COLORADO · The Denver Hospice-Care Synergy Dispatch Health Jefferson Center for Mental Health...

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Changing The Way Employers Buy Health Care www.managedcaredigest.com

MANAGED CAREDIGEST SERIES®

SINCE 1987

13th Edition

In partnership with the Colorado Business Group on Healthwww.CBGHealth.org

COLORADOHEALTH CARE DATA SUMMARY™ | 2017

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2 Colorado Health Care Data Summary™ 2017 Managed Care Digest Series®

IntroductionSanofi U.S. (Sanofi) and the Colorado Business Group on Health

(CBGH) are pleased to present the Colorado Health Care Data Summary™ for 2017, an overview of demographic, utilization,

pharmacotherapy, and financial measures for Type 2 diabetes,

cardiovascular, and other chronic disease patients in key local

markets across the state of Colorado. The Summary also provides

data on hospital utilization, readmissions, disability, and other chronic

disease spending measures that can help providers and employers

better identify opportunities to serve the needs of their patients. Most

of the data are drawn from the Managed Care Digest Series®.

Sanofi, as sponsor of this Summary, maintains an arm’s-length

relationship with the organizations that prepare this Summary and

carry out the research. The desire of Sanofi is that the information in

this report be completely independent and objective.

Now in its 13th edition, this Summary features a number of

examples of the kinds of patient-level, disease-specific

data that can be provided using the Managed Care Digest Series®

as a resource. CBGH chose Type 2 diabetes (a chronic disease

marked by high levels of glucose in the blood) as the focus

of this resource, as the Centers for Disease Control and

Prevention estimates that 90% to 95% of all Americans with

diabetes—translating to 5% to 7% of the U.S. population—have

Type 2 diabetes.

Unless otherwise noted, the data in this Summary (covering 2014

through 2016) were gathered by QuintilesIMS, Durham, NC, a

leading provider of innovative health care data products and

analytic services.

COLORADO HEALTH CARE DATA SUMMARY™

Introduction ................................................................. 2

Diabetes

Executive Summary ................................................... 3–4

Diabetes in Colorado .......................................... 5–6

Utilization ................................................................... 7

Pharmacotherapy ............................................... 8–9

Persistency .............................................................. 10

Charges ................................................................... 11

Hospital Cases ........................................................ 12

ALOS/Readmissions ................................................ 13

CV Disease in Colorado ........................................... 14

Lipid Disorders in Colorado ...................................... 15

Obesity, Depression, and RA

Hospital Cases ......................................................... 16

Chronic Disease Spending ................................. 17–18

IBI Disability Claims .................................................... 19

Methodology/Position Statement ........................... 20

CONTENTS

Employer / Purchaser MembersBoards of Education Self-funded Trust

Boulder Valley School District

City of Colorado Springs

CIVHC

Compassion International

Colorado Public Employees’

Retirement Association (PERA)

Colorado Springs School District 11

Elward Systems Corporation

Pinnacol Assurance

Poudre School District

St. Vrain Valley School District

TIAA

United States Olympic Committee

University of Colorado

Affiliate MembersAbbVie

Aetna

AstraZeneca

Centura Health Employer Solutions

Cigna

CNIC Health Solutions, Inc.

Colorado Permanente Medical Group

Continental Benefits

Craig Hospital

The Denver Hospice-Care Synergy

Dispatch Health

Jefferson Center for Mental Health

Kaiser Permanente

Merck & Co., Inc.

Novo Nordisk, Inc.

Rocky Mountain Cancer Centers

Sanofi US

Telligen

Association MembersAurora Chamber of Commerce

Denver Metro Chamber of Commerce

Employers Council

South Metro Denver

Chamber of Commerce

The role of the CBGH is to help make these data more widely available to

interested parties.

