Healthcare Costs
Inpatient, outpatient and primary care costs increased from the pre-CT SIM implementation years through the CT SIM implementation years for Medicare and private insurance beneficiaries with the exception of inpatient Medicare costs, which decreased. Total pharmacy costs, data available only for privately insured patients, had a steady increase from 2013 to 2017.
The largest expenses by far were inpatient costs with Medicare patients substantially outspending those privately insured. In 2015, the year prior to the CT SIM implementation, inpatient costs for Medicare beneficiaries were 8.5 times that of private insurance beneficiaries. Medicare costs were $611 PMPM while private insurance costs were $74 PMPM. By 2017, two years into the CT SIM implementation, inpatient costs for Medicare beneficiaries reduced to 6.2 times that of private insurance beneficiaries. Medicare inpatient costs decreased to $595 PMPM while private inpatient insurance costs increased to $90 PMPM.
Outpatient expenses increased for both Medicare and privately covered patients. In 2015, outpatient Medicare costs were $145 PMPM and private insurance costs were $56 PMPM. By 2017, costs increased to $157 PMPM for Medicare patients and to $64 PMPM for privately covered patients.
Primary care expenses increased for both Medicare and privately covered patients. In 2015, primary care costs were $31 PMPM and private insurance costs were $27 PMPM. By 2017, costs increased to $42 PMPM for Medicare patients and to $31 PMPM for privately covered patients.
Total pharmacy costs for privately insured patients increased from $98 PMPM in 2015 to $125 PMPM in 2017. Medicare pharmacy costs increased from $393 PMPM in 2013 to $497 PMPM in 2015; no data were available for 2016 nor 2017.