910,335.46$321,660.33$28,374.47$350,034.80$927,381.17$158,629.77$1,086,010.94$1,451,887.51$57,327.50$1,509,215.01$85,114.72$0.00$7,566.00$1,619.52$94,300.24$3,202,349.94$4,398,933.09$7,601,283.03
$5,084.94$1,937,363.96$4,498.75$1,714,022.62$2,389.33$910,335.46$918.73$350,034.80$2,850.42$1,086,010.94$3,961.19$1,509,215.01$247.51$94,300.24$8,405.12$11,545.76$19,950.87
Number of Non-Zero People901421473643253733383753781061437838378359359359880471128381381381
Non-Zero PMPY$1,496.98$12,694.62$13,179.35$3,747.41$1,076.82$7,081.51$392.62$2,073.68$2,408.29$32,166.03$4,729.08$25,002.49$2,453.39$4,174.47$2,873.04$4,044.25$159.69$4,203.94$967.21$160.98$1,619.52$736.72$8,405.12$11,545.76$19,950.87
19 to 34Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$591.88$3,645.14$4,237.02$3,924.10$768.89$4,692.98$261.05$1,638.28$1,899.34$0.19$306.82$307.01$1,064.51$333.85$1,398.36$2,692.35$118.51$2,810.86$186.21$0.00$60.16$4.65$251.02$6,879.19$8,717.39$15,596.57
Number of People176176176176176176176176176176176176176176176176176176176176176176176176176176
Total Cost per Category$104,170.00$641,544.79$745,714.79$690,641.05$135,323.92$825,964.97$45,945.03$288,337.94$334,282.97$33.27$53,999.73$54,033.00$187,353.11$58,757.40$246,110.51$473,854.27$20,857.50$494,711.77$32,773.16$0.00$10,588.00$817.86$44,179.02$1,210,736.94$1,534,260.09$2,744,997.03
$4,237.02$745,714.79$4,692.98$825,964.97$1,899.34$334,282.97$307.01$54,033.00$1,398.36$246,110.51$2,810.86$494,711.77$251.02$44,179.02$6,879.19$8,717.39$15,596.57
Number of Non-Zero People4965701681401741541751761231751117516416416430032158176176176
Non-Zero PMPY$2,125.92$9,869.92$10,653.07$4,110.96$966.60$5,823.67$298.34$1,647.65$1,899.34$33.27$26,999.87$18,011.00$1,070.59$5,341.58$1,406.35$2,889.36$127.18$3,016.54$1,092.44$330.88$817.86$761.71$6,879.19$8,717.39$15,596.57
Graphs
1999 ALTZHEIMER'S DUAL COSTS1999 ALTZHEIMER'S DUAL COSTS1999 ALTZHEIMER'S DUAL COSTS1999 ALTZHEIMER'S DUAL COSTS
85+Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$70.38$2,123.63$2,194.01$218.27$358.59$576.86$43.56$1,005.30$1,048.86$25,626.29$1,499.03$27,125.32$108.44$87.09$195.53$1,539.16$168.41$1,707.56$19.68$242.62$0.63$0.00$262.93$5,335.94$27,775.13$33,111.08
Number of People1,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,0651,065
Total Cost per Category$74,957.88$2,261,667.52$2,336,625.40$232,458.40$381,899.15$614,357.55$46,392.81$1,070,645.29$1,117,038.10$27,292,001.38$1,596,462.44$28,888,463.82$115,486.18$92,750.40$208,236.58$1,639,201.08$179,355.00$1,818,556.08$20,964.41$258,390.12$666.00$0.00$280,020.53$5,682,779.33$29,580,518.73$35,263,298.06
$2,194.01$2,336,625.40$576.86$614,357.55$1,048.86$1,117,038.10$27,125.32$28,888,463.82$195.53$208,236.58$1,707.56$1,818,556.08$262.93$280,020.53$5,335.94$27,775.13$33,111.08
Number of Non-Zero People922672676208169336801,0501,0521,0431741,050835498531,0341,0341,0347934201111,0651,0651,065
Non-Zero PMPY$814.76$8,470.66$8,751.41$374.93$468.01$782.25$68.22$1,019.66$1,061.82$26,166.83$9,175.07$27,512.82$138.31$1,892.87$244.12$1,585.30$173.46$1,758.76$265.37$7,599.71$333.00$2,522.71$5,335.94$27,775.13$33,111.08
75 to 84Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$95.53$3,161.42$3,256.95$405.17$531.05$936.22$60.61$1,247.22$1,307.83$23,812.89$1,528.94$25,341.83$549.87$191.43$741.30$1,898.34$181.47$2,079.81$84.26$229.24$0.94$0.00$314.45$6,973.57$27,004.81$33,978.38
Number of People669669669669669669669669669669669669669669669669669669669669669669669669669669
Total Cost per Category$63,908.56$2,114,990.85$2,178,899.41$271,060.33$355,272.67$626,333.00$40,546.76$834,390.40$874,937.16$15,930,822.15$1,022,860.37$16,953,682.52$367,862.41$128,064.56$495,926.97$1,269,987.68$121,402.50$1,391,390.18$56,371.63$153,364.77$629.00$0.00$210,365.40$4,665,315.25$18,066,219.39$22,731,534.64
$3,256.95$2,178,899.41$936.22$626,333.00$1,307.83$874,937.16$25,341.83$16,953,682.52$741.30$495,926.97$2,079.81$1,391,390.18$314.45$210,365.40$6,973.57$27,004.81$33,978.38
Number of Non-Zero People7122222342152959843066166261512862454375558651651651892630113669669669
Non-Zero PMPY$900.12$9,526.99$9,770.85$643.85$671.59$1,662.53$94.29$1,262.32$1,321.66$25,903.78$7,991.10$27,169.36$677.46$1,707.53$888.76$1,950.83$186.49$2,137.31$633.39$5,898.65$209.67$1,861.64$6,973.57$27,004.81$33,978.38
65 to 74Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$154.90$5,410.11$5,565.00$594.01$468.78$1,062.80$67.56$1,589.56$1,657.13$25,132.05$2,060.67$27,192.72$1,177.89$198.80$1,376.70$2,188.24$189.88$2,378.12$49.23$305.02$0.00$0.00$354.25$10,082.18$29,504.53$39,586.71
Number of People163163163163163163163163163163163163163163163163163163163163163163163163163163
Total Cost per Category$25,248.00$881,847.44$907,095.44$96,823.71$76,411.95$173,235.66$11,013.09$259,098.29$270,111.38$4,096,524.00$335,889.48$4,432,413.48$191,996.75$32,404.79$224,401.54$356,683.49$30,950.00$387,633.49$8,024.30$49,718.99$0.00$0.00$57,743.29$1,643,395.24$4,809,239.04$6,452,634.28