CONTACT

Provided by

Sanofi U.S., Bridgewater, NJ

Developed and produced by

Forte Information Resources, LLC, Denver, CO www.forteinformation.com

Data provided by

QuintilesIMS, Durham, NC

MANAGED CAREDIGEST SERIES®

SINCE 1987

www.managedcaredigest.com

Robert SmithExecutive Director

Colorado Business Group on Health

P. 303-922-0939 | E. [email protected]

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Managed Care Digest Series® Colorado Health Care Data Summary™ 2017 3

<70 <100 100–129 130–789 ≥1900%

20%

40%

60%

80%

33.6%29.4%

70.1%65.6%

19.0% 21.2%

10.0% 11.9%

0.9% 1.2%

Colorado Nation

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11.0%

<7.0% 7.1–7.9% 8.0–9.0% >9.0%0%

15%

30%

45%

60%

50.4%47.3%

21.3% 21.8%

13.4% 14.8%16.8%

Colorado Nation

Pe

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1 The A1c test measures the amount of glucose present in the blood during the past 2–3 months. Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in 2016.

NOTE: LDL-C is low-density lipoprotein cholesterol.

Data source: QuintilesIMS © 2017

NEARLY 50% OF CO TYPE 2 DIABETES PTS. HAVE AN A1c ≥7.0% • In 2016, 49.6% of

Colorado Type 2 diabetes patients recorded an A1c level of 7.0% or above on their latest exam. From 2006 (5.5%) to 2015 (6.4%) diabetes prevalence among Coloradans increased by 0.9 percentage points, yet remained below the all state’s median prevalence for all 10 years shown.

PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY LDL-C LEVEL RANGE (mg/dL), 2016

DISTRIBUTION OF TYPE 2 DIABETES PATIENTS, BY A1c LEVEL RANGE, 20161

DIABETES PREVALENCE, COLORADO VS. ALL STATES’ MEDIAN, 2006–2015

2006 2007 2008 2009 2010 2011 2012 2013 2014 20152%

4%

6%

8%

10%

Colorado All States’ Median

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7.4%7.8% 7.9% 8.0%

8.3%8.9% 8.9% 9.0% 9.1% 9.1%

5.5% 5.6%6.1% 5.9% 6.0%

6.6%7.2%

6.3%6.9%

6.4%

PERCENTAGE OF TYPE 2 DIABETES PATIENTS RECEIVING VARIOUS SERVICES, 2016

MARKETA1c Test1 Blood

Glucose TestOphthalmologic

ExamSerum

Cholesterol Test

Urine Microalbumin

Test

Colorado 77.0% 87.1% 68.4% 84.1% 72.1%

NATION 73.9% 86.6% 69.1% 84.3% 71.3%

Data source: Centers for Disease Control and Prevention © 2017


EXEC

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AMI CardiovascularDisease

CongestiveHeart Failure

Nephropathy Neuropathy PAD Retinopathy SevereHypoglycemia

Stroke0%

10%

20%

30%

40%

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2.2% 2.6%

35.2%

38.2%

11.1%13.0%

32.8%31.7%

33.3% 33.2%

14.0% 14.2%

17.2%15.5%

3.7% 3.5% 3.6% 4.3%

Colorado Nation


1 The A1c test measures how much glucose has been in the blood during the past 2–3 months. Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in a given year.

2 A complication is defined as a patient condition caused by the Type 2 diabetes of the patient. These conditions are a direct result of having Type 2 diabetes. Complications of Type 2 diabetes include, but are not limited to, acute myocardial infarction (AMI), cardiovascular (CV) disease, severe hypoglycemia, nephropathy, neuropathy, peripheral artery disease (PAD), stroke, and retinopathy.

NOTE: On all pages, the percentages are representative of the universe of Type 2 diabetes patients on whom claims data have been collected in a given year. LDL-C is low-density lipoprotein cholesterol. Throughout this report, the Fort Collins market includes Loveland and the Boulder market includes Longmont.

WELL-CONTROLLED A1c SHARES DECLINE IN SIX CO MARKETS • From 2015 to 2016, the

percentages of Type 2 diabetes patients with an A1c level of 7.0% or below decreased in Denver, Colorado Springs, Pueblo, Fort Collins, Greeley, and across the state. Denver reported the largest such decline, at 4.6 percentage points.

SHARE OF CO TYPE 2 DIABETES PTS. WITH AN A1c >9.0% GROWS • Across Colorado,

the portion of Type 2 diabetes patients with an A1c level above 9.0% rose to 14.8% in 2016 from 13.7% in 2015. The shares of such patients also increased in Denver, Pueblo, Grand Junction, and Greeley.

