Small Group Claims Data

One of the carrier's provides some claims data from their pool of small groups in Virginia with certain size group renewals. We thought you might find some of the information interesting:

22% of Claims: Inpatient Services

• Surgery accounted for 52% of inpatient costs. Top “drivers” (as they called them) were cardiovascular and orthopedic procedures (including spine, knee and hip surgeries)

21% of Claims: Outpatient Services

• Surgery accounted for 23% of outpatient costs – Top driver was orthopedic surgery
• Emergency room accounted for 30% of outpatient costs
• Diagnostic procedures accounted for 37% of outpatient costs

36% of Claims: Professional Services

• Office and outpatient visits accounted for 30% of professional services
• Surgery accounted for 9% of professional services

21% of Claims: Prescriptions Drugs

• Brand name drugs account for 76% of total cost of prescription drugs
• Generic drugs are being dispensed at higher and higher rates
• People are asking for generic drugs and that is showing up in the data. Here is look at the percentage of drugs that are being dispensed as generic drugs over the last 4 years:

2005……………….51%
2006……………….57%
2007……………….62%
2008……………….67%