Transcript DMW Discussion Points

Sample Company Report
Discussion Points
1
This page identifies the information of the client’s current
raw medical claims and explains how it is analyzed
through the Decision Master claims analysis program.
This program will show the high/ low utilization areas
and then compared with normative benchmarks from the
Kaiser Family Foundation HRET and Medstat. This page
also states the time period, number of employees, single
and family contracts and the total enrolled.
Total enrolled is calculated as follows: Single + ((Single
+1) x 2 ))+ (( Single + 2)*3)) + (Family *3.2). This
calculation is used only when broker does not provide
exact counts on Group Submission Form, as the Total
Enrolled number can be over-ridden.
The accuracy of this Total Enrolled is important because
it gets used to calculate all the “per 1000” numbers for
the normative comparisons.
This page illustrates the overall financial impact of the
total health plan costs and compares it with the
normative data provided by Kaiser Family
Foundation/HRET based on size, industry and region
selected in the GSF. KFF is used for the per employee
per year norm, as Medstat doesn’t include any fixed cost
or fees, purely claims data. This is the most common
norm that employers often see in trade journals
regarding plan costs.
The Health Plan Cost Norm is being compared to
whichever categories are selected from the following:
-Region (4 US Census Regions:
Northeast/Midwest/South and West)
-Industry (Industrials/High Tech/Wholesale-Retail/Financials/Health Care/-Non Profit/Government)
-Size (2-199 or 200+)
The norm is a weighted average, based upon the
single/family contracts entered on the GSF and shown on
page 2.
Health Plan Costs are determined either with the client’s
PAID premium (if fully insured) or Net PAID claims (Less
Specific) plus administrative costs (if self funded). If self
funded, the individual PAID claims above and beyond the
specific stop loss deductible are not included in the plan
cost listed here. [NOTE: SOME CARRIERS ONLY PROVIDE
CLAIM CHARGES OR PAID, BUT NOT BOTH.] The monthly
dollar totals can be viewed in the drill down cube under
the Claims History cube.
The Prescription Drug Cost line comes from the RX
claims line in the GSF. If the Rx data is included in the
medical claims file, the broker needs to get the total
amount and include it in the
GSF. It will be scrubbed out the the data file by the data
analyst at Zywave. Any RX/PBM type costs that get
entered on the group submission form under the RX plan
costs will actually roll into the Administrative
Costs/Premium line. Any TPA “handling” type fees to go
here.
NOTE: Charges vs. Paid should track pretty closely
month by month. If you see a large discrepancy you
may want to use drill down to determine if there is a
large claim involved, other coverage or perhaps payment
issue.
Medical claims Cost are just the claims data from the
carrier; the premium or fixed costs displayed in the
previous 2 exhibits are not included.
This is also on a per member basis, whereas the
previous 2 exhibits are on a per employee basis.
This page and all norms going forward use the Medstat
data.
If Rx dollars are entered into the Annual Prescription
Drug Cost line in the GSF, this actual and norm number
will include Rx. If nothing is entered on this line in the
GSF, it will be medical only for the actual and norm, and
footnoted as such.
If this norm is the reverse of the KFF norms on the
previous pages, the admin/fixed costs and/or Rx could
be the driver. Also if the group is fully insured, there
loss ratio could be very low.
This exhibit is age/gender adjusted if the census is
provided.
This exhibit show the ee/spouse/dependent cost
relationship to illustrate how the employer will monitor
changes or shifts costs to the appropriate member.
These numbers represent the actual paid claims for
employees, spouses and dependents claimants and not
the actual total enrolled members.
Discussion Point: You should use this information over
time to evaluate if dependent claims exceed the norm.
This will help determine a need for further cost shifting
discussions. (Suggest utilizing a Spousal Carveout plan
design piece out of Broker Briefcase).
This exhibit is NOT age/gender adjusted if the census is
provided.
This exhibit illustrates where the claims occurred on an
inpatient or an outpatient basis.
