9
SANOFI / MANAGED CARE DIGEST SERIES
®
/ WHERE INFORMATION BECOMES INTELLIGENCE.
™
HOSPITALS/SYSTEMS DIGEST 2013
Key Takeaway
Considering that the risk of chronic disease increases with age and the share of Americans age
65 and older is expected to continue to grow at a rapid pace, Medicare and other payers are
looking for additional ways to cut costs, while still providing efficient and effective care. With higher
incidence of chronic diseases likely resulting in increased Medicare spending on patient care, a
heavier focus on preventive care may help manage rising costs for this complex patient population.
Data source: IMS Health © 2013
• Medicare covered a noteworthy 62.0% of
inpatient prostate cancer cases in 2011, more
than double the percentage of such cases
covered by commercial insurance (30.4%).
• By comparison, 43.9% of inpatient breast cancer
cases were covered by Medicare in 2011, while
commercial insurance and Medicaid together
accounted for 50.9% of such cases.
Large Portion of Prostate Cancer Cases Is Covered by Medicare
• In 2011, the majority of inpatient cases were
patients age 65 and older for seven out of the
10 disease states listed, with the three highest
such shares tied to cardiovascular conditions.
• Yet, regardless of disease, Medicare covered
the highest share of inpatient cases in 2011.
The percentage of atrial fibrillation/atrial flutter
cases covered by Medicare topped 80%.
HOSPI TALS
DEMOGRAPHICS
PERCENTAGE OF HOSPITAL INPATIENT CASES, BY PAYER, 2011
PERCENTAGE OF INPATIENT CASES, 2011
ACS
Angina
AFib/
AFlutter
Asthma
Depres-
sion
Diabetes
Mellitus
Hyper-
tension
MS
Osteo-
arthritis
Stroke
AGE
0–14
0.0% 0.0% 0.0% 11.5% 3.0% 0.4% 0.2% 0.2% 0.0% 0.3%
15–44
4.6
4.8
2.4
30.8
44.7
11.5
9.1
25.3
2.6
4.0
45–64
42.4
35.7
18.1
32.3
37.0
37.6
36.8
52.1
40.9
27.3
65+
53.0
59.5
79.5
25.4
15.4
50.5
53.9
22.5
56.5
68.4
GENDER
Male
60.1% 56.0% 50.0% 34.9% 44.7% 48.8% 45.9% 29.6% 39.9% 49.8%
Female
39.9
44.0
50.0
65.1
55.3
51.2
54.1
70.4
60.1
50.2
PAYER
Medicare 59.0% 65.1% 80.3% 34.3% 35.5% 60.1% 59.1% 54.6% 58.3% 70.0%
Medicaid 8.3
7.4
3.5
26.2
25.0
11.9
9.4
11.9
3.8
6.1
Commercial
Insurance
1
24.5
20.5
12.6
29.5
26.2
19.8
23.1
27.7
32.6
17.2
0%
16%
32%
48%
64%
Percentage of Cases
Breast Cancer
Prostate Cancer
43.9%
12.5%
38.4%
62.0%
3.2%
30.4%
Medicare
Medicaid
Commercial Insurance
1
Aging Population Drives Need for Cardiovascular Care
CHRONIC DISEASE
1
Includes HMOs, PPOs, point-of-service plans and exclusive provider organizations.
I...,II,1,2,3,4,5,6,7,8 10,11,12,13,14,15,16,17,18,19,...IV