Health Care Trends: Cost

Provides data on the cost of health care, reflecting payments and charges by diagnosis and procedures in Michigan and nationally along with an identification of key areas of use of health care services and regional variations in care.  Trend data is provided to enable tracking of changes in cost and use patterns over time.

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In health care costs, Michigan is doing something right

Editor’s Note: This column was published in Bridge Magazine. Variation in health care spending between states has been well documented for decades by many researchers, most notably, those who produce the Dartmouth Atlas of Health Care. The reasons behi …

Publication

Health Plan Selection: Factors Influencing Michiganders’ Choice of Health Insurance

              Introduction 2014 marked the first open enrollment for individual coverage on the health insurance marketplace. In Michigan, over 272,000 people enrolled in health coverage during this time,1 choosing fr …

News Article

Costs, Not Physician Choice, Most Important Factor In Individual Health Coverage Plan Selection

A report released today by the Center for Healthcare Research & Transformation (CHRT) shows that individuals selecting health coverage in Michigan are making their buying decision based on costs more than choice of physicians and network size. The …

News Article

Hospital Costs Lower in Michigan than in Indiana, Wisconsin; Michigan’s Certificate of Need Laws, Dominant Insurer Likely Contributed to Differences

A report released today by the Center for Healthcare Research & Transformation (CHRT) shows substantial variation in hospital costs between Indiana, Michigan and Wisconsin, with Michigan as the lowest cost among the three states. Many complex facto …

Publication

A Tale of Three Cities: Hospital and Health System Costs in the Midwest

      There is tremendous variation in health care spending by geographic region in the United States.5 To better understand this variation, CHRT analyzed health care markets, state-level regulation, and hospital cost variation in three …

Publication

Rate Analysis: 2015 Michigan Health Insurance Marketplace

              Overview of the 2015 Michigan Health Insurance MarketplaceOn November 15, 2014, Michigan’s health insurance marketplace launched its second annual open enrollment period. During this period, which runs u …

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We must save lives by stopping this silent killer

Co-authors Marianne Udow-Phillips, director of the Center for Healthcare Research & Transformation Theodore J. Iwashyna, M.D., Ph.D., Research Scientist, Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System; Associate P …

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Obesity in Michigan: What Can We Do?

Editor’s Note: This column appeared in Bridge Magazine. In 1990, 14.1 percent of Michigan’s population was considered obese. Twenty years later, that rate was at 30.3 percent and has stayed fairly constant for the last few years. Michigan is one of the …

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A Crucial Ingredient in the Affordable Care Act to Getting Young People to Get Coverage

Like everyone I know who is a health policy junkie, I have been very excited about the launch of the health insurance exchanges. But, my excitement is not just because of my professional interest—and wanting to see how these things actually work and ho …

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Explaining the Affordable Care Act

Health care reform is indeed a journey—not a destination. And, judging from all of the requests that our Center is getting to explain the Affordable Care Act, it is probably going to be a journey for a very long time (assuming, of course, that it doesn …

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The Importance of Federally Qualified Health Centers and the ACA

Editor’s Note: This column appeared in Bridge Magazine. About six months after the Affordable Care Act (ACA) was passed in 2010, our Center hosted a symposium in Ann Arbor on the future of the health care safety net. Sara Rosenbaum, an expert on both t …

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Patient Engagement and Shared Decision Making: Is This the Moment?

Patient engagement is a hot topic in health care right now. Providers, regulators and health plans are all trying to figure out how to better involve patients in their own medical care. Shared decision making—a concept that grew out of Jack Wennberg’s …

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Obamacare seems to be Helping to Curtail Health Care Costs

Editor’s Note: This column previously appeared in Bridge Magazine. In recent months, a conversation has burgeoned in health and public policy forums about the slowdown in the growth of health care spending. We are all asking the same questions: Is this …

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The Medicaid Expansion in Michigan Needs to Get Done Now

Editor’s Note: This column previously appeared in Bridge Magazine. On February 6, 2013, Governor Snyder announced his support for expanding Medicaid as envisioned in the Affordable Care Act. In his announcement, he talked about how the expansion would …

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The ACA and the Hospital Readmissions Policy Debate

Of the Affordable Care Act’s (ACA’s) many provisions aimed at improving health care access, quality, and efficiency, one has been the subject of considerable recent debate: the hospital readmission reduction program. The program’s approach has some mer …

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The Bitter Pill: Time Magazine’s Story on Health Care Costs

Steven Brill’s article on health care costs in the March 4 issue of Time magazine is the talk of the town in health care. While journalists have generally praised the piece, reactions from those in health care have been mixed. The American Hospital Ass …

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The Slowdown in Health Care Costs: Is it Real?