Discussion Point:
• In many cases, outpatient services tend to be less
costly than inpatient. However, in certain parts of the
country, some procedures may be less costly when
performed inpatient. This permits the client to evaluate
both where the patient is being directed, how much it
cost s in that environment and where plan changes are
required to “steer” patients to the appropriate
environment for certain procedures (inpatient or
outpatient).
• The Inpatient and Outpatient Claims are annualized
paid dollars based on the carrier codes. They may not
match figures used elsewhere in the report because of
this.
This exhibit is NOT age/gender adjusted if the census is
provided.
This page portrays an overall picture of the location of
healthcare claims occurred compared to the norm using
the standard Centers for Medicare and Medicaid Services
Place of Service coding.
Discussion Points:
• Drill down can be incorporated to help “dissect”
claimant information. By selecting the Place of Service
Summary from the Claims History Cube, you can discuss
whether the employee or dependent is incurring the
claim, and formulate proper education decisions directed
either towards the employee or the dependent.
• The Other category includes codes that don’t fall into
other five main places of service categories such as
ambulance, labs/x-rays and home health etc, or
improper coding was associated with the claim and thus
will typically be higher than the rest.
• This chart is driven only by the carrier’s place of service
codes. If no ER appears, either they do not have an
emergency room place of service code or they are not
using it. If there are no claims showing up on the ER
category, they are usually included in the Outpatient
Hospital category.
• Top 6 categories appear on this graph.
Focus on the top areas that vary from the norm and use
Drill Down to find out what types of services are being
rendered.
The Office POS includes things like chiro, OPMH, PT or
surgical procedures and will not match the Office Visit
pages later in the report, as those are a subset of this
POS exhibit.
This exhibit is age/gender adjusted if a census is
provided. It is not region, industry or plan type specific.
This page identifies the 10 high cost claimants, which are
identified by a unique identifier. Primary diagnosis will
be listed as the highest cost diagnosis and all other
diagnosis are bundled in. You can view the other
diagnosis for each claimant in the High Cost Claimant
drill down cube.
Discussion Points:
The drill down component can be used to show details of
the high cost claimants.
• Should case management be addressed?
• Is Stop Loss set an accurate level?
You can check the specific level noted on the group
submission form.
You can see which claimants may have hit the specific
stop loss by comparing the Total paid to the Liability at
the bottom.
Paid claim distribution by claimant should be used with
the following page. You can basically determine the
“80/20” or “70/30” rule for the group by looking at the
Actual Cumulative column for the number of claimants
on this page, compared to the dollars paid for the same
category on the next page.
It helps identify the percentage of claimants that are
driving the majority of cost to the plan.
It can also be a starting point to discuss a consumer
driven type plan, like an HRA or HSA plan design.
Paid claims Distribution by dollars
See previous page description.
The Inpatient Analysis provides cost and utilization
information for the plan and the comparison to norms.
This includes both facility and professional claims
provided at the Place of Service = inpatient.
Admits/1000 – can be used to check over-utilization of
the IP benefit. May want to check with the UM vendor if
this is above the norm, and also use drill down to see
what types of admission they are.
Ave. Paid/admit – this may relate to the effectiveness of
your health plan provider discounts or that the
procedures are more of a high cost nature.
Ave LOS – May want to work with the UM vendor on
being more aggressive, or if the types of admissions tend
to be more severe.
The Inpatient Hospital drill down cube can be used to
assess whether utilization or medical cost is driving your
overall healthcare costs. If utilization is high, you might
review your utilization review vendor.
If average charges are high, you might review whether
you are getting the proper “steerage” to network
providers, or evaluate if the network discounts are good.
The numbers on the bar graph and actual/norm
admissions don’t match because the graph numbers are
based on a “per 1000” basis. The definition of a per
1000 basis is the standard measurement of utilizing data
and is the # of actual or norm admissions/charges
divided by the total number of claimants times 1000.
The actual numbers will be annualized if <12 months of
data is provided.
Review the IP copays in Alternative Modeling here.
This exhibit is age/gender adjusted if census it provided.
Average days/1000 - Work with the UM vendor on the
frequency of admit or the type of admit.
Aver paid/day – Could be a result of poor network
contracts or the type of services (more high cost) that
the plan encountered.