$5,565.00$907,095.44$1,062.80$173,235.66$1,657.13$270,111.38$27,192.72$4,432,413.48$1,376.70$224,401.54$2,378.12$387,633.49$354.25$57,743.29$10,082.18$29,504.53$39,586.71
Number of Non-Zero People28676710714215412215815814936153142181451571571572490033163163163
Non-Zero PMPY$901.71$13,161.90$13,538.74$904.89$538.11$2,371.64$90.27$1,639.86$1,709.57$27,493.45$9,330.26$28,970.02$1,352.09$1,800.27$1,547.60$2,271.87$197.13$2,469.00$334.35$5,524.33$1,749.80$10,082.18$29,504.53$39,586.71
55 to 64Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$186.40$4,884.25$5,070.66$4,323.68$262.30$4,585.98$144.70$1,393.57$1,538.26$19,539.62$637.93$20,177.54$9,687.14$181.51$9,868.66$2,425.75$177.27$2,603.02$138.07$0.00$19.24$0.00$157.31$7,497.63$36,503.80$44,001.43
Number of People3333333333333333333333333333333333333333333333333333
Total Cost per Category$6,151.34$161,180.39$167,331.73$142,681.43$8,655.82$151,337.25$4,774.98$45,987.74$50,762.72$644,807.33$21,051.54$665,858.87$319,675.68$5,989.96$325,665.64$80,049.67$5,850.00$85,899.67$4,556.36$0.00$635.00$0.00$5,191.36$247,421.81$1,204,625.43$1,452,047.24
$5,070.66$167,331.73$4,585.98$151,337.25$1,538.26$50,762.72$20,177.54$665,858.87$9,868.66$325,665.64$2,603.02$85,899.67$157.31$5,191.36$7,497.63$36,503.80$44,001.43
Number of Non-Zero People81212272630273333234243153133333350106333333
Non-Zero PMPY$768.92$13,431.70$13,944.31$5,284.50$332.92$15,700.43$176.85$1,393.57$1,538.26$28,035.10$5,262.89$27,744.12$10,312.12$1,197.99$10,505.34$2,425.75$177.27$2,603.02$911.27$635.00$865.23$7,497.63$36,503.80$44,001.43
45 to 54Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$320.00$5,008.48$5,328.48$3,703.30$1,069.97$4,773.27$141.15$2,229.47$2,370.63$15,568.26$1,311.77$16,880.03$12,648.72$41.98$12,690.70$2,535.95$188.96$2,724.91$81.16$887.31$7.75$0.00$976.22$10,630.15$35,114.09$45,744.24
Number of People1212121212121212121212121212121212121212121212121212
Total Cost per Category$3,840.00$60,101.74$63,941.74$44,439.60$12,839.69$57,279.29$1,693.85$26,753.68$28,447.53$186,819.12$15,741.24$202,560.36$151,784.62$503.76$152,288.38$30,431.43$2,267.50$32,698.93$973.90$10,647.75$93.00$0.00$11,714.65$127,561.76$421,369.12$548,930.88
$5,328.48$63,941.74$4,773.27$57,279.29$2,370.63$28,447.53$16,880.03$202,560.36$12,690.70$152,288.38$2,724.91$32,698.93$976.22$11,714.65$10,630.15$35,114.09$45,744.24
Number of Non-Zero People4771211121012127171221212121222205121212
Non-Zero PMPY$960.00$8,585.96$9,134.53$3,703.30$1,167.24$17,421.99$169.39$2,229.47$2,370.63$26,688.45$15,741.24$28,937.19$12,648.72$251.88$12,690.70$2,535.95$188.96$2,724.91$486.95$5,323.88$46.50$2,342.93$10,630.15$35,114.09$45,744.24
35 to 44Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$0.00$0.00$0.00$10,812.83$406.20$11,219.03$14.33$700.88$715.21$3,275.25$0.00$3,275.25$58,952.45$0.00$58,952.45$6,761.71$238.75$7,000.46$1,590.98$0.00$0.00$0.00$1,590.98$2,698.05$80,055.32$82,753.37
Number of People44444444444444444444444444
Total Cost per Category$0.00$0.00$0.00$43,251.32$1,624.79$44,876.11$57.31$2,803.52$2,860.83$13,101.00$0.00$13,101.00$235,809.80$0.00$235,809.80$27,046.84$955.00$28,001.84$6,363.90$0.00$0.00$0.00$6,363.90$10,792.21$320,221.27$331,013.48
$0.00$0.00$11,219.03$44,876.11$715.21$2,860.83$3,275.25$13,101.00$58,952.45$235,809.80$7,000.46$28,001.84$1,590.98$6,363.90$2,698.05$80,055.32$82,753.37
Number of Non-Zero People00043444410140444410001444
Non-Zero PMPY$10,812.83$541.60$70,171.48$14.33$700.88$715.21$13,101.00$13,101.00$58,952.45$58,952.45$6,761.71$238.75$7,000.46$6,363.90$6,363.90$2,698.05$80,055.32$82,753.37
1999 ALL OTHER NON-PSYCH DIAGNOSES DUAL COSTS1999 ALL OTHER NON-PSYCH DIAGNOSES DUAL COSTS1999 ALL OTHER NON-PSYCH DIAGNOSES DUAL COSTS1999 ALL OTHER NON-PSYCH DIAGNOSES DUAL COSTS
85+Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$66.68$1,776.86$1,843.53$335.53$453.41$788.93$63.70$984.96$1,048.65$15,112.00$900.15$16,012.15$973.98$456.42$1,430.40$1,491.56$160.10$1,651.67$125.61$169.48$2.17$0.00$297.26$4,866.88$18,205.72$23,072.60
Number of People774774774774774774774774774774774774774774774774774774774774774774774774774774
Total Cost per Category$51,609.24$1,375,285.90$1,426,895.14$259,699.07$350,936.30$610,635.37$49,302.33$762,355.86$811,658.19$11,696,685.47$696,716.52$12,393,401.99$753,864.03$353,268.98$1,107,133.01$1,154,469.49$123,920.00$1,278,389.49$97,222.93$131,180.60$1,679.00$0.00$230,082.53$3,766,967.09$14,091,228.63$17,858,195.72
$1,843.53$1,426,895.14$788.93$610,635.37$1,048.65$811,658.19$16,012.15$12,393,401.99$1,430.40$1,107,133.01$1,651.67$1,278,389.49$297.26$230,082.53$4,866.88$18,205.72$23,072.60
Number of Non-Zero People661811815095736525477577575059752666112168373873873816528120197774774774
Non-Zero PMPY$781.96$7,598.26$7,883.40$510.21$612.45$2,092.79$90.13$1,007.08$1,072.20$23,161.75$7,182.64$23,561.60$1,140.49$2,919.58$1,620.99$1,564.32$167.91$1,732.24$589.23$4,685.02$139.92$1,167.93$4,866.88$18,205.72$23,072.60
75 to 84Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$138.12$3,012.42$3,150.54$572.89$656.71$1,229.60$121.46$1,297.81$1,419.27$5,531.61$745.95$6,277.56$1,091.62$553.30$1,644.93$1,562.63$123.23$1,685.86$213.33$91.87$2.86$0.00$308.06$6,571.40$9,144.42$15,715.82