On February 5, 2013, Congressional Budget Office (CBO) director Douglas Elmendorf testified before Congress on the CBO’s budget outlook for 2013-2023. As reported in the New York Times and elsewhere, the health care outlook was remarkable: projected Me …

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Positive Steps Towards Improving Quality and Reducing Costs

Why does health care cost so much more in America than in any other country in the world? One major reason is that our system is really a non-system. That is, in America we have many different payers, financing mechanisms, benefit designs, and structur …

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The Medicare Facts

Medicare is a sensitive political topic. Today’s seniors are understandably protective of their benefits, and future seniors are worried those benefits won’t be there when they become eligible (whether the eligibility age is increased or not). But for …

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It’s the Math: The Medicaid Expansion in Michigan

In many respects, the Affordable Care Act is a law about health care coverage. It is designed to expand coverage, mostly by using two tools: (1) the requirement for individuals to have/purchase health coverage or face tax penalties (known as the indivi …

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A Caveat on the Cheesecake Factory and Health Care

Atul Gawande’s latest article in the New Yorker magazine is a hot trending story in health care. It even spawned an editorial in the Wall Street Journal that seemed oddly confused about what Gawande was advocating. In his article, Gawande talks about l …

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Poverty and Health: A Connection We Can’t Ignore

In a New York Times op-ed last December, Elizabeth Bradley and Lauren Taylor wrote about the study of global health spending published they published in the journal BMJ Quality and Safety. Their analysis broadened the concept of international health ca …

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After SCOTUS: The Status Quo is Not an Option

Everybody and their brother will be blogging about the Supreme Court arguments on health care reform over the next several weeks. I do not want to add to the noise by focusing on the arguments and/or who has the winning position: many others will offer …

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Who Can Tell the Public the Truth About Health Care Costs?

The Feb. 16 issue of the New England Journal of Medicine had an excellent commentary by Peter Newman about how difficult it is to talk to the public about health care costs. He captures the issue well: “The problem is that no one in charge seems willin …

Publication

Health Care Cost Drivers: Chronic Disease, Comorbidity, and Health Risk Factors in the U.S. and Michigan

[Revised with minor corrections, including re-numbered figures, on September 24, 2010.] In the wake of national health reform, health systems, health plans, providers, and policy makers will be discussing what can be done to contain health care costs—w …