Use the IP drill down to get to the details and provide
answers.
This exhibit is age/gender adjusted if census is provided.
This page shows the details of the number of admits,
total paid and the percent of total paid for the Top 10
providers related to Inpatient Hospital. Duplicates may
appear if paid as both in-network and out of network, but
they will be listed separately.
Discussion Points:
• This will allow you to show the effectiveness of how the
current plan directs people in-network. If a client has a
PPO network, but the participation in the network is low,
client might want to evaluate their hospital networks or
plan design.
• Additionally, the client may need to do more employee
communication to help steer clients to the PPO network
providers, by analyzing the network dimension in drill
down. Use BB to provide EE education materials.
• Payment could also reflect non-PPO due to utilization
management determinations.
• Any provider with “0” admits is a professional provider.
The IP norms include both professional and facility
claims, so we want to capture the paid dollars on this
exhibit. We’ve distinguished between professional and
facility by attaching the admit only to the facility claims.
“Others” are all the other providers below the Top 10.
See drill down for the complete list.
NOTE: This is a great Drill Down feature to graph.
This exhibit shows the top 10 surgical procedures by
claims and total paid dollars as well as average paid
procedure.
Discussion Points:
• The Inpatient Surgery drill down cube can be utilized to
help assess which providers are being utilized.
• Use of wellness materials from Broker Briefcase is
appropriate here – pre-natal care, cancer materials,
smoking cessation, etc.
This exhibit include the professional (usually surgeon)
fee only.
Outpatient Surgeries/1000 – if this is high you can use
the drill down cube to see who is using the services and
which providers they are using. An OP surgery copay
may be appropriate – you can model this in the
Alternative Modeling section.
If the Average Paid/procedure is above the norm, you it
may be due to the network discounts or the types of
services being utilized. Drill down on the Outpatient
surgery cube to see the details.
The amount paid is for the surgeon’s fees only; it doesn’t
include the facility or anesthesiologist.
Outpatient Surgery by procedure give you an overview of
the top 10 procedures by the paid amount. This can
assist in plan design options and also which providers are
being utilized.
ER Visits per 1000 – to determine the cause of visits
over the norm, use the ER cube in drill down to view the
ICD9 name, relationship and network indicators. An ER
copay may be in order, as well as an educational
campaign to promote urgent care centers in the network
and the cost of an ER visit versus and office visit (usually
3 times the amount).
This exhibit illustrates the plan’s overall office visit
utilization and costs and compares it with the normative
data.
Discussion Points:
• Utilize the advanced drill down component to assess
the high/low utilization and cost areas.
• Incorporate Broker Briefcase education communication
pieces to help reduce the actual number of office visits.
• Suggest adding a nurse-line
• Suggest changing office visit copays in the Alternative
Modeling component to show overall illustration of
potential plan savings and employee disruption.
• If the report is based on a capitated HMO, this office
visit page may not be included in the report, if the
payment process doesn’t capture the necessary data
elements..
The range of codes include in office visit claims are
99201-99215, 99241-99245. These are the new and
established patient, brief and extended visit, and office
consult codes.
This page will not match the Place of Service exhibit
earlier in the report, as it is a subset.
This page could include chiro visits, if they are billed as
consults in the range of codes above, vs. a manipulation.
The exhibit is age/gender adjusted if census is provided.
This page shows the details of the number of visits, total
paid and percent of total paid for the Top 10 providers.
Duplicates will also appear in this exhibit as well if the
providers were paid as network and non-network.
Discussion Points:
• You can show how effective the current plan directs
people toward in-network and to once again conduct a
network evaluation of their providers and clinics.
• Go to Drill down and us the pie chart to provide a high
impact graph.
“Others” includes all other providers below the Top 10.
See drill down for a complete list of providers.
This page identifies the inpatient mental health utilization
and costs.
Discussion Points:
• If either utilization or average paid is high, the client
might want to consider evaluating their mental
health/utilization management / EAP /programs.
• Other ideas would be to incorporate Broker Briefcase
EAP Plan Design and Mental Health brochures to help
reduce costs and provide overall employee well being.