Number of People1,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,027
Total Cost per Category$141,847.56$3,093,754.81$3,235,602.37$588,354.47$674,443.66$1,262,798.13$124,735.99$1,332,854.49$1,457,590.48$5,680,963.84$766,093.62$6,447,057.46$1,121,096.80$568,244.10$1,689,340.90$1,604,822.13$126,560.00$1,731,382.13$219,086.79$94,351.71$2,941.00$0.00$316,379.50$6,748,829.18$9,391,321.79$16,140,150.97
$3,150.54$3,235,602.37$1,229.60$1,262,798.13$1,419.27$1,457,590.48$6,277.56$6,447,057.46$1,644.93$1,689,340.90$1,685.86$1,731,382.13$308.06$316,379.50$6,571.40$9,144.42$15,715.82
Number of Non-Zero People1612952957728059198331,0131,014267115331937196950913906913332191003511,0271,0271,027
Non-Zero PMPY$881.04$10,487.30$10,968.14$762.12$837.82$2,594.01$149.74$1,315.75$1,437.47$21,277.02$6,661.68$19,477.51$1,196.47$2,899.20$1,778.25$1,757.75$139.69$1,896.37$659.90$4,965.88$294.10$901.37$6,571.40$9,144.42$15,715.82
65 to 74Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$118.90$2,279.62$2,398.52$609.69$605.33$1,215.02$122.14$1,032.35$1,154.49$2,437.89$391.08$2,828.97$924.02$482.49$1,406.51$1,539.48$102.94$1,642.42$200.75$47.06$3.91$0.00$251.71$5,038.66$5,858.97$10,897.63
Number of People1,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,103
Total Cost per Category$131,144.37$2,514,418.75$2,645,563.12$672,489.44$667,676.91$1,340,166.35$134,722.04$1,138,680.28$1,273,402.32$2,688,993.25$431,357.16$3,120,350.41$1,019,193.65$532,182.28$1,551,375.93$1,698,045.72$113,540.00$1,811,585.72$221,421.88$51,908.57$4,311.00$0.00$277,641.45$5,557,645.83$6,462,439.47$12,020,085.30
$2,398.52$2,645,563.12$1,215.02$1,340,166.35$1,154.49$1,273,402.32$2,828.97$3,120,350.41$1,406.51$1,551,375.93$1,642.42$1,811,585.72$251.71$277,641.45$5,038.66$5,858.97$10,897.63
Number of Non-Zero People1352452508628609829411,0751,077115651561,0321411,033928927928297162303241,1031,1031,103
Non-Zero PMPY$971.44$10,262.93$10,582.25$780.15$776.37$2,402.61$143.17$1,059.24$1,182.36$23,382.55$6,636.26$20,002.25$987.59$3,774.34$1,501.82$1,829.79$122.48$1,952.14$745.53$3,244.29$187.43$856.92$5,038.66$5,858.97$10,897.63
55 to 64Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$240.66$2,969.21$3,209.87$1,077.62$1,001.04$2,078.66$193.89$1,216.49$1,410.38$1,454.52$259.12$1,713.63$1,843.93$703.23$2,547.16$2,164.47$126.62$2,291.09$352.07$3.94$3.89$0.00$359.89$6,505.09$7,105.59$13,610.68
Number of People492492492492492492492492492492492492492492492492492492492492492492492492492492
Total Cost per Category$118,406.52$1,460,850.47$1,579,256.99$530,188.16$492,511.02$1,022,699.18$95,392.31$598,512.68$693,904.99$715,621.61$127,484.78$843,106.39$907,213.22$345,989.62$1,253,202.84$1,064,919.57$62,297.50$1,127,217.07$173,216.53$1,939.49$1,912.00$0.00$177,068.02$3,200,504.59$3,495,950.89$6,696,455.48
$3,209.87$1,579,256.99$2,078.66$1,022,699.18$1,410.38$693,904.99$1,713.63$843,106.39$2,547.16$1,253,202.84$2,291.09$1,127,217.07$359.89$177,068.02$6,505.09$7,105.59$13,610.68
Number of Non-Zero People70121124436393463432475476362449480754814284284281792180189492492492
Non-Zero PMPY$1,691.52$12,073.14$12,735.94$1,216.03$1,253.21$4,168.28$220.82$1,260.03$1,457.78$19,878.38$5,311.87$17,206.25$1,890.03$4,613.19$2,605.41$2,488.13$145.55$2,633.68$967.69$969.75$106.22$936.87$6,505.09$7,105.59$13,610.68
45 to 54Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$199.47$2,586.91$2,786.38$831.62$909.65$1,741.27$165.42$1,004.33$1,169.75$2,300.42$162.03$2,462.46$1,795.96$503.77$2,299.72$2,052.81$105.70$2,158.51$339.25$8.83$7.14$0.00$355.22$5,514.76$7,458.55$12,973.31
Number of People363363363363363363363363363363363363363363363363363363363363363363363363363363
Total Cost per Category$72,406.78$939,047.71$1,011,454.49$301,878.82$330,202.37$632,081.19$60,047.23$364,570.86$424,618.09$835,054.08$58,817.73$893,871.81$651,932.44$182,867.31$834,799.75$745,170.23$38,370.00$783,540.23$123,147.70$3,203.80$2,593.00$0.00$128,944.50$2,001,857.48$2,707,452.58$4,709,310.06
$2,786.38$1,011,454.49$1,741.27$632,081.19$1,169.75$424,618.09$2,462.46$893,871.81$2,299.72$834,799.75$2,158.51$783,540.23$355.22$128,944.50$5,514.76$7,458.55$12,973.31
Number of Non-Zero People537981302292330319354355211029349403493143143141151210130363363363
Non-Zero PMPY$1,366.17$11,886.68$12,487.09$999.60$1,130.83$3,890.95$188.24$1,029.86$1,196.11$39,764.48$5,881.77$30,823.17$1,868.00$4,571.68$2,391.98$2,373.15$122.20$2,495.35$1,070.85$3,203.80$123.48$991.88$5,514.76$7,458.55$12,973.31
35 to 44Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$128.62$2,174.51$2,303.13$1,064.03$1,153.10$2,217.13$194.02$913.06$1,107.08$618.06$86.88$704.94$4,328.95$580.24$4,909.19$2,329.29$92.02$2,421.30$721.70$37.89$19.66$7.76$787.00$5,667.37$8,782.39$14,449.77
Number of People300300300300300300300300300300300300300300300300300300300300300300300300300300