PERCENTAGE OF TYPE 2 DIABETES PATIENTS RECEIVING AN A1c TEST, 2015–20161

Denver ColoradoSprings

Pueblo GrandJunction

FortCollins

Boulder Greeley Colorado60%

66%

72%

78%

84%

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77.1% 77.6%76.2%

77.4%

74.5% 75.4%

82.4% 82.5%

76.6%73.8%

75.7% 74.6%75.9%

73.6%

76.9% 77.0%

2015 2016 Nation 2016 = 73.9%

PERCENTAGE OF TYPE 2 DIABETES PATIENTS WITH AN A1c LEVEL ≤7.0%, 2015–20161

PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY ACTUAL COMPLICATION, 20162



FortCollins


43%

48%

53%

58%

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51.3% 50.6%49.6%

48.4%46.9%

48.5%

51.0%52.0%

50.8%49.7%

50.8%

48.0%

44.3%

54.0%

50.4%

2015 2016 Nation 2016 = 47.3%

PERCENTAGE OF TYPE 2 DIABETES PATIENTS WITH AN A1c LEVEL >9.0%, 2015–20161

12.6%14.0%

17.6% 16.9% 18.1%19.1%

13.2%

17.4% 15.8%

13.0%11.4%

17.7%

21.0%

13.7%

14.8%



FortCollins


6%

12%

18%

24%

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2015 2016 Nation 2016 = 16.8%

14.9%

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PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY PAYER, 2014–20161

DIABETES IN COLORADO


DISTRIBUTION OF TYPE 2 DIABETES PATIENTS, BY AGE AND GENDER, 2016

DenverColorado

SpringsPueblo

Grand Junction

Fort Collins

Boulder Greeley Colorado NATION

AGE GROUP

0–17 1.2% 0.8% 1.1% 0.9% 0.6% 1.3% 0.7% 1.1% 1.4%

18–35 3.3 3.1 2.5 2.8 2.7 2.8 2.8 3.1 3.0

36–64 42.5 45.4 40.4 40.4 39.2 47.3 50.3 42.8 44.7

65–79 40.1 38.8 40.6 41.1 42.9 38.9 36.4 40.1 38.7

80+ 12.8 12.0 15.4 14.8 14.6 9.8 9.9 12.9 12.2

GENDER

Male 49.2% 48.2% 46.2% 48.2% 47.8% 51.8% 53.4% 49.0% 47.1%

Female 50.9 51.8 53.9 51.8 52.3 48.2 46.6 51.0 52.9

HALF OF CO TYPE 2 DIABETES PTS. HAVE COMM. INSURANCE• In 2016, 50.0% of

Colorado Type 2 diabetes patients had commercial insurance coverage. By local Colorado market profiled, Boulder had the highest such percentage (56.1%), followed by Greeley (56.0%). For its part, Denver’s share was third highest (52.3%).

1 Includes HMOs, PPOs, point-of-service plans, and exclusive provider organizations.

PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY PAYER, 2016

Commercial Insurance1 Medicare Medicaid

MARKET

Denver 52.3% 35.2% 10.8%

Colorado Springs 48.3 36.7 11.1

Pueblo 38.5 42.6 16.2

Grand Junction 48.4 36.9 11.8

Fort Collins 45.6 44.5 8.7

Boulder 56.1 35.4 7.3

Greeley 56.0 30.2 12.3

Colorado 50.0 37.1 10.9

NATION 48.2% 37.2% 13.3%

2014 2015 2016 2014 2015 20160%

14%

28%

42%

56%

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52.8%

37.2%

8.3%

51.3%

36.8%

10.2%

50.0%

37.1%

10.9%

48.4%

39.3%

11.3%

48.2%

38.1%

12.5%

48.2%

37.2%

13.3%

Commercial Insurance1 Medicare Medicaid

Colorado Nation

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DIABETES IN COLORADO

CO TYPE 2 DIABETES PTS. HAVE HIGH RATES OF DEPRESSION• In 2016, the shares

of Type 2 diabetes patients diagnosed with depression exceeded that of the nation (10.8%) in seven of eight profiled Colorado markets, and was highest in Grand Junction (16.5%).

PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY ACTUAL COMPLICATION, 20162

MARKETAMI

CV Disease

Congestive Heart Failure

Nephro- pathy

Neuropathy PAD RetinopathySevere

Hypogly- cemia

Stroke

Denver 2.4% 37.7% 12.0% 37.0% 34.1% 13.7% 16.3% 4.4% 3.7%

Colorado Springs 1.6 29.2 8.7 29.9 31.5 12.1 24.5 2.1 3.5

Pueblo 1.2 29.3 10.4 32.7 33.0 21.8 18.1 2.3 3.6

Grand Junction 3.6 37.0 12.5 25.0 39.6 7.9 14.2 3.6 3.8

Fort Collins 2.0 37.9 10.9 26.4 28.9 23.1 17.1 2.9 4.4

Boulder 1.2 30.6 9.7 23.0 33.9 6.6 12.5 3.3 2.4

Greeley 2.3 30.8 11.5 26.4 32.6 14.4 19.7 3.4 4.0

Colorado 2.2 35.2 11.1 32.8 33.3 14.0 17.2 3.7 3.6

NATION 2.6% 38.2% 13.0% 31.7% 33.2% 14.2% 15.5% 3.5% 4.3%

1 A comorbidity is a condition a Type 2 diabetes patient may also have, which is not directly related to the diabetes. Comorbidities were narrowed down to a subset of conditions which are typically present in patients with Type 2 diabetes. Comorbidities of Type 2 diabetes include, but are not limited to, depression, hyperlipidemia, hypertension, obesity, and pneumonia.

2 A complication is defined as a patient condition caused by the Type 2 diabetes of the patient. These conditions are a direct result of having Type 2 diabetes. Complications of Type 2 diabetes include, but are not limited to, acute myocardial infarction (AMI), cardiovascular (CV) disease, severe hypoglycemia, nephropathy, neuropathy, peripheral artery disease (PAD), stroke, and retinopathy.


PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY ACTUAL COMORBIDITY, 20161

MARKET Depression Hyperlipidemia Hypertension Obesity

Denver 13.3% 57.6% 74.8% 21.0%

Colorado Springs 12.5 54.3 73.0 21.2

Pueblo 10.2 44.1 76.2 16.6

Grand Junction 16.5 52.0 75.1 25.4

Fort Collins 13.9 41.8 68.0 17.6

Boulder 12.7 59.3 70.6 16.9

Greeley 13.0 52.0 74.9 14.4

Colorado 13.1 54.5 74.0 20.4

NATION 10.8% 60.0% 80.4% 22.1%

PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY NUMBER OF COMORBIDITIES AND COMPLICATIONS, 2016

DenverColorado

SpringsPueblo

Grand Junction

Fort Collins

Boulder Greeley Colorado NATION

COMORBIDITIES1

0 43.3% 51.4% 52.8% 36.3% 60.8% 58.4% 50.7% 47.8% 39.4%

1 14.1 13.9 13.1 14.9 14.4 11.6 14.6 14.0 13.1

2 12.1 10.6 10.8 12.6 9.1 10.7 12.0 11.5 11.5

>2 30.6 24.1 23.4 36.2 15.8 19.3 22.8 26.7 36.0

COMPLICATIONS2

0 45.1% 48.9% 48.7% 44.0% 48.5% 58.0% 55.9% 47.9% 45.7%

1 16.3 17.2 16.8 16.7 18.7 17.1 16.8 16.8 16.6

2 9.9 9.9 10.1 10.7 9.9 9.0 8.2 9.8 9.9

>2 28.7 24.0 24.4 28.5 22.9 15.9 19.1 25.5 27.8

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DIABETES: UTILIZATION

A1c LEVELS ARE ELEVATED IN MANY COLORADO MARKETS• The percentages

of Type 2 diabetes patients with an A1c level greater than 9.0% on their latest exam surpassed the state (14.8%) and national (16.8%) benchmarks in four of the profiled local markets in 2016: Colorado Springs (16.9%), Pueblo (19.1%), Grand Junction (17.4%), and Greeley (21.0%) .

