Evansville Community Health Audit™ Volume II

Comparative Analysis

Evansville Indiana patients' total claims were further examined to specifically compare the data for two selected regions within the community.

In the following section, data for Evansville patients living in Warrick, Posey, Gibson and Vanderburgh counties are grouped (and referred to as the Four-County Area) and compared to Vanderburgh county itself.

The Evansville Community Health Audit™ Volume I studies the community's entire claims for the period, comparing totals for Indiana, Illinois and Kentucky patients.

CHART 1 ­ Total Claims

The facing page presents the comparisons of Evansville's Indiana patients' total claims for the period audited (November, 1993 through October, 1994). The actual dollar amounts are presented below for clarity of comparison.

For the entire Four-County Area and for Vanderburg County, Medicare patients incurred the majority of health care claims costs, followed by Private Payors' patients. 71% of the claims costs for Evansville's patients residing in Indiana was filed by patients residing in Vandergurgh county.

FOUR-COUNTY AREA PATIENTS

Payor Claims Cost % of Cost

MEDICAID $33,894,458 9%
SELF PAY $11,930,988 3%
MEDICARE $166,423,741 47%
PRIVATE PAY $144,963,995 41%
TOTAL $357,213,182 100%

VANDERBURGH PATIENTS

Payor Claims Cost % of Cost

MEDICAID $27,717,218 11%
SELF PAY $9,207,666 4%
MEDICARE $122,061,910 48%
PRIVATE PAY $92,982,540 37%
TOTAL $251,969,334 100%

CHART 2 - Lifestyle/Behavior Claims as a Percentage of Total Claims

Evansville's Indiana patients filed $150,354,527 in lifestyle/behavior related claims. This represents 42% of all claims filed by Indiana residents at the community's hospitals during the period audited. The Audit found that 70% ($105,545,087) of the region's lifestyle-related claims cost was incurred by Vanderburgh county residents

FOUR-COUNTY AREA PATIENTS

ALL OTHER CLAIMS $206,858,655 58%
LIFESTYLE RELATED $150,354,527 42%
TOTAL $357,213,182 100%

VANDERBURGH PATIENTS

ALL OTHER CLAIMS $146,424,247 58%
LIFESTYLE RELATED $105,545,087 42%
TOTAL $251,969,334 100%

CHART 3 - Lifestyle Related Claims: Potential Savings vs. Non-Savings

The potential savings represents costs that could potentially be avoided through improvements in lifestyle habits and behaviors. These figures also provide a "budget maximum" when planning for intervention expenditures. For example, potential savings for Evansville's Indiana patients residing in Vanderburgh County totals $44,054,489. This is 42% of its total of $105,545,087 of lifestyle/behavior related claims. In preparing a budget for health promotion, the dollars allocated for this group should never exceed the potential savings amount, since no program is 100% effective in reducing risk factors. And given the nature of lifestyle related illness, namely that in many cases it is the result of long-term behavior, the potential savings should be viewed also as a long-term goal, with incremental progress achieved each year, and budgeted accordingly.

Vanderburgh County residing patients incurred 71% ($44,054,489) of Evansville's Indiana patients' total potentially avoidable claims dollars ($62,159,678).

FOUR-COUNTY AREA PATIENTS

POTENTIAL SAVINGS $62,159,678 41%
NON-SAVINGS $88,194,848 59%
TOTAL LIFESTYLE $150,354,527 100%

VANDERBURGH PATIENTS

POTENTIAL SAVINGS $44,054,489 42%
NON-SAVINGS $61,490,598 58%
TOTAL LIFESTYLE $105,545,087 100%

CHART 4 - Lifestyle Claims and Potential Savings by Region

Charts 4 through 14 will allow the Evansville Community to zero in on where the lifestyle/behavior related claims are occurring, and target health promotion efforts accordingly. Chart 4 presents a break down of the lifestyle costs and potential savings by region and payor.

Chart 4 comparisons reveal that in both the entire Four-County Area and Vanderburgh County, Medicare filers generated the most potential savings, followed by Private Payors' patients.