  1. .S. Department of Health and Human Services. May 2014. Profile of Affordable Care Act Coverage Expansion Enrollment in Medicaid/CHIP and the Health Insurance Marketplace, 10-1-2013 to 3-31-2014: Michigan. http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/pdf/mi.pdf (accessed 4/10/15).
  2. CHRT analysis of data available at data.healthcare.gov.
  3. J. Fangmeier. Rate Analysis: 2015 Michigan Health Insurance Marketplace. (Ann Arbor: MI: Center for Healthcare Research & Transformation, January 2015). http://www.chrt.org/publication/rate-analysis-2015-michigan-health insurance-marketplace.
  4. CHRT analysis of data available at data.healthcare.gov.
  5. R.M. Henke et al. 2011. Geographic Variation: A View From the Hospital Sector. Medical Care Research and Review, 68(6): 699-711.
  6. Kaiser Family Foundation. 2014. Health Care Expenditures per Capita by State of Residence, 2009. http://kff.org/other/state-indicator/health-spending-per-capita/ (accessed 1/1/15).
  7. Kaiser Family Foundation. 2014. Average Annual Percent Growth in Health Care Expenditures by State of Residence, 2009. http://kff.org/other/state-indicator/averageannual-percent-growth-in-health-care-expenditures-by-state-of-residence/ (accessed 1/1/15).
  8. Kaiser Family Foundation. 2014. Large Group Insurance Competition, 2012. http://kff.org/other/state-indicator/large-group-insurance-market-competition/ (accessed 12/23/14).
  9. Kaiser Family Foundation. 2014. Small Group Insurance Competition, 2012. http://kff.org/other/state-indicator/small-group-insurance-market-competition/ (accessed 12/23/14).
  10. Kaiser Family Foundation. 2014. Individual Insurance Competition, 2012. http://kff.org/other/state-indicator/individual-insurance-market-competition/ (accessed 12/23/14).
  11. Kaiser Family Foundation. 2014. Health Care Expenditures per Capita by State of Residence, 2009. http://kff.org/other/state-indicator/health-spending-per-capita/ (accessed 1/1/15).
  12. Kaiser Family Foundation. 2014. Large Group Insurance Competition, 2012. http://kff.org/other/state-indicator/large-group-insurance-market-competition/ (accessed 12/23/14).
  13. Kaiser Family Foundation. 2014. Small Group Insurance Competition, 2012. http://kff.org/other/state-indicator/small-group-insurance-marketcompetition/ (accessed 12/23/14).
  14. Kaiser Family Foundation. 2014. Individual Insurance Competition, 2012. http://kff.org/other/state-indicator/individual-insurance-market-competition/ (accessed 12/23/14).
  15. National Conference of State Legislators. 2014. Certificate of Need: State Health Laws and Programs. http://www.ncsl.org/research/health/con-certificate-of-needstate-laws.aspx (accessed 12/23/14)
  16. G. Boulton. April 15, 2012. Froedtert Health, other systems court customers in affluent areas. Milwaukee Journal Sentinel. (accessed 12/24/14).
  17. J.K. Wall. June 1, 2013. Indianapolis hospitals hit with tough bargaining environment. Indianapolis Business Journal. (accessed 12/22/14).
  18. National Conference of State Legislators. 2014. Certificate of Need: State Health Laws and Programs. http://www.ncsl.org/research/health/con-certificate-ofneed-state-laws.aspx (accessed 12/23/14).
  19. Kaiser Family Foundation. 2014. Health Care Expenditures per Capita by State of Residence, 2009. http://kff.org/other/stateindicator/health-spending-per-capita/ (accessed 1/1/15).
  20. Kaiser Family Foundation. 2014. Average Annual Percent Growth in Health Care Expenditures by State of Residence, 2009. http://kff.org/other/state-indicator/average-annual-percent-growth-in-healthcare-expenditures-by-state-of-residence/ (accessed 1/1/15).
  21. Kaiser Family Foundation. 2014. Health Care Expenditures per Capita by Service by State of Residence, 2009. http://kff.org/other/state-indicator/health-spending-per-capitaby- service/ (accessed 12/23/14).
  22. This report focuses on hospital costs rather than health insurance premiums. However, it is important to note that lower hospital costs may not correspond to lower premiums.
  23. United States Census Bureau. N.d. American FactFinder: Community Facts. http://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml (accessed 2/23/15).
  24. Total profit margin is referred to as “excess” profit margin by health care rating agencies such as Standard and Poor’s.