PERCENTAGE OF TYPE 2 DIABETES PATIENTS, BY SERVICE, 2016

Denver Colorado Springs Pueblo Grand Junction Fort Collins Boulder Greeley Colorado60%

67%

74%

81%

88%

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A1c Test1 Serum Cholesterol Test Nation A1c Test1 = 73.9% Nation Serum Cholesterol Test = 84.3%

77.6%

84.5%

77.4%

84.1%

75.4%

83.4%

82.5%

84.8%

73.8%

83.2%

74.6%

82.6%

73.6%

83.8%

77.0%

84.1%

DISTRIBUTION OF TYPE 2 DIABETES PATIENTS, BY A1c LEVEL RANGE, 20161

MARKET ≤7.0% 7.1–7.9% 8.0–9.0% >9.0%

Denver 51.3% 21.5% 13.2% 14.0%

Colorado Springs 49.6 20.5 13.1 16.9

Pueblo 46.9 21.1 12.9 19.1

Grand Junction 51.0 21.4 10.2 17.4

Fort Collins 50.8 19.9 14.4 14.9

Boulder 50.8 21.8 16.0 11.4

Greeley 44.3 21.0 13.9 21.0

Colorado 50.4 21.3 13.4 14.8

NATION 47.3% 21.8% 14.1% 16.8%



FortCollins

Boulder Greeley Colorado Nation0%

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20%

30%

40%

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37.2% 36.6% 35.1% 35.9%33.1% 34.3%

36.6% 37.0%34.7%

32.4%35.9%

38.8%36.8%

39.1%36.6% 36.5% 36.6% 36.3%

2015 2016

PERCENTAGE OF TYPE 2 DIABETES PATIENTS WITH LDL-C ≥70 mg/dL, 2015–2016

1 The A1c test measures how much glucose has been in the blood during the past 2–3 months. Figures reflect the percentage of Type 2 diabetes patients who have had at least one A1c test in 2016.

NOTE: LDL-C is low-density lipoprotein cholesterol.


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DIABETES: PHARMACOTHERAPY


1 Patients who filled prescriptions for any insulin products may have also filled prescriptions for products in the non-insulin category, and vice versa.2 A complication is defined as a patient condition caused by the Type 2 diabetes of the patient. These conditions are a direct result of having Type 2 diabetes.

Complications of Type 2 diabetes include, but are not limited to, acute myocardial infarction (AMI), cardiovascular (CV) disease, severe hypoglycemia, nephropathy, neuropathy, peripheral artery disease (PAD), stroke, and retinopathy.

Insulin Therapies Long-Acting Insulin: Insulin replacement product with a long duration of action. “Gen 1” refers to long-acting basal insulins approved through 2014, as well as long-acting insulin follow-on biologics/biosimilar medications approved after 2014. “Gen 2” refers to non-follow-on biologics/biosimilar longer-acting basal insulins approved in 2015 or after.Mixed Insulin: Insulin replacement product combining a short-acting and an intermediate-acting insulin productRapid-Acting Insulin: Insulin replacement product with a rapid onset

NOTE: Throughout this report, n/a indicates that data were not available. “Gen 1” refers to long-acting basal insulins approved through 2014, as well as long-acting insulin follow-on biologics/biosimilar medications approved after 2014. “Gen 2” refers to non-follow-on biologics/biosimilar longer-acting basal insulins approved in 2015 or after. Gen 2 therapies are available as pens only.

PERCENTAGE OF COMMERCIAL TYPE 2 DIABETES PATIENTS RECEIVING GEN 1 VS. GEN 2 LONG-ACTING INSULIN,BY ACTUAL COMPLICATION, 20162