FOUR-COUNTY AREA PATIENTS

Payor L/B Related $ % L/B Potential Savings $ % Savings

MEDICAID $9,958,059 7%$5,148,437 8%
SELF PAY $5,586,766 4%$2,748,606 4%
MEDICARE $77,995,775 52% $29,135,394 47%
PRIVATE PAY $56,813,927 38% $25,127,242 40%
TOTAL $150,354,527 100% $62,159,678 100%

VANDERBURGH PATIENTS

Payor L/B Related $ % L/B Potential Savings $ % Savings

MEDICAID $8,029,033 8%$4,224,505 10%
SELF PAY $4,354,692 4%$2,181,130 5%
MEDICARE $56,809,759 54% $21,434,767 49%
PRIVATE PAY $36,351,603 34% $16,214,088 37%
TOTAL $105,545,087 100% $44,054,489 100%

CHART 5 - Lifestyle Cost & Potential Savings by Health Risk for All Patients

Chart 6 opposite illustrates the lifestyle costs and potential savings for all Evansville's Indiana patients during the period audited. Lack of exercise accounted for the most avoidable claims cost, followed by accidents, obesity and smoking.

FOUR-COUNTY AREA PATIENTS

Risk Category L/B Related $ % L/B Potential Savings $ % Savings

SMOKING $21,593,945 14% $9,127,114 15%
OBESITY $33,385,185 22% $11,986,474 19%
CHOLESTEROL $15,562,181 10%$2,673,271 4%
BLOOD PRESSURE $16,919,444 11%$4,007,001 6%
EXERCISE $24,799,226 16% $14,237,340 23%
STRESS $3,865,201 3%$2,692,165 4%
ALCOHOL $7,561,794 5%$3,071,825 5%
DRUGS $1,836,173 1%$1,316,751 2%
DENTAL $90,079 0%$84,148 0%
PRENATAL $540,509 0%$282,793 0%
ACCIDENTS $24,051,357 16% $12,532,862 20%
STD$149,431 0%$147,936 0%
TOTAL $150,354,527 100% $62,159,678 100%

VANDERBURGH PATIENTS

Risk Category L/B Related $ % L/B Potential Savings $ % Savings

SMOKING $15,022,987 14% $6,459,851 15%
OBESITY $23,341,077 22% $8,539,761 19%
CHOLESTEROL $10,520,990 10%$1,786,883 4%
BLOOD PRESSURE $12,029,407 11%$2,917,658 7%
EXERCISE $16,287,053 15% $9,205,874 21%
STRESS $2,966,302 3%$2,066,570 5%
ALCOHOL $5,659,390 5%$2,437,603 6%
DRUGS $1,433,508 1%$1,032,607 2%
DENTAL $57,223 0%$52,794 0%
PRENATAL $418,921 0%$223,102 1%
ACCIDENTS $17,730,085 17% $9,254,426 21%
STD$78,142 0%$77,360 0%
TOTAL $105,545,087 100% $44,054,489 100%

Chart 6 - Potential Savings by Age and Sex for All Patients

Chart 6 on the opposite page and the tables below provide an age/sex distribution of potential savings for all Evansville's Indiana patients. For both regions, males and females filed equal avoidable claims costs, with males age 45 to 64 and 18 to 44 and females over 75 incurring the largest single portions of potential savings. Patients in all age/sex groups 18 and over filed significant avoidable claims costs.

FOUR-COUNTY AREA PATIENTS

Age
Males
Males
Females
Females
0 - 17 $1,862,749 3%$1,745,726 3%
18 - 44 $7,972,946 13% $6,794,786 11%
45 - 64 $9,353,734 15% $7,486,435 12%
65 - 74 $7,167,530 12% $6,834,881 11%
75 + $5,007,640 8%$7,933,251 13%
TOTAL $31,364,598 50%$30,795,080 50%

VANDERBURGH PATIENTS

Age
Males
Males
Females
Females
0 - 17 $1,305,359 3%$1,329,216 3%
18 - 44 $5,746,959 13% $4,844,381 11%
45 - 64 $6,212,199 14% $4,957,406 11%
65 - 74 $5,195,066 12% $4,796,281 11%
75 + $3,672,109 8%$5,995,513 14%
TOTAL $22,131,692 50%$21,922,797 50%

CHART 7 - Medicare Patients' Lifestyle Cost & Potential Savings by Risk

The top health risk categories for Evansville's Medicare patients residing in Indiana were: obesity, smoking and lack of exercise, followed by accidents and blood pressure.