  25. M.E. McNamara and J. H. Goldman. 2014. U.S. Not-For-Profit Health Care System Ratios: Operating Performance Weakened in 2013. (New York, NY: Standard and Poor’s Financial Services). http://www.standardandpoors.com/spf/upload/Events_US/US_PF_Event_Webcast81414_NFPHC_Article2.pdf (accessed 12/30/14).
  26. Kaiser Family Foundation. 2014. Health Care Expenditures per Capita by Service by State of Residence, 2009. http://kff.org/other/state-indicator/health-spending-per-capita-by-service/ (accessed 12/23/14).
  27. M.R. McKellar et al. 2014. Insurer Market Structure and Variation in Commercial Health Care Spending. Health Services Research, 49(3): 878-892.
  28. G.A. Melnick et al. 2011. The Increased Concentration of Health Plan Markets Can Benefit Consumers Through Lower Hospital Prices. Health Affairs, 30(9): 1728-1733.
  29. A.S. Moriya et al. 2010. Hospital Prices and Market Structure in the Hospital and Insurance Industries. Health Economics, Policy and Law, 5: 459-479.
  30. Kaiser Family Foundation. 2014. Large Group Insurance Competition, 2012. http://kff.org/other/state-indicator/large-group-insurance-market-competition/ (accessed 12/23/14).
  31. Kaiser Family Foundation. 2014. Small Group Insurance Competition, 2012. http://kff.org/other/state-indicator/small-group-insurance-market-competition/ (accessed 12/23/14).
  32. Kaiser Family Foundation. 2014. Individual Insurance Competition, 2012. http://kff.org/other/state-indicator/individual-insurance-market-competition/ (accessed 12/23/14).
  33. Market concentration is measured by the Herfindahl-Hirschman Index (HHI). The index quantifies market concentration based on how evenly market share is distributed. HHI values range from 0 to 10,000, where zero indicates perfect competition and 10,000 indicates a complete monopoly. It is calculated by squaring the market share of each firm and summing these values. HHI values below 1,000 generally indicate that a market is highly competitive; values from 1,000 to 1,500 indicate an unconcentrated market; values from 1,500 to 2,500 indicate a moderately concentrated market; and values greater than 2,500 indicate a highly concentrated, or uncompetitive, market.
  34. L.P. Garrison, Jr. 1991. Assessment of the Effectiveness of Supply-Side Cost-Containment Measures. Health Care Financing Review, Supplement: 13-20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195140/ (accessed 2/18/15).
  35. F. Hellinger. 2009. The Effect of Certificate-of-Need Laws on Hospital Beds and Healthcare Expenditures: An Empirical Analysis. American Journal of Managed Care, 15(10):737-744.
  36. V. Ho et al. 2007. Cardiac Certificate of Need Regulations and the Availability and Use of Revascularization Services. American Heart Journal, 154: 767-775. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2084214/ (accessed 2/18/15).
  37. C.J. Conover and F.A. Sloan. 1998. Does Removing Certification-of-Need Regulations Lead to a Surge in Health Care Spending? Journal of Health Politics, Policy and Law, 23(3): 455-481
  38. P.L. Delameter et al. 2013. Do More Hospital Beds Lead to Higher Hospitalization Rates? A Spatial Examination of Roemer’s Law. PLOS One, 8(2): e54900. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0054900 (accessed 1/1/15).
  39. D.M. Berwick. 2002. A User’s Manual for the IOM’s “Quality Chasm’ Report.” Health Affairs, 21(3): 80-90. http://healthaff.highwire.org/content/21/3/80.full.pdf+html (accessed 1/14/15).
  40. National Conference of State Legislators. 2014. Certificate of Need: State Health Laws and Programs. http://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx (accessed 12/23/14).
  41. G. Boulton. April 15, 2012. Froedtert Health, other systems court customers in affluent areas. Milwaukee Journal Sentinel. http://www.jsonline.com/business/froedtert-health-other-systems-court-customers-in-affluent-areas-g24vqj0-147497635.html (accessed 12/24/14).
  42. G. Boulton. November 29, 2014. Free-standing emergency departments carry a high price for convenience. Milwaukee Journal Sentinel. http://www.jsonline.com/business/free-standing-emergency-departments-carry-a-high-price-for-convenienceb99398740z1- 284225751.html (accessed 12/24/14).
  43. Wheaton Franciscan Healthcare. 2013. Wheaton Franciscan Healthcare to Build New Medical Clinic in Cudahy. http://www.mywheaton.org/about-wheaton/newsroom/wheaton-franciscan-healthcare-to-build-new-medical-clinic-in-cud/ (accessed 12/24/14).