Some example of the brochures are: Mental Health
News: Depression You Are Not Alone; Anxiety and Panic
Attacks, Get your Life Back; Substance Abuse and your
Employee Assistance Program.
• IPMH admits are usually fairly low, so there may not be
a lot of data to work with, especially if the group is small.
IPMH providers often use “cycle billing”. For longer
admits, like 30 days, they may bill weekly to begin
getting paid before the discharge date. Consequently
the claims data may appear to have more frequent
admits and lower average paid/admits. Just be aware of
this when reviewing this page.
The exhibit is age/gender adjusted if census is provided.
This page shows the number of visits and
average paid compared with normative data.
Discussion Points:
• The Outpatient Mental Health drill down cube can be
used to analyze the utilization and cost details of this
category.
• Suggest changing outpatient mental health copays and
maximum number of visits to help reduce costs in the
Alternative Modeling component.
• Suggest installing an EAP program and utilize the
broker briefcase pieces to help explain to your client.
If the number for actual visits is low, an EAP program
may carve out some of the visits from the medical
claims. You may suppress this page in the management
report by using the Advanced Report capabilities.
This exhibit is age/gender adjusted if census is provided.
This chart illustrates the 24 major diagnostic categories
and lists the total paid and percent of total paid. This
information is then being sorted by the variance to the
normative data to show the high / low cost medical
areas.
Discussion Points:
• Use the Claims History to determine what factors are
driving up the utilization and total charges, by filtering
on highest MDC’s and then ICD9 name, etc.
• This information can be very useful for determining the
appropriate form of management intervention and
wellness programs; prenatal services, cancer screenings
etc. are in place.
• The norm percentages are applied against the actual
paid claims by the plan to populate the norm paid
column.
This exhibit is age/gender adjusted if census is provided.
This page illustrates certain claims that are identified as
lifestyle related. Certain illnesses/accidents can be
related to choices people make.
Discussion Points:
• Theoretically, lifestyle related claims could be
eliminated through a healthier lifestyle. By reviewing this
exhibit, the client can address those areas where
education, training, etc. can help the participants
become more health conscious and enable the plan to
install design and cost management strategies.
• Some people ask how breast cancer or diabetes, for
example, can be lifestyle related. Part of an individual’s
lifestyle is regular checkups/examinations and proper
administration of regulating medications. Regular
checkups would promote early detection and proper
medication would regulate an existing disease, both of
which would reduce claims associated with these
categories.
• Incorporate Broker Briefcase Live Well/Work Well
brochures can be used to help with employee education.
• Lifestyle behaviors contribute up to 50% of an
individual's health status, followed by environment
(20%), genetics (20%) and access to care (10%).
Source: Institute for the Future and the Centers for
Disease Control and Prevention.
Disease Management & Intervention Opportunities
Meant to set the stage for the DM section.
• Mercer 2004 study shows that 58% of employer
sponsored health plans are using Disease Management
as a saving strategy.
• Medicare is launching a DM study of 20,000 patients to
review the effectiveness and of these programs.
• These graphs on this page are not the group’s data,
but a Medstat data portraying the employer cost
associated with diseases above the health plan costs.
DM suggestions:
Arthritis has a large disability component.
Seek out DM opportunities.
Try to keep the chronic asthmatics out of the hospital.
Work on patient compliance and education to control
these diseases
Use Drill Down to locate the specific cancers that are
affecting this group.
Utilize wellness screenings for specific high frequency
cancers, or utilized other health educational
opportunities based on the outcome of the details of the
high cost cancers affecting the group.
Utilize the mental health pages to determine how this
disease state compares with their overall mental health
claims.
Utilize an EAP service or local providers to provide
programming and materials on depression.
Utilize Drill Down to determine who is driving these
costs. Utilize DM vendors to assist with educational
materials and compliance on this disease state.
Use Drill Down to determine which types of heart disease
categories are driving the costs. As noted in the text,
the following heart diseases are included in this section:
Ischemic heart disease (also called coronary artery
disease), hypertension (high blood pressure), myocardial
infarction (heart attack), cholesterol management and
congestive heart failure
This is a great page to consider cross-selling
opportunities with P&C. If some of these claims are
being driven by worksite situations, Workers’ Comp,
safety or ergonomics could all play a role.