FOUR-COUNTY AREA PATIENTS

Risk Category L/B Related $ % L/B Potential Savings $ % Savings

SMOKING $13,117,585 17% $6,008,205 21%
OBESITY $18,722,353 24% $6,473,463 22%
CHOLESTEROL $9,483,589 12%$1,619,961 6%
BLOOD PRESSURE $11,987,686 15% $2,979,634 10%
EXERCISE $11,761,057 15% $5,700,473 20%
STRESS $868,635 1%$607,564 2%
ALCOHOL $2,934,494 4%$1,036,871 4%
DRUGS $225,721 0%$147,053 1%
DENTAL $25,980 0%$24,788 0%
PRENATAL $5,184 0% $2,409 0%
ACCIDENTS $8,783,399 11% $4,455,685 15%
STD$80,090 0%$79,289 0%
TOTAL $77,995,775 100%$29,135,394 100%

VANDERBURGH PATIENTS

Risk Category L/B Related $ % L/B Potential Savings $ % Savings

SMOKING $9,409,276 17% $4,387,954 20%
OBESITY $13,817,317 24% $4,851,651 23%
CHOLESTEROL $6,688,300 12%$1,129,687 5%
BLOOD PRESSURE $8,955,939 16% $2,242,617 10%
EXERCISE $8,329,794 15% $4,007,870 19%
STRESS $748,082 1%$523,253 2%
ALCOHOL $2,101,217 4%$806,689 4%
DRUGS $212,752 0%$139,034 1%
DENTAL $14,270 0%$13,533 0%
PRENATAL $5,184 0% $2,409 0%
ACCIDENTS $6,496,583 11% $3,299,334 15%
STD$31,046 0%$30,736 0%
TOTAL $56,809,759 100%$21,434,767 100%

CHART 8 - Medicare Patients' Potential Savings by Age and Sex

Chart 9 on the opposite page and the tables below provide a break down of the potential savings for Evansville Community's Medicare patients by age and sex.

Obesity-related potential savings were found primarily among males and females 65 to 74 and females 75 to 84 for the Four-County area, with more costs concentrated among females 65 to 84 for Vanderburgh patients. For both groups, males and females 65 to 74 and males 75 to 84 filed most of the potentially avoidable costs related to smoking. Potential savings related to exercise was incurred by males and females 65 to 74 in Vanderburgh County, while the Four-County Area experienced high costs also in the females 75 to 84 age band.

FOUR-COUNTY AREA PATIENTS

Age
Males
Males
Females
Females
0 - 64 $2,151,686 7%$1,668,430 6%
65 - 74 $6,559,048 23% $6,558,451 23%
75 - 84 $3,876,991 13% $5,676,075 19%
85 + $719,049 2%$1,925,664 7%
TOTAL $13,306,774 46%$15,828,620 54%

VANDERBURGH PATIENTS

Age
Males
Males
Females
Females
0 - 64 $1,654,180 8%$1,340,461 6%
65 - 74 $4,762,518 22% $4,600,363 21%
75 - 84 $2,896,754 14% $4,202,860 20%
85 + $464,986 2%$1,512,644 7%
TOTAL $9,778,438 46%$11,656,328 54%

CHART 9 - Medicaid Patients' Lifestyle Cost & Potential Savings by Risk

The top risk categories for Evansville's Medicaid patients residing in Indiana were accidents and obesity, followed by stress and lack of exercise. Accident-related claims costs represent the most potential for savings.

FOUR-COUNTY AREA PATIENTS

Risk Category L/B Related $ % L/B Potential Savings $ % Savings

SMOKING $1,443,153 14%$628,877 12%
OBESITY $1,856,638 19% $957,900 19%
CHOLESTEROL $557,072 6%$98,223 2%
BLOOD PRESSURE $501,435 5%$131,072 3%
EXERCISE $1,071,032 11% $667,290 13%
STRESS $961,080 10% $669,491 13%
ALCOHOL $935,470 9%$520,796 10%
DRUGS $390,166 4%$266,085 5%
DENTAL $20,643 0%$19,337 0%
PRENATAL $334,264 3%$181,863 4%
ACCIDENTS $1,860,356 19% $981,021 19%
STD$26,750 0%$26,482 1%
TOTAL $9,958,059 100%$5,148,437 100%