Total Cost per Category$38,584.62$652,353.07$690,937.69$319,209.77$345,928.57$665,138.34$58,205.45$273,917.95$332,123.40$185,417.42$26,063.62$211,481.04$1,298,685.89$174,071.28$1,472,757.17$698,786.24$27,605.00$726,391.24$216,508.74$11,368.31$5,897.00$2,326.72$236,100.77$1,700,211.54$2,634,718.11$4,334,929.65
$2,303.13$690,937.69$2,217.13$665,138.34$1,107.08$332,123.40$704.94$211,481.04$4,909.19$1,472,757.17$2,421.30$726,391.24$787.00$236,100.77$5,667.37$8,782.39$14,449.77
Number of Non-Zero People345052251237274267294298651129432294261261261821363110300300300
Non-Zero PMPY$1,134.84$13,047.06$13,287.26$1,271.75$1,459.61$7,167.24$218.00$931.69$1,114.51$30,902.90$5,212.72$19,225.55$4,417.30$5,439.73$5,009.38$2,677.34$105.77$2,783.11$2,640.35$11,368.31$163.81$775.57$2,146.37$5,667.37$8,782.39$14,449.77
19 to 34Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$180.36$1,137.95$1,318.31$795.26$769.01$1,564.26$129.22$638.97$768.19$1,384.15$1.52$1,385.68$1,943.52$59.55$2,003.07$1,415.44$64.43$1,479.86$348.91$164.42$19.37$0.00$532.69$3,120.32$5,931.75$9,052.07
Number of People201201201201201201201201201201201201201201201201201201201201201201201201201201
Total Cost per Category$36,253.18$228,727.95$264,981.13$159,846.52$154,570.47$314,416.99$25,973.90$128,432.10$154,406.00$278,215.09$305.59$278,520.68$390,647.13$11,969.70$402,616.83$284,502.80$12,950.00$297,452.80$70,130.37$33,047.42$3,893.00$0.00$107,070.79$627,183.60$1,192,281.62$1,819,465.22
$1,318.31$264,981.13$1,564.26$314,416.99$768.19$154,406.00$1,385.68$278,520.68$2,003.07$402,616.83$1,479.86$297,452.80$532.69$107,070.79$3,120.32$5,931.75$9,052.07
Number of Non-Zero People1928311611471751631891915161891118916916816952121071201201201
Non-Zero PMPY$1,908.06$8,168.86$8,547.78$992.84$1,051.50$4,028.94$159.35$679.53$808.41$55,643.02$305.59$46,420.11$2,066.92$1,088.15$2,130.25$1,683.45$77.08$1,760.08$1,348.66$33,047.42$185.38$1,508.04$3,120.32$5,931.75$9,052.07
1999 CARDIOVASCULAR DUAL COSTS1999 CARDIOVASCULAR DUAL COSTS1999 CARDIOVASCULAR DUAL COSTS1999 CARDIOVASCULAR DUAL COSTS
85+Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$76.17$2,082.03$2,158.20$376.34$484.75$861.09$66.52$1,121.24$1,187.76$15,153.88$1,023.02$16,176.90$1,055.74$553.88$1,609.63$1,567.09$168.33$1,735.42$136.30$137.38$2.35$0.00$276.03$5,538.60$18,466.43$24,005.03
Number of People617617617617617617617617617617617617617617617617617617617617617617617617617617
Total Cost per Category$46,996.92$1,284,615.02$1,331,611.94$232,203.63$299,089.35$531,292.98$41,042.32$691,804.38$732,846.70$9,349,944.84$631,200.73$9,981,145.57$651,394.63$341,746.61$993,141.24$966,892.83$103,860.00$1,070,752.83$84,094.16$84,765.81$1,451.00$0.00$170,310.97$3,417,316.06$11,393,786.17$14,811,102.23
$2,158.20$1,331,611.94$861.09$531,292.98$1,187.76$732,846.70$16,176.90$9,981,145.57$1,609.63$993,141.24$1,735.42$1,070,752.83$276.03$170,310.97$5,538.60$18,466.43$24,005.03
Number of Non-Zero People60168168416472532440608608398884155291125505925925921332190157617617617
Non-Zero PMPY$783.28$7,646.52$7,926.26$558.18$633.66$2,223.10$93.28$1,137.84$1,205.34$23,492.32$7,172.74$24,050.95$1,231.37$3,051.31$1,805.71$1,633.26$175.44$1,808.70$632.29$4,036.47$161.22$1,084.78$5,538.60$18,466.43$24,005.03
75 to 84Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$167.26$3,839.53$4,006.80$655.71$783.29$1,439.00$134.98$1,570.04$1,705.02$5,675.26$896.80$6,572.06$1,169.71$687.89$1,857.61$1,749.11$138.10$1,887.22$240.25$70.87$3.73$0.00$314.85$8,088.68$9,693.89$17,782.56
Number of People733733733733733733733733733733733733733733733733733733733733733733733733733733
Total Cost per Category$122,604.79$2,814,378.48$2,936,983.27$480,638.36$574,148.06$1,054,786.42$98,940.36$1,150,842.42$1,249,782.78$4,159,967.99$657,353.48$4,817,321.47$857,400.85$504,223.89$1,361,624.74$1,282,099.50$101,230.00$1,383,329.50$176,103.87$51,948.64$2,736.00$0.00$230,788.51$5,928,998.84$7,105,617.85$13,034,616.69
$4,006.80$2,936,983.27$1,439.00$1,054,786.42$1,705.02$1,249,782.78$6,572.06$4,817,321.47$1,857.61$1,361,624.74$1,887.22$1,383,329.50$314.85$230,788.51$8,088.68$9,693.89$17,782.56
Number of Non-Zero People139254254568608674596729729192992496721736856636586632621190273733733733
Non-Zero PMPY$882.05$11,080.23$11,562.93$846.19$944.32$2,837.07$166.01$1,578.66$1,714.38$21,666.50$6,639.93$19,346.67$1,275.89$2,914.59$1,987.77$1,933.79$153.84$2,086.47$672.15$4,722.60$304.00$845.38$8,088.68$9,693.89$17,782.56
65 to 74Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$152.38$3,264.16$3,416.54$730.24$779.12$1,509.37$141.80$1,309.91$1,451.72$2,472.69$567.98$3,040.67$1,071.54$629.05$1,700.58$1,809.67$121.68$1,931.35$255.15$55.50$5.08$0.00$315.73$6,860.88$6,505.08$13,365.95
Number of People686686686686686686686686686686686686686686686686686686686686686686686686686686
Total Cost per Category$104,533.61$2,239,214.05$2,343,747.66$500,947.94$534,477.24$1,035,425.18$97,276.16$898,600.96$995,877.12$1,696,266.01$389,632.46$2,085,898.47$735,073.62$431,524.95$1,166,598.57$1,241,432.97$83,470.00$1,324,902.97$175,035.09$38,075.95$3,482.00$0.00$216,593.04$4,706,560.70$4,462,482.31$9,169,043.01