This category will be important to watch. As obesity has
been billed an ‘epidemic’ in the US, there is a lot of focus
on this area. Some payors or plan sponsors are already
excluding bariatric surgeries, which would fall into this
category. However, this has a huge impact on other
disease states if the coding is listed as secondary or not
at all (traditionally many providers have coded these
claims under another disease, so they may be underreported).
Also, Medicare as recently announced a study project of
over 20,000 patients on this topic, to determine if and
when Medicare would pay for certain procedures. The
outcome could impact private pay insurance.
Obesity for our purposes is based on the ICD9:
278.00 - A BMI of 30 or more is considered obese (body
mass index)
278.01 - A BMI of 39 or more or 50-100% or 100
pounds above their ideal body weight - Morbid Obesity
A BMI between 25 to 29.9 is considered overweight and
not included in this category
This summary page discusses the favorable
and/unfavorable areas of the current health plan to help
with the analysis of healthcare costs.
Note that even in the standard report, the following
areas are listed, which allow you to go back and build
those pages if they are unfavorable: maternity, chiro,
PT, Radiology.
A common differential between charges and paid is 40 –
50%. This varies by plan design, discount, non-covered
services, subrogation and COB.
Use the Total Claim Payment figure in Alternative
Modeling to get a more accurate figure for estimating
plan savings. Use the Total Claim Payment multiplied by
the percentage differential of the alternative plan.
The Total Claim Payment includes the claims paid over
the specific, in a self-funded group.
Notes and Questions
Project assumptions
1.
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3.
4.
5.
When making comparisons between Zywave’s Health Plan Analysis and a Carrier Report you will find that there will be
differences in paid claims amounts and total charge amounts that can be attributed but not limited to the following
exclusions in the program:
A.
Over age 65 (The norms do not include claimants over 65).
B.
Dental/RX Claims
C.
Pended claims
D.
Adjustments
E.
Recoups
F.
Any other exclusions (by group, location, etc.) requested by broker on group submission form
G.
Specific stop loss attachment points
H.
Remit cycle (Carrier & remit report not run on same day). We ask for purely paid data; carrier may limit the incurred
dates within the paid time period.
What time frame is the report based on?
The report is on 12 months of data (Exhibits with norms will annualize if less than 12 months of data to compare the
group to the benchmarks). In v4.0, only projects date 1/1/2002 and forward can be run as those are the norm
dates available.
Is there a minimum and maximum charge for a report?
The minimum charge for a report is 100 lives or $480 if at $.40. The maximum for 2000 – 4999 is $9600. 5000+ is a
special quote by the Zywave sales person.
How does the client gain access to the report on their Mywave page?
The partner must release to the individual Mywave users they want to access the report. An icon will appear on their
Mywave page near their greeting. The project must be approved to release to the client.
When DMW annualizes utilization and charges for projects with less than 12 months of claims, is it based on the
months entered in the GSF or the actual number of months claims were paid?
Months with paid claims.
Notes and Questions
Management Report
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6.
Will the customized management report automatically reset after the person logs out?
The report will not reset itself. Once it has been customized it saves that information until the report is customized again.
Can I change the Management report? Like adding or deleting certain exhibits?
Yes, if you create an Advanced report in the administration area, that will be come the standard report when it gets built
by you or the client.
Can the Normative Data be changed for a specific report?
No, the norms can’t be changed. However is member census data is provided, the norms for cost/utilization using
Medstat will be age/gender adjusted in many exhibits.
If the report runs over 2 calendar years, the norm year with the most number of months will be used (ex:
10/02 – 9/03 will use 2003). If it is 6 months of each year, the first year will be used. (7/02 – 6/03 will use
2002.)
What can we do if we are having problems printing the actual management report?
Check with your printer drivers to make sure your driver is updated with the latest version. You can obtain the latest
driver by contacting your printer’s website. Also, try and increase the DPI to 600 on their printers (dots per inch), as we
have a higher resolution on DMW.