VANDERBURGH PATIENTS

Risk Category L/B Related $ % L/B Potential Savings $ % Savings

SMOKING $1,075,868 13%$479,007 11%
OBESITY $1,428,391 18% $734,063 17%
CHOLESTEROL $423,370 5%$73,584 2%
BLOOD PRESSURE $363,275 5%$98,386 2%
EXERCISE $784,298 10% $496,011 12%
STRESS $855,685 11% $596,193 14%
ALCOHOL $825,201 10%$462,985 11%
DRUGS $338,621 4%$232,970 6%
DENTAL $18,554 0%$17,342 0%
PRENATAL $245,558 3%$140,586 3%
ACCIDENTS $1,648,093 21% $871,480 21%
STD$22,119 0%$21,898 1%
TOTAL $8,029,033 100%$4,224,505 100%

CHART 10 - Medicaid Patients Potential Savings by Age and Sex

Females incurred the majority of the avoidable claims cost for Evansville's Indiana Medicaid patients. Avoidable costs related to accidents were found among females age 18 to 44, followed by males 0 to 17 and 18 to 44. CHA found obesity related potential savings in the female 18 to 44 age band as well, followed by females 45 to 64 and males 18 to 44.

FOUR-COUNTY AREA PATIENTS

Age
Males
Males
Females
Females
0 - 17 $470,295 9%$443,238 9%
18 - 44 $596,207 12% $1,411,304 27%
45 - 64 $801,135 16% $1,106,612 21%
65 - 74 $19,972 0%$19,815 0%
75 + $154,470 3%$125,389 2%
TOTAL $2,042,079 40%$3,106,358 60%

VANDERBURGH PATIENTS
Age
Males
Males
Females
Females
0 - 17 $412,631 10%$368,935 9%
18 - 44 $520,591 12% $1,219,877 29%
45 - 64 $630,341 15% $842,386 20%
65 - 74 $213 0% $19,422 0%
75 + $106,544 3%$103,563 2%
TOTAL $1,670,320 40%$2,554,184 60%

CHART 11 - Self-Paying Patients' Lifestyle Cost & Potential Savings by Risk

Evansville's Self-Paying patients residing in Indiana filed the majority of lifestyle and potentially avoidable claims costs in the accident category. Significant costs were also found in the exercise, alcohol, and obesity categories.

FOUR-COUNTY AREA PATIENTS

Risk Category L/B Related $ % L/B Potential Savings $ % Savings

SMOKING $443,716 8%$131,433 5%
OBESITY $828,394 15% $295,018 11%
CHOLESTEROL $284,377 5%$51,242 2%
BLOOD PRESSURE $225,424 4%$52,435 2%
EXERCISE $641,965 11% $417,107 15%
STRESS $228,284 4%$158,855 6%
ALCOHOL $558,486 10% $304,697 11%
DRUGS $306,053 5%$190,253 7%
DENTAL $18,545 0%$17,665 1%
PRENATAL $33,439 1%$15,538 1%
ACCIDENTS $2,014,931 36% $1,111,239 40%
STD$3,154 0%$3,123 0%
TOTAL $5,586,766 100%$2,748,606 100%

VANDERBURGH PATIENTS

Risk Category L/B Related $ % L/B Potential Savings $ % Savings

SMOKING $326,611 8%$93,135 4%
OBESITY $625,092 14% $236,936 11%
CHOLESTEROL $182,312 4%$32,157 1%
BLOOD PRESSURE $161,095 4%$37,479 2%
EXERCISE $448,779 10% $295,953 14%
STRESS $179,649 4%$125,064 6%
ALCOHOL $459,852 11% $254,837 12%
DRUGS $263,806 6%$163,450 7%
DENTAL $8,451 0% $7,963 0%
PRENATAL $20,722 0%$9,629 0%
ACCIDENTS $1,675,170 38% $921,405 42%
STD$3,154 0%$3,123 0%
TOTAL $4,354,692 100%$2,181,130 100%

CHART 12 - Self-Paying Patients' Potential Savings by Age and Sex

Males age 18 to 44 generated the majority of Evansville's Indiana Self-Paying patients' potential savings. Females of the same age also generated significant avoidable costs.