$3,416.54$2,343,747.66$1,509.37$1,035,425.18$1,451.72$995,877.12$3,040.67$2,085,898.47$1,700.58$1,166,598.57$1,931.35$1,324,902.97$315.73$216,593.04$6,860.88$6,505.08$13,365.95
Number of Non-Zero People11120220556056362659867467675561086491086506066056062098150225686686686
Non-Zero PMPY$941.74$11,085.22$11,432.92$894.55$949.34$2,828.27$162.67$1,333.24$1,473.19$22,616.88$6,957.72$19,313.87$1,132.62$3,995.60$1,794.77$2,048.57$137.97$2,186.31$837.49$4,759.49$232.13$962.64$6,860.88$6,505.08$13,365.95
55 to 64Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$390.24$4,726.10$5,116.33$1,236.18$1,405.46$2,641.64$240.91$1,629.43$1,870.33$1,109.22$391.53$1,500.75$1,861.09$819.10$2,680.18$2,526.41$150.22$2,676.62$427.09$3.93$4.14$0.00$435.16$9,402.63$7,518.38$16,921.02
Number of People279279279279279279279279279279279279279279279279279279279279279279279279279279
Total Cost per Category$108,876.65$1,318,580.54$1,427,457.19$344,893.33$392,123.13$737,016.46$67,212.57$454,610.25$521,822.82$309,471.45$109,236.66$418,708.11$519,243.31$228,528.21$747,771.52$704,867.03$41,910.00$746,777.03$119,159.04$1,096.10$1,155.00$0.00$121,410.14$2,623,333.93$2,097,629.34$4,720,963.27
$5,116.33$1,427,457.19$2,641.64$737,016.46$1,870.33$521,822.82$1,500.75$418,708.11$2,680.18$747,771.52$2,676.62$746,777.03$435.16$121,410.14$9,402.63$7,518.38$16,921.02
Number of Non-Zero People629799256239272246270270212133273552742482482481151110118279279279
Non-Zero PMPY$1,756.08$13,593.61$14,418.76$1,347.24$1,640.68$4,618.60$273.22$1,683.74$1,932.68$14,736.74$5,201.75$12,688.12$1,901.99$4,155.06$2,729.09$2,842.21$168.99$3,011.20$1,036.17$1,096.10$105.00$1,028.90$9,402.63$7,518.38$16,921.02
45 to 54Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$420.30$4,646.35$5,066.65$1,230.80$1,515.57$2,746.36$279.95$1,502.62$1,782.57$1,235.32$317.26$1,552.58$1,007.10$641.70$1,648.80$2,633.85$139.40$2,773.25$498.91$0.00$9.84$0.00$508.75$9,122.40$6,956.55$16,078.96
Number of People154154154154154154154154154154154154154154154154154154154154154154154154154154
Total Cost per Category$64,726.78$715,537.84$780,264.62$189,542.60$233,397.55$422,940.15$43,112.55$231,403.25$274,515.80$190,239.25$48,857.82$239,097.07$155,093.04$98,821.61$253,914.65$405,612.28$21,467.50$427,079.78$76,832.00$0.00$1,515.00$0.00$78,347.00$1,404,850.07$1,071,309.00$2,476,159.07
$5,066.65$780,264.62$2,746.36$422,940.15$1,782.57$274,515.80$1,552.58$239,097.07$1,648.80$253,914.65$2,773.25$427,079.78$508.75$78,347.00$9,122.40$6,956.55$16,078.96
Number of Non-Zero People43575914013114714215215278131502215014214214259011065154154154
Non-Zero PMPY$1,505.27$12,553.30$13,224.82$1,353.88$1,781.66$3,932.20$303.61$1,522.39$1,806.03$27,177.04$6,107.23$18,392.08$1,033.95$4,491.89$1,692.76$2,856.42$151.18$3,007.60$1,302.24$137.73$1,205.34$9,122.40$6,956.55$16,078.96
35 to 44Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$320.69$5,385.43$5,706.12$2,080.90$3,157.67$5,238.56$537.24$1,771.84$2,309.09$972.84$306.67$1,279.51$2,709.91$278.66$2,988.57$3,256.28$128.26$3,384.54$939.77$0.00$17.82$0.00$957.58$11,840.03$10,023.94$21,863.97
Number of People8282828282828282828282828282828282828282828282828282
Total Cost per Category$26,296.62$441,605.09$467,901.71$170,633.64$258,928.55$429,562.19$44,053.97$145,291.04$189,345.01$79,772.62$25,146.85$104,919.47$222,212.88$22,850.25$245,063.13$267,014.73$10,517.50$277,532.23$77,060.80$0.00$1,461.00$0.00$78,521.80$970,882.58$821,962.96$1,792,845.54
$5,706.12$467,901.71$5,238.56$429,562.19$2,309.09$189,345.01$1,279.51$104,919.47$2,988.57$245,063.13$3,384.54$277,532.23$957.58$78,521.80$11,840.03$10,023.94$21,863.97
Number of Non-Zero People19222468657777828234781128175757528011036828282
Non-Zero PMPY$1,384.03$20,072.96$19,495.90$2,509.32$3,983.52$8,464.61$572.13$1,771.84$2,309.09$26,590.87$6,286.71$14,988.50$2,743.37$1,904.19$3,025.47$3,560.20$140.23$3,700.43$2,752.17$132.82$2,181.16$11,840.03$10,023.94$21,863.97
19 to 34Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
Per Member per Year$837.10$4,540.14$5,377.24$2,051.99$2,951.36$5,003.35$441.02$2,046.53$2,487.55$1,819.25$0.00$1,819.25$3,105.16$309.86$3,415.01$3,439.12$160.00$3,599.12$748.57$1,139.57$36.79$0.00$1,924.93$11,736.03$11,890.43$23,626.45
Number of People2929292929292929292929292929292929292929292929292929
Total Cost per Category$24,275.92$131,664.05$155,939.97$59,507.63$85,589.54$145,097.17$12,789.60$59,349.44$72,139.04$52,758.21$0.00$52,758.21$90,049.61$8,985.81$99,035.42$99,734.41$4,640.00$104,374.41$21,708.52$33,047.42$1,067.00$0.00$55,822.94$340,344.78$344,822.38$685,167.16
$5,377.24$155,939.97$5,003.35$145,097.17$2,487.55$72,139.04$1,819.25$52,758.21$3,415.01$99,035.42$3,599.12$104,374.41$1,924.93$55,822.94$11,736.03$11,890.43$23,626.45
Number of Non-Zero People61011262626242929202265262525251512017292929
Non-Zero PMPY$4,045.99$13,166.41$14,176.36$2,288.76$3,291.91$9,044.11$532.90$2,046.53$2,487.55$26,379.11$26,379.11$3,463.45$1,797.16$3,809.05$3,989.38$185.60$4,174.98$1,447.23$33,047.42$533.50$3,283.70$11,736.03$11,890.43$23,626.45