  44. Wheaton Franciscan Healthcare. 2013. Wheaton Franciscan Healthcare – All Saints to Open New Physician Office Building. http://www.mywheaton.org/about-wheaton/newsroom/all-saints-to-open-new-physician/ (accessed 12/24/14).
  45. G. Boulton. March 19, 2013. Colombia St. Mary’s ProHealth Care to develop joint cardiothoracic surgery program. Milwaukee Journal Sentinel. http://www.jsonline.com/business/columbia-st-marys-prohealth-care-to-develop-joint-cardiothoracic-surgery-program-iu97gdd-198966601.html (accessed 12/24/14).
  46. Aurora Health Care. 2013. Aurora Health Care purchases Manitowoc Surgery Center. http://www.aurorahealthcare.org/aboutus/news-media-center/release.asp?AutoNumber=823 (accessed 12/24/14).
  47. G. Boulton. August 6, 2014. Six Wisconsin health care systems form statewide network. Milwaukee Journal Sentinel. http://www.jsonline.com/business/six-wisconsin-health-care-systems-form-statewide-network-b99325675z1-270178061.html (accessed 12/24/14).
  48. G. Boulton. November 11, 2014. Froedtert Health completes purchase of Network Health stake. Milwaukee Journal Sentinel. http://www.jsonline.com/business/froedtert-health- completes-purchase-of-network-health-stake-b99388655z1-282313501.html (accessed 12/24/14).
  49. J.K. Wall. June 1, 2013. Indianapolis hospitals hit with tough bargaining environment. Indianapolis Business Journal. http://www.ibj.com/articles/41633-indianapolis-hospitals-hit-with-tough-bargaining-environment (accessed 12/22/14).
  50. J.K. Wall. September 12, 2013. Worried about future, IU Health cuts 800 jobs despite profit rise. Indianapolis Business Journal. http://www.ibj.com/articles/43479-worried-about- future-iu-health-cuts-800-jobs-despite-profit-rise (accessed 12/22/14).
  51. J.K. Wall. June 28, 2013. St. Vincent Health eliminating about 865 jobs in Indiana. Indianapolis Business Journal. http://www.ibj.com/articles/42213-st-vincent-health-eliminating- about-865-jobs-in-indiana (accessed 12/22/14).
  52. J.K. Wall. October 23, 2013. Franciscan Hospitals to eliminate 935 full time positions. Indianapolis Business Journal. http://www.ibj.com/articles/44199-franciscan-hospitals-to-eliminate-925-full-time-positions (accessed 12/22/14).
  53. Kokomo Hospital plans on cutting 50 jobs. September 17, 2013. Indianapolis Business Journal. http://www.ibj.com/articles/43557-kokomo-hospital-plans-on-cutting-50-jobs (accessed 12/22/14).
  54. Franciscan Alliance, the parent company of Franciscan St. Francis Health, eliminated 935 positions statewide in 2013. It was not specified how many of these positions were at Franciscan St. Francis Health.
  55. J. Greene. July 7, 2013. Beaumont plans $140M expansion: ER, retail. Crain’s Detroit Business. http://www.crainsdetroit.com/article/20130707/NEWS/307079979/beaumont-plans-140m-expansion-er-retail (accessed 12/30/14).
  56. J. Greene. May 10, 2013. Beaumont’s new oncology unit in Troy focuses on families, integrates “green” principles. Crain’s Detroit Business. http://www.crainsdetroit.com/article/20130510/NEWS/130519982/beaumonts-new-oncology-unit-in-troy-focuseson-families-integrates (accessed 12/30/14).
  57. J. Greene. July 7, 2013. Beaumont plans $140M expansion: ER, retail. Crain’s Detroit Business. http://www.crainsdetroit.com/article/20130707/NEWS/307079979/beaumont-plans-140m-expansion-er-retail (accessed 12/30/14).
  58. J. Greene. November 5, 2014. Botsford Hospital announces $160 million expansion. Crain’s Detroit Business. http://www.crainsdetroit.com/article/20141105/NEWS/141109935/botsford-hospital-plans-160m-expansion (accessed 12/30/14).
  59. J. Greene. July 21, 2013. Health systems use “every tool” to keep on top of bottom lines. Crain’s Detroit Business. http://www.crainsdetroit.com/article/20130721/NEWS/307219980/health-systems-use-every-tool-to-keep-on-top-of-bottom-lines (accessed 12/30/14).
  60. American Hospital Directory. 2014. http://www.ahd.com/ (accessed 12/30/14).
  61. S.A. Magnus and D.G. Smith. 2000. Better Medicare Cost Report Data are Needed to Help Hospitals Benchmark Costs and Performance. Health Care Management Review, 25(4): 65-76.
  62. F. Asper. 2013. Introduction to Medicare Cost Reports. Research Data Assistance Center. http://www.resdac.org/sites/resdac.org/files/Introduction%20to%20Medicare%20 Cost%20Reports%20(Slides).pdf (accessed 12/30/14).
  63. Audited financial statements are an alternative source of financial data for many hospitals. However, this data is not public for all hospitals and health systems.