Also, make sure their browser has DMW listed as a trusted site. Go to the browser, internet options, security and add
www.dmwarehouse.com as a trusted site.
What is a CPT and ICD9 code?
Current Procedural Terminology is the code used to bill for a professional procedure.
International Classification of Diseases 9th edition – is the diagnosis code the patient is being treated for.
Notes and Questions
Drill Down
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In Drill Down, Office Visit cube, what is an encounters?
Encounters are grouped by Date of Service, so there could be more that 1 claim generated on the same date, and it
would count as 1 encounter.
Can a client include client location code in Drill Down?
Yes, if the carrier can provide it, it will names “Codelocation” as one of the categories.
Will we be charged for a sample report?
If a partner wants to re-run one of their projects as a sample they can do that without being charged. Most partners run
it under the ABC Company MyWave. You must obtain the client and/or carrier’s release. Contact your Partner
Consultant for details.
Will we be charged to run a Roll-up report?
You can also run a roll-up report when you are already running/paying for other divisions of a company. An example
would be PPO Plan (250 ee’s) and POS Plan (150 ee’s) and then an all company of 400 employees wouldn’t be
charged. You need to complete a Group Submission Form for the roll-up and let us know what to combine in the
Comments tab.
Claims History Cube vs. IP Hosp cube Tip:
The Place of Service "Inpatient Hospital" in the Claims History cube is broadly defined as any claim coded with an
"Inpatient" Place of Service as defined by the carrier's logic. A charge may be professional or facility and may be of
any amount.
The Inpatient Hospital cube is much more strictly defined. A claim must meet the following criteria to be
included in the Inpatient Hospital cube:
•
The claim must be defined as "Inpatient" as defined by the carrier's logic.
•
This refers to hospitalizations, but may also include testing or other procedures traditionally done in an inpatient
setting on an outpatient basis. There are also certain types of facilities that we consider to be inpatient, such as
nursing homes or skilled care facilities.
•
We are reporting exactly what we receive from the carrier or TPA in form of their coding so if a claim is coded as
inpatient hospital that is how it is reported, even if there is no stay associated. That is one of the reasons that there
is a floor associated with a claim's charge amount.
OP Hospital Cube:
The Outpatient Hospital cube does not require that a claim be coded "Outpatient Hospital," but may also include Places of
Service such as "Ambulatory Surgery Center" and "Emergency Room." Our logic dictates that the claim must only
be considered not Inpatient and are facility charges. If you include "Surgery Center" and "Emergency Room" in the
filter on Place of Service in the claims history cube then you will see that the totals of people, claims, charges, and
paid are higher than the totals in the Outpatient Hospital cube.
Notes and Questions
Alternative Modeling
1.
2.
What do I do if I receive an error message when entering in a new plan design in the alternative modeling
component?
You need to make sure that they set up the current plan design.
How does the in- and out-of-network calculation work:
□ Amount paid towards In-Network are applied to In-Network and Out-of-Network.
Amounts paid towards Out-of-Network are applied to In-Network and Out-of-Network.
□ Amounts paid towards In-Network are only applied to In-Network.
Amounts paid towards Out-Network are only applied to Out-of-Network.
The first option, in- and out-of-network claims total together to meet the deductible and out-of-pocket max. The second
option, they need to be met independently.
3.
Utilization Adjustment Factors - Factors are available for the following benefit categories: office visit, outpatient mental
health and chiropractic from $5 to $25; emergency room visits from $25 to $150. If no factor is available, “NA” will display.
This allows modeling to determine is services would have been avoided by increasing the copay amounts. The number of
visits with and without the factors will be displayed at the bottom of the comparison.
4.
Reduction in liability: This figure is calculated on charges, to ensure that the patient responsibility doesn’t get considered
twice. In order to calculate a more realistic savings for the plan, multiply the percentage of reduction in liability by the
Total Claim Payment on the At-A-Glance page of the report.