Medicaid InpatientMedicare InpatientTotal InpatientMedicaid OutpatientMedicare OutpatientTotal OutpatientMedicaid PhysicianMedicare PhysicianTotal PhysicianMedicaid Nursing HomeMedicare Nursing HomeTotal Nursing HomeMedicaid Home Based Community ServicesMedicare Home Based Community ServicesTotal Home HealthMedicaid DrugMedicaid Drug Dispensing FeeTotal DrugMedicare Durable Medical EquipmentMedicare HospiceMedicaid DentalMedicaid HMO PremiumTotal Other CostsTotal MedicareTotal MedicaidTotal Costs
85+$66.68$1,776.86$1,843.53$335.53$453.41$788.93$63.70$984.96$1,048.65$15,112.00$900.15$16,012.15$973.98$456.42$1,430.40$1,491.56$160.10$1,651.67$125.61$169.48$2.17$0.00$297.26$4,866.88$18,205.72$23,072.60
85+774774774774774774774774774774774774774774774774774774774774774774774774774774
75 to 84$138.12$3,012.42$3,150.54$572.89$656.71$1,229.60$121.46$1,297.81$1,419.27$5,531.61$745.95$6,277.56$1,091.62$553.30$1,644.93$1,562.63$123.23$1,685.86$213.33$91.87$2.86$0.00$308.06$6,571.40$9,144.42$15,715.82
75 to 841,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,0271,027
65 to 74$118.90$2,279.62$2,398.52$609.69$605.33$1,215.02$122.14$1,032.35$1,154.49$2,437.89$391.08$2,828.97$924.02$482.49$1,406.51$1,539.48$102.94$1,642.42$200.75$47.06$3.91$0.00$251.71$5,038.66$5,858.97$10,897.63
65 to 741,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,1031,103
55 to 64$240.66$2,969.21$3,209.87$1,077.62$1,001.04$2,078.66$193.89$1,216.49$1,410.38$1,454.52$259.12$1,713.63$1,843.93$703.23$2,547.16$2,164.47$126.62$2,291.09$352.07$3.94$3.89$0.00$359.89$6,505.09$7,105.59$13,610.68
55 to 64492492492492492492492492492492492492492492492492492492492492492492492492492492
45 to 54$199.47$2,586.91$2,786.38$831.62$909.65$1,741.27$165.42$1,004.33$1,169.75$2,300.42$162.03$2,462.46$1,795.96$503.77$2,299.72$2,052.81$105.70$2,158.51$339.25$8.83$7.14$0.00$355.22$5,514.76$7,458.55$12,973.31
45 to 54363363363363363363363363363363363363363363363363363363363363363363363363363363
35 to 44$128.62$2,174.51$2,303.13$1,064.03$1,153.10$2,217.13$194.02$913.06$1,107.08$618.06$86.88$704.94$4,328.95$580.24$4,909.19$2,329.29$92.02$2,421.30$721.70$37.89$19.66$7.76$787.00$5,667.37$8,782.39$14,449.77
35 to 44300300300300300300300300300300300300300300300300300300300300300300300300300300
19 to 34$180.36$1,137.95$1,318.31$795.26$769.01$1,564.26$129.22$638.97$768.19$1,384.15$1.52$1,385.68$1,943.52$59.55$2,003.07$1,415.44$64.43$1,479.86$348.91$164.42$19.37$0.00$532.69$3,120.32$5,931.75$9,052.07
19 to 34201201201201201201201201201201201201201201201201201201201201201201201201201201
19 to 3419 to 34
35 to 4435 to 44
45 to 5445 to 54
55 to 6455 to 64
65 to 7465 to 74
75 to 8475 to 84
85 +85 +
Schizophrenia
Major Depression
1999 Number of Dual Eligible People Diagnosed with Schizophrenia or Major Depression
178
176
483
381
332
380
160
259
135
315
93
369
42
339
19 to 3419 to 34
35 to 4435 to 44
45 to 5445 to 54
55 to 6455 to 64
65 to 7465 to 74
75 to 8475 to 84
85 +85 +
Schizophrenia
Major Depression
1999 Per Member Per Year Costs of Dual Eligible People Diagnosed with Schizophrenia or Major Depression
24566.0662921348
15596.5740340909
26025.9595859213
19950.8740944882
30026.875753012
19258.5632368421
34646.872125
23892.382972973
39153.8775555556
27850.0210793651
40995.6021505376
32030.3488888889
48921.110952381
33933.1798230088
Schizophrenia19 to 34Schizophrenia19 to 34Schizophrenia19 to 34Schizophrenia19 to 34Schizophrenia19 to 34Schizophrenia19 to 34Schizophrenia19 to 34
Major DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor Depression
Schizophrenia35 to 44Schizophrenia35 to 44Schizophrenia35 to 44Schizophrenia35 to 44Schizophrenia35 to 44Schizophrenia35 to 44Schizophrenia35 to 44
Major DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor Depression
Schizophrenia45 to 54Schizophrenia45 to 54Schizophrenia45 to 54Schizophrenia45 to 54Schizophrenia45 to 54Schizophrenia45 to 54Schizophrenia45 to 54
Major DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor Depression
Schizophrenia55 to 64Schizophrenia55 to 64Schizophrenia55 to 64Schizophrenia55 to 64Schizophrenia55 to 64Schizophrenia55 to 64Schizophrenia55 to 64
Major DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor Depression
Schizophrenia65 to 74Schizophrenia65 to 74Schizophrenia65 to 74Schizophrenia65 to 74Schizophrenia65 to 74Schizophrenia65 to 74Schizophrenia65 to 74
Major DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor Depression
Schizophrenia75 to 84Schizophrenia75 to 84Schizophrenia75 to 84Schizophrenia75 to 84Schizophrenia75 to 84Schizophrenia75 to 84Schizophrenia75 to 84
Major DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor Depression
Schizophrenia85 +Schizophrenia85 +Schizophrenia85 +Schizophrenia85 +Schizophrenia85 +Schizophrenia85 +Schizophrenia85 +
Major DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor DepressionMajor Depression
Total Inpatient
Total Outpatient
Total Physician
Total Nursing Home
Total Home Health
Total Drug
Total Other Costs
1999 Per Member Per Year Costs of Dual Eligible People Diagnosed with Schizophrenia or Major Depression