FOUR-COUNTY AREA PATIENTS

Age
Males
Males
Females
Females
0 - 17 $114,393 4%$103,061 4%
18 - 44 $1,054,986 38% $656,692 24%
45 - 64 $340,547 12%$307,078 11%
65 - 74 $28,283 1%$39,973 1%
75 + $35,491 1%$68,103 2%
TOTAL $1,573,700 57%$1,174,906 43%

VANDERBURGH PATIENTS

Age
Males
Males
Females
Females
0 - 17 $76,713 4%$80,289 4%
18 - 44 $901,753 41% $511,800 23%
45 - 64 $256,552 12%$219,998 10%
65 - 74 $17,437 1%$30,101 1%
75 + $28,471 1%$58,016 3%
TOTAL $1,280,926 59%$900,204 41%

CHART 13 - Private Insurers' Patients' Lifestyle Costs and Savings by Risk

Evansville's Private Insurers' Patients residing in Indiana incurred lifestyle related and potentially avoidable costs primarily in the exercise, accident and obesity categories.

FOUR-COUNTY AREA PATIENTS

Risk Category L/B Related $ % L/B Potential Savings $ % Savings

SMOKING $6,589,491 12%$2,358,599 9%
OBESITY $11,977,800 21% $4,260,092 17%
CHOLESTEROL $5,237,143 9%$903,845 4%
BLOOD PRESSURE $4,204,899 7%$843,858 3%
EXERCISE $11,325,173 20% $7,452,470 30%
STRESS $1,807,202 3%$1,256,256 5%
ALCOHOL $3,133,344 6%$1,209,461 5%
DRUGS $914,232 2%$713,360 3%
DENTAL $24,911 0%$22,358 0%
PRENATAL $167,623 0%$82,984 0%
ACCIDENTS $11,392,671 20% $5,984,917 24%
STD$39,437 0%$39,042 0%
TOTAL $56,813,927 100%$25,127,242 100%

VANDERBURGH PATIENTS

Risk Category L/B Related $ % L/B Potential Savings $ % Savings

SMOKING $4,211,231 12%$1,499,755 9%
OBESITY $7,470,278 21% $2,717,111 17%
CHOLESTEROL $3,227,009 9%$551,455 3%
BLOOD PRESSURE $2,549,098 7%$539,177 3%
EXERCISE $6,724,182 18% $4,406,041 27%
STRESS $1,182,886 3%$822,060 5%
ALCOHOL $2,273,120 6%$913,092 6%
DRUGS $618,331 2%$497,152 3%
DENTAL $15,949 0%$13,956 0%
PRENATAL $147,458 0%$70,479 0%
ACCIDENTS $7,910,239 22% $4,162,206 26%
STD$21,823 0%$21,604 0%
TOTAL $36,351,603 100%$16,214,088 100%

CHART 14 - Private Insurers' Patients' Potential Savings by Age and Sex

Males 45 to 64, followed by males 18 to 44 and females of the same ages, filed most of the potentially avoidable costs related to lack of exercise for Indiana Private Insurers' patients. Avoidable accident-related costs were found among males 18 to 44, followed by females of the same ages and males 45 to 64 and under 18. Obesity was a high cost factor among females 45 to 64 and males of the same ages, followed by females 18 to 44.

FOUR-COUNTY AREA PATIENTS

Age
Males
Males
Females
Females
0 - 17 $1,278,061 5%$1,193,645 5%
18 - 44 $5,739,428 23% $4,351,370 17%
45 - 64 $6,642,692 26% $4,785,518 19%
65 - 74 $560,227 2%$216,642 1%
75 + $221,639 1%$138,021 1%
TOTAL $14,442,046 57%$10,685,196 43%

VANDERBURGH PATIENTS
Age
Males
Males
Females
Females
0 - 17 $816,014 5%$879,991 5%
18 - 44 $3,849,419 24% $2,796,927 17%
45 - 64 $4,146,321 26% $2,870,338 18%
65 - 74 $414,898 3%$146,395 1%
75 + $175,354 1%$118,429 1%
TOTAL $9,402,007 58%$6,812,081 42%

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