  64. United States Census Bureau. N.d. American FactFinder: Community Facts. http://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml (accessed 2/23/15).
  65. Contractual allowances refer to discounts negotiated by insurers on behalf of their members.
  66. Total operating expenses included depreciation expenses.
  67. J. Greene. September 30, 2014. DMC Surgery Hospital still closed after flooding, 127 employees to be laid off. Crain’s Detroit Business. http://www.crainsdetroit.com/article/20140930/NEWS/140939972/dmc-surgery-hospital-still-closed-after-flooding-127-employees-to-be (accessed 12/30/14).
  68. S.A. Magnus and D.G. Smith. 2000. Better Medicare Cost Report Data are Needed to Help Hospitals Benchmark Costs and Performance. Health Care Management Review, 25(4): 65-76.
  69. Total profit margin was referred to as “excess” profit margin by health care rating agencies such as S&P.
  70. American Hospital Association. 2015. Fast Facts on U.S. Hospitals. http://www.aha.org/research/rc/stat-studies/fast-facts.shtml (accessed 2/25/15).
  71. M.E. McNamara and J. H. Goldman. 2014. U.S. Not-For-Profit Health Care System Ratios: Operating Performance Weakened in 2013. (New York, NY: Standard and Poor’s Financial Services). http://www.standardandpoors.com/spf/upload/Events_US/US_PF_Event_Webcast81414_NFPHC_Article2.pdf (accessed 12/30/14).
  72. M.E. McNamara and J.H. Goldman. 2014. U.S. Not-For-Profit Health Care Stand-Alone Ratios: Operating Margin Pressure Signals More Stress Ahead. (New York, NY: Standard and Poor’s Financial Services). http://www.standardandpoors.com/spf/upload/Events_US/US_PF_Event_Webcast81414_NFPHC_Article1.pdf (accessed 12/30/14).
  73. All marketplace analysis was completed using 2014 and 2015 qualified health plan individual market medical plan data available at data.healthcare.gov.
  74. Plan offerings do not include catastrophic plans or child-only plans.
  75. E. Carpenter. Avalere Analysis: Most Popular Exchange Plans Are Increasing Price. November 2014. Avalere Health.
  76. Centers for Disease Control and Prevention.
  77. Agency for Healthcare Research and Quality. Research in Action, issue #19. The High Concentration of U.S. Health Care Expenditures, June 2006.
  78. Healthcare Cost & Utilization Project (HCUP), 2007.
  79. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb72.jsp
  80. Data Specifications: Continuous enrollment, Age 18-64, Non-Medicare, Michigan Membership, Members with Pharmacy Benefit Coverage, Limited to claims with condition-specific diagnoses as primary or secondary (multiple) Pharmacy claims are not included (diagnosis not available on pharmacy claims) Source: BCBSM OSCAR
  81. Condition-specific spending represents payments made for medical claims with an ICD-9 code for that condition, and does not include pharmacy data. Total spending is payments for all medical and pharmacy claims for any individual who had at least one claim related to the chronic condition. Some of the spending in “total spending” could be pharmacy spending related to the chronic condition. The members represented in each category are not unique—if someone has both diabetes and asthma they will be counted in each category.
  82. Ann Fam Med. 2009 July; 7(4): 357–363. doi: 10.1370/afm.983.Defining Comorbidity: Implications for Understanding Health and Health Services Valderas, J. M.MD, PhD, MPH, et. al.
  83. BMC Health Serve Res. 2006; 6: 84.Published online 2006 July 4. doe: 10.1186/1472-6963-6-84. Comorbidity in patients with diabetes mellitus: impact on medical health care utilization. Jeroen N Struijs,1 Caroline A Baan,1 Francois G Schellevis,2 Gert P Westert,1 and Geertrudis AM van den Bos
  84. Data Specifications: Continuous enrollment; Age 18–64; Non-Medicare, Michigan Membership; Members with Pharmacy Benefit Coverage; Includes all claims paid for members within each condition category regardless of diagnosis. NOTE: Patients are unique to each category. Source: BCBSM OSCAR
  85. Chronic diseases and their common risk factors. World Health Organization, 2005.
  86. MEPS Statistical Brief 247, http://www.meps.ahrq.gov/ mepsweb/data_files/publications/st247/stat247.shtml
  87. EA Finkelstein, IC Fiebelkorn, G Wang. State-Level Estimates of Annual Medical Expenditures Attributable to Obesity. Obesity Research. Vol. 12 No. 1 January 2004