3955.9806741573
11142.7095505618
1362.2290449438
0
3586.9174719101
4480.0181460674
38.2114044944
4237.0158522727
4692.9827840909
1899.3350568182
307.0056818182
1398.3551704546
2810.8623295454
251.0171590909
3591.9859213251
10667.5717391304
1535.9564803313
434.9809937888
4399.8651552795
5352.8945962733
42.704699793
5084.9447769029
4498.7470341207
2389.3319160105
918.7265091864
2850.4224146982
3961.1942519685
247.5071916011
3354.722439759
12242.4809036145
1436.4942168675
356.7181024096
7322.6457831325
5233.9165662651
79.8977409639
4468.4833157895
4121.663631579
2268.7518157895
1791.3211842105
2173.6112105263
4060.8374210526
373.8946578947
3896.8684375
12894.845
1682.009125
4041.6401875
7656.54225
4416.9891875
57.9779375
5971.0272586873
4372.3394208494
2729.5685714286
3906.9995752896
2910.1066409266
3588.9656756757
413.3758301158
6390.0511111111
7583.6594074074
1565.866962963
16273.2279259259
3699.8028148148
3571.4511851852
69.8181481481
6363.7548888889
2875.3682539683
2452.5786031746
8749.5197777778
3573.836984127
3261.3795238095
573.583047619
4696.7737634409
2473.4417204301
1334.6804301075
27842.4565591398
1724.9835483871
2792.2695698925
130.9965591398
6058.5546883469
1489.2908401084
2038.3955284553
17524.1916802168
1679.504200542
2773.131300813
467.2806504065
8817.7519047619
1459.4385714286
2054.5361904762
32806.2616666667
1217.8357142857
2356.3042857143
208.9826190476
2608.2905309735
1030.1302359882
1468.5566961652
24676.2078171091
1018.3781710914
2668.1819764012
463.4343952802
19 to 3419 to 34
35 to 4435 to 44
45 to 5445 to 54
55 to 6455 to 64
65 to 7465 to 74
75 to 8475 to 84
85 +85 +
Schizophrenia
Major Depression
1999 Median Per Member per Year Costs of Dual Eligible People Diagnosed with Schizophrenia or Major Depression
18720.86
8089.71
17102.79
11003.07
21319.17
12060.42
23169.99
14422.43
39847.09
23395.72
39684.83
30622.99
44571.15
36423.41
Schizophrenia19 to 34Schizophrenia19 to 34
Major DepressionMajor Depression
Schizophrenia35 to 44Schizophrenia35 to 44
Major DepressionMajor Depression
Schizophrenia45 to 54Schizophrenia45 to 54
Major DepressionMajor Depression
Schizophrenia55 to 64Schizophrenia55 to 64
Major DepressionMajor Depression
Schizophrenia65 to 74Schizophrenia65 to 74
Major DepressionMajor Depression
Schizophrenia75 to 84Schizophrenia75 to 84
Major DepressionMajor Depression
Schizophrenia85 +Schizophrenia85 +
Major DepressionMajor Depression
Total Medicaid
Total Medicare
1999 Per Member Per Year Costs of Dual Eligible People Diagnosed with Schizophrenia or Major Depression
19308.2613483146
5257.8049438202
8717.386875
6879.1871590909
20345.0755486542
5680.8840372671
11545.7561417323
8405.1179527559
24916.3045180723
5110.5712349398
10832.7594736842
8425.8037631579
28141.8905
6504.981625
12536.2981081081
11356.0848648649
30897.8668888889
8256.0106666667
14888.5897142857
12961.4313650794
33468.84
7526.7621505376
19848.42100271
12181.9278861789
36204.7707142857
12716.3402380952
26621.1870501475
7311.9927728614
Increasing Life Expectancy and Reducing Costs for People with Serious Mental Illness
1. Integrated Illness Self-Management and Technology
2. Prevention, Health Promotion, Peer Support and Technology
Telehealth and Illness Self-Management
Illness Self-Management Health Coaching for n=71 older adults (mean age 60) with
mental disorders and chronic illness (diabetes, COPD, CHF, CVD,
hypertension, arthritis)
Self-management support, cognitive behavioral, and motivational skills training
We Know Integrated Self-management Works
Self-Management Training and Support Outcomes
Improved Self-management • Patient and provider ratings
of self-management – Knowledge of Symptoms,
Meds, Coping – Symptom Distress – Symptoms Affecting
Functioning
• Improved participation in
the health care encounter
Decreased hospitalizations
31%
0%
17.40%
12.10%
25% 25%
BL 10mo 14mo
Hospitalizations I-IMR UC
Pilot 1: Automated Remote Telemedicine Supported Medical Illness Self-Management
Health Buddy: Electronic unit connected to a phone line provides two-way communication between healthcare providers and patients. -100 participants age 18+ with SMI plus CHF, COPD, Diabetes, or CAD) enrolled in 12 month RCT cross-over design (HB v. wait list control)
Health Buddy Automated Daily: - Self-monitoring - Health Data Entry - Self-management Education - Remote Nurse Monitoring
63% (n=15) Fasting Glucose >130
At Baseline: 63% FG>130
After Telehealth Majority (2/3) in range FG
Service Use Outcomes for People with Diabetes (both p
TeleFriend
• Tablet-based, in-home program • Users complete daily sessions (5-10 minutes) • Sessions include medication adherence
monitoring, symptom monitoring, education about illness, training on illness self-management and healthy lifestyle behaviors, trivia question or inspirational quote
• Content & monitoring matched to users’ diagnoses
• Responses sent to secure server and reviewed daily on desktop application by Telehealth Specialist
Which Works Best for Implementing Chronic Disease Self-Management in High Risk, Complex Patients?
