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HOSPI TALS IN MULT IHOSPI TAL SYSTEMS
HOSPITALS/SYSTEMS DIGEST 2013
SANOFI / MANAGED CARE DIGEST SERIES
®
/ WHERE INFORMATION BECOMES INTELLIGENCE.
™
Data source: IMS Health © 2013
UT I L I ZAT ION
Utilization Measures Are Relatively Low for MHS-Owned HMOs
Key Takeaway
By many measures, hospital and physician utilization rates fell at HMOs, regardless of MHS
ownership status, between 2010 and 2011. Still, MHS-owned HMOs reported lower utilization
across the board when compared with their non-MHS-owned counterparts in 2011, perhaps a
reflection of long-standing reductions in their member-to-hospital and member-to-PCP ratios.
1
• After annual increases between 2006 (4.0)
and 2010 (5.2), the number of physician
encounters per member at non-MHS-owned
HMOs declined modestly in 2011, to 5.0.
• Compared with non-MHS-owned HMOs
and HMOs overall (both 5.0), HMOs owned
by MHSs averaged fewer physician
encounters per member in 2011, at 4.7.
3.0
3.7
4.4
5.1
5.8
Physician Encounters
MHS-Owned HMOs
Non-MHS-Owned HMOs
All HMOs
3.9
4.2 4.3 4.2
—4.7—
4.0
4.3
4.6
5.0
5.2
5.0
4.0
4.3
4.6
4.9
5.2
5.0
2006
2007
2008
2009
2010
2011
NUMBER OF PHYSICIAN ENCOUNTERS PER HMO MEMBER, 2006–2011
• For each of the five utilization measures
profiled, HMOs owned by MHSs recorded
noticeably lower utilization ratios in 2011
than their non‑MHS‑owned counterparts.
• In 2011, HMOs owned by MHSs averaged
354.5 hospital days per 1,000 members, a
notable 10.1% below the hospital days
ratio at non-MHS-owned plans (394.3).
HMO UTILIZATION AND MEMBERS PER PROVIDER
MHS-Owned HMOs
Non-MHS-Owned HMOs
ALL HMOs
UTILIZATION MEASURE
2009 2010 2011 2009 2010 2011
2009 2010 2011
Hospital Days per
1,000 Members
353.0 367.6 354.5 391.1 407.2 394.3
385.0 401.1 388.6
Hospital Admissions per
1,000 Members
86.1 88.8 80.3 94.7 96.5 91.9
93.3 95.4 90.3
Average Length of Stay per
Hospital Admission
4.2
4.4
4.4
4.5
4.6
4.7
4.5
4.6
4.6
Average No. of Physician
Encounters per HMO Member
4.2
4.7
4.7
5.0
5.2
5.0
4.9
5.2
5.0
Average No. of Ambulatory Visits
per HMO Member
2.0
2.1
2.0
2.0
2.2
2.2
2.0
2.2
2.2
PROVIDER MEASURE
Average No. of HMO Members
per Hospital
5,861 4,809 4,721 3,380 3,714 3,600
3,740 3,862 3,754
Average No. of HMO Members
per Primary Care Physician
307
268
253
122
130
141
153
152
160
Physician Encounters per Non-MHS-Owned HMO Member Drop
LONG-TERM TREND
1
See page 12 of the HMO-PPO
Rx
Digest for 2012–2013
I...,18,19,20,21,22,23,24,25,26,27 29,30,31,32,33,34,35,36,37,38,...IV