Lifestyle-Related Claims are from Hewitt & Associates recommendations. Lifestyle Codes are
identified based on ICD9 codes shown below:
Lifestyle Category
Description / Examples
ICD-9 Code Ranges
Accidental Injury and Poisoning
Fractures, dislocations, sprains / strains, internal injuries,
open wounds, burns, poisoning by drugs / substances,
toxic effects of nonmedicinal substances, frostbite,
hypothermia, heat stroke, poison ivy, asphyxiation,
electrocution
800.00-993.99 and 994.00-994.19 and
994.70-994.79 and 994.80-994.89
Alcohol and Substance Abuse
Alcoholic psychoses, drug psychoses, alcohol dependence
syndrome, drug dependence, nondependent abuse of
drugs, heart / liver disease resulting from excessive
alcohol consumption
291.00-292.99 and 303.00-305.99 and
425.50-425.59 and 571.00-571.09 and
571.30-571.39
Breast Cancer
Primary, secondary, and in situ cancers of the female
breast
174.00-175.99 and 198.80-198.89 and
233.00-233.09 and 238.30-238.39 and
239.30-239.39
Cerebrovascular Disease
Intracerebral hemorrhage, cerebrovascular disease, stroke
430.00-440.99
Cervical / Uterine Cancer
Primary, secondary, and in situ cancers of the ovaries /
cervix / uterus
179.00-180.99 and 182.00-184.99 and
198.60-198.69 and 233.10-233.19 and
233.20-233.39 and 236.00-236.09 and
236.20-236.39
Colon / Rectal Cancer
Malignant neoplasm of colon, secondary neoplasm of large
intestine / rectum, carcinoma of colon / rectum
153.00-154.99 and 197.50-197.59 and
230.30-230.49
Diabetes
Diabetes and its resulting complications
250.00-250.99
Intervertebral Disc and Back
Problems
Disc displacement / degeneration, back pain
722.00-722.99 and 724.00-724.99
Heart Disease
Heart attack, ischemic heart disease, angina
410.00-414.99 and 426.00-429.99
Inguinal Hernia
Over exertion
550.00-550.99
High Blood Pressure
Renal disease, hypertension
401.00-405.99
Kidney Disease
Nephrotic syndrome, chronic glomerulonephritis, kidney
infections, calculus of kidney/ureter, calculus of lower
urinary tract, cystitis
581.00-583.99 and 585.00-586.99 and
590.00-590.99 and 592.00-502.99 and
594.00-595.99
Obesity
Eating of too great an amount of nutrients
278.00-278.99
Respiratory Problems
Cancers, respiratory problems (i.e., emphysema) related
to smoking and pollution
140.00-141.99
148.00-148.99
161.00-163.99
231.00-231.99
496.00-496.99
and
and
and
and
144.00-146.99
150.00-150.99
210.00-210.99
491.00-492.99
and
and
and
and
Skin Cancer
Primary, secondary, and in situ cancers of the skin due to
over exposure to sun
172.00-173.99 and 232.00-232.99 and
238.20-238.29 and 239.20-239.29
Stress-Related Illness
Psychalgia (i.e., psychogenic pain, tension headache),
acute reactions to stress (i.e., disturbance of emotions,
disturbance of consciousness, psychomotor disturbance),
ulcer
307.80-307.89 and 308.00-308.99 and
531.00-534.99
States in each Census Region (KFF uses the 4 regions; Medstat uses 9 divisions)
Northeast
New England
Connecticut
Maine
Massachusetts
Mid-Atlantic
New Hampshire
Rhode Island
Vermont
New Jersey
New York
Pennsylvania
Midwest
East North Central
West North Central
Indiana
Illinois
Michigan
Ohio
Wisconsin
Iowa
Kansas
Minnesota
Missouri
Nebraska
North Dakota
South Dakota
South
South Atlantic
East South Central
West South Central
Delaware
District of Columbia
Florida
Georgia
Maryland
N. Carolina
S. Carolina
Virginia
W. Virginia
Alabama
Kentucky
Mississippi
Tennessee
Arkansas
Louisiana
Oklahoma
Texas
West
Mountain
Arizona
Colorado
Idaho
Montana
Pacific
Nevada
New Mexico
Utah
Wyoming
Alaska
California
Hawaii
Oregon
Washington