• Automated Telehealth? Or
• Health Coaching and Self-management Training
NIMH Randomized Trial with VinFen (n=300) Bartels, PI
What About Peers, Mobile Technology
And Illness Self-managent?
Pilot Study of Integrated Medical and Psychiatric Self-Management mHealth for Adults with SMI
• Psychoeducation • Coping skills training • Relapse prevention
training • Behavioral tailoring
Fortuna, K., Gill, L., Lohman, M., Bruce, M., & Bartels, S. (2017). Adaptation and usability of an integrated medical and psychiatric self-management smartphone application for middle-aged and older adults with serious mental illness. American Journal of Geriatric Psychiatry.
Improved Self-management
What About Prevention?
Cardiovascular Disease (CVD) Risk Factors and Major Mental Illness
Vancamfort et al., 2013: Meta-analysis of 136 studies
Modifiable Risk Factors Serious Mental Illness
Prevalence Compared to General Population
Abdominal Obesity 4.4 X
Smoking 3-4X
Diabetes 2X
Hypertension 1.4 X
Metabolic Syndrome 2.4X
Hyperlipidemia 2.7X
The InSHAPE Program
Integrated Health Promotion and Health Behavior Change: In SHAPE
• Nurse Evaluation and Consultation • Initial Fitness Assessment
– Individualized fitness and healthy lifestyle assessment
• Individual Meetings with a “Health Mentor” • Vouchers to Local Fitness Centers
• Individual and group nutrition education
• Smoking cessation referrals
• Group Education/Motivational “Celebrations“
Promoting Health and Functioning in Persons with SMI: CDC - R01 DD000140 (PI: Bartels) Health Promotion and Fitness for Younger and Older Adults With SMI: R01 MH078052-01 (PI: Bartels)
1st RCT (n=133) : At 12 months: 49% in
intervention group achieved either clinically
significant increased fitness (>50 m on
6MWT) or weight loss (5% or greater)
41% 51%
46% 37% 38% 37%
0%
20%
40%
60%
80%
100%
6-month 12-month 18-month
In SHAPEFitness Club Membership and Education
2nd RCT Boston, Mass (Multiple Sites: n=210; half underserved minorities)
51% achieved either clinically significant increased fitness (>50 m on 6MWT) or weight loss (5% or greater)
Weight Loss and Fitness Outcomes
WE KNOW WHAT WORKS!
Research Review of Health Promotion Programs for People with Serious Mental Illness http://www.integration.samhsa.gov/health-wellness/wellnesswhitepaper Health Promotion Resource Guide: Choosing Evidence-based Practices for Reducing Obesity and Improving Fitness for People with Serious Mental Illness http://www.integration.samhsa.gov/health-wellness/Health_Promotion_Guide.pdf
http://www.integration.samhsa.gov/health-wellness/wellnesswhitepaperhttp://www.integration.samhsa.gov/health-wellness/Health_Promotion_Guide.pdf
It’s Hard Enough to Change Health Behaviors……….
But Even Harder to Change the Behavior
of Organizations….
What does it take to implement health promotion?
(especially when it is not in the mission, competency, scope of practice, or financing of a health care
organization)
Can Behavioral Health Organizations Change Health Behaviors?
Rediscovering the Neck
48 mental health organizations:
Three phases of 16 organizations over two years
Estimated
Patient Participants:
2400
Training and Individual Technical Assistance
• Individually tailored, phone-based implementation technical assistance
Virtual Learning Collaborative
• Coaching organizations to work together to share processes and outcomes, engage in group problem solving, and apply systems improvement
Randomized
R01MH102325, PI: Bartels
Are Learning Collaboratives the Most Effective Approach to Implementing a New Practice that Requires a Significant Change in Organizational Culture?
Individual Technical Assistance (18 months)
Learning Collaborative (18 months)
Ongoing engagement with
research team (until 24 months)
Ongoing engagement with
research team (until 24 months)
Participation Over 24 Months
Site Selection Sites selected for each phase to achieve an optimal mix of the following:
– Organizational readiness
– Geographic distribution
– Diversity of patient population
– Organizational size
– Urban vs. rural
http://www.thenationalcouncil.org/training-courses/dartmouths-shape-implementation-study/
InSHAPE From Community Need, to Research, to Implementation
(The 16 Year Science to Practice Gap!)
Community Development
Identification of Need,
Community Coalition
Development of InSHAPE Model
(2002)
Effectiveness Research
Academic Research Partnership,
1st Pilot Study (2004-2009)
Effectiveness RCT Studies
(CDC, NIMH) (2006-2012)
Implementation Research
Statewide Implementation and
Evaluation (2009-2014); Statewide
Medicaid Incentives Grant (2011-2016)
Nationwide Implementation
Project (2014-2018)
Is Fidelity the Gold Standard for Successful and
Sustainable Implementation?
What About Adaptation and
Innovation?
Paradox of Ensuring Fidelity While Promoting Contextually Relevant Change
• Adherence to core intervention (fidelity) vs. the modification (adaptation) of a program to improve the fit for a specific health care setting.
• Chambers et al. assert the goal of long-term program sustainability needs to reflect real-world challenges in the fit between the intervention and the context
• Fidelity consistent vs. fidelity inconsistent
modifications to InSHAPE health promotion program
What if Organ