Trends In Medical And Pharmacy Spending In The Affordable Care Act Markets, 2015-19.

To control rising costs, it is critical for payers, providers, and policy makers to understand trends in health care spending. Using data from both on- and off-exchange Affordable Care Act (ACA)-compliant small-group and individual insurance markets in the United States for the period 2015-19, we analyzed the contributions of trends in utilization, unit price, and service mix to growth in overall health care spending. Overall annual growth trends in health care spending per member per month during that period were 4.0 percent in the small-group market and 1.1 percent in the individual market. In the small-group market, professional and outpatient facility services contributed the most to spending growth, driven by unit price increases. In the individual market, pharmacy and outpatient facility services accounted for the greatest growth in spending, driven by a combination of unit price increases and changes in the mix of services. Addressing these contributors to growth can help contain costs and premiums and provide more stability to ACA-compliant insurance markets.

A 4-Year Retrospective Claims Analysis of Oral Corticosteroid Use and Health Conditions in Newly Diagnosed Medicare FFS Patients with COPD.

Purpose: We analyzed population-level administrative claims data for Medicare fee-for-service (FFS) beneficiaries to provide insights on systemic oral corticosteroid (OCS) use patterns and associated health conditions and acute events among patients newly diagnosed with chronic obstructive pulmonary disease (COPD). Background: COPD is a progressive inflammatory disease of the lungs, characterized by acute exacerbations that may lead to increased mortality. Short courses of systemic corticosteroids (SCS) are recommended to reduce recovery time from exacerbations, although SCS use has been associated with increased risk of adverse events. Methods: This study used 2013-2019 Medicare 100% FFS research identifiable files, which contain all Medicare Parts A, B, and D paid claims incurred by 100% of Medicare FFS beneficiaries. Descriptive statistics for patients newly diagnosed with COPD were analyzed, including OCS use, select health conditions and acute events, and COPD exacerbations. Statistical models were used to analyze the relationship between the incidence of select health conditions and events and cumulative OCS dosage. Results: Of Medicare FFS patients newly diagnosed with COPD, 36% received OCS in the 48 months following diagnosis, and 38% of OCS episodes lasted longer than the recommended 5-7 days. Patients had a variety of health conditions or acute events in the 24-month period prior to new COPD diagnosis, such as hypertension, depression/anxiety, type 2 diabetes, or osteoporosis, that could heighten the risks of OCS use. Patients treated with >1000 mg of prednisolone equivalent OCS in the 48 months following COPD diagnosis had a higher incidence of new conditions or events, including cardiovascular disease, heart failure, hypertension, obesity, dyspepsia, infections, and depression/anxiety, than patients with no OCS use. Conclusion: These results highlight the potential risks of OCS in COPD treatment, including prolonged use among complex Medicare patients, and reinforce the importance of preventive treatment strategies and therapy optimization early in the disease course.