PERCENTAGE OF TYPE 2 DIABETES PATIENTS RECEIVING VARIOUS INSULIN THERAPIES,PENS VS. VIALS, 20161

Any Insulin

Products

Long-Acting Insulin: Gen 1

Long-Acting Insulin: Gen 2

Rapid-Acting Insulin

Mixed Insulin

MARKET Pens Vials Pens Pens Vials Pens Vials

Denver 34.3% 18.2% 8.8% 2.8% 9.6% 8.2% 1.0% 1.2%

Colorado Springs 36.9 21.3 8.4 2.2 11.1 8.9 1.5 0.8

Pueblo 42.5 25.3 11.2 2.4 14.5 7.6 2.0 2.5

Grand Junction 37.3 20.8 8.2 3.5 11.2 8.7 1.5 1.3

Fort Collins 35.9 19.0 9.4 3.2 12.0 9.3 0.9 1.0

Boulder 39.5 20.1 10.6 2.8 12.8 10.9 1.2 0.7

Greeley 38.7 21.3 9.3 3.6 12.6 7.0 1.9 1.9

Colorado 36.2 19.7 9.1 2.8 10.8 8.4 1.2 1.3

NATION 33.7% 18.2% 8.0% 3.2% 10.9% 6.7% 2.1% 2.1%

SMALL SHARE OF CO TYPE 2 DIABETES PTS. FILL GEN 2 INSULINS• In 2016, the percentage

of Colorado Type 2 diabetes who were dispensed a second- generation long-acting insulin product (2.8%)was below the national benchmark (3.2%). Further, Colorado Type 2 diabetes patients who were dispensed a Gen 2 long-acting insulin were less likely to have any of the profiled complications than their peers who filled a Gen 1 insulin that year.

CV Disease

Nation ColoradoColorado Nation Colorado Nation Colorado Nation Colorado Nation0%

9%

18%

27%

36%

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27.4%

21.8%

31.0%

28.5%

33.7%

29.3%

32.2%

29.3%

9.6%

6.6%

10.5%9.2%

—n/a—

5.6% 5.3%

3.2% 2.4%3.6%

2.5%

Gen 1 Gen 2

Nephropathy PAD Severe Hypoglycemia Stroke

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DIABETES: PHARMACOTHERAPY


1 Patients who filled prescriptions for any insulin products may have also filled prescriptions for products in the non-insulin category, and vice versa.

Non-Insulin Therapies Biguanides: Improve insulin sensitivity; reduce the production of glucose by the liver, decrease intestinal absorption of glucose, and increase the peripheral uptake and use of circulating glucose.Dipeptidyl Peptidase 4 (DPP-4) Inhibitors: Inhibit DPP-4 enzymes and slow inactivation of incretin hormones, helping to regulate glucose homeostasis through increased insulin release and decreased glucagon levels.GLP-1 Receptor Agonists: Used in conjunction with oral agents; increase glucose-dependent insulin secretion and pancreatic beta-cell sensitivity, reduce glucagon production, slow rate of absorption of glucose in the digestive tract by slowing gastric emptying, and suppress appetite.Insulin Sensitizing Agents: Increase insulin sensitivity by improving response to insulin in liver, adipose tissue, and skeletal muscle, resulting in decreased production of glucose by the liver and increased peripheral uptake and use of circulating glucose.Sodium/Glucose Cotransporter 2 (SGLT-2) Inhibitors: Lowers blood glucose concentration so that glucose is excreted instead of reabsorbed.Sulfonylureas: Stimulate the release of insulin in the pancreas.

PERCENTAGE OF TYPE 2 DIABETES PATIENTS RECEIVING VARIOUS COMBINATION THERAPIES, 2016

0%

5%

10%

15%

20%

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17.1%

7.2%

15.8%

6.1%

15.4%

5.8%

16.4%

6.2%

16.7%

5.9%

15.6%

6.0%

18.6%

6.7%

16.7%

6.7%



FortCollins

Boulder Greeley Colorado

Use of 2 Non-Insulin Products Use of 3 Non-Insulin Products

Nation Use of 2 Non-Insulin Products = 18.6% Nation Use of 3 Non-Insulin Products = 8.2%

PERCENTAGE OF TYPE 2 DIABETES PATIENTS RECEIVING VARIOUS NON-INSULIN ANTIDIABETIC THERAPIES, 20161

Any Non-Insulin Antidiabetic

Products

DPP-4 Inhibitors

GLP-1 + Long-Acting

Insulin

Insulin Sensitizing Agents

SGLT-2 Inhibitors

Sulfonylureas

Denver 84.6% 10.7% 3.0% 7.8% 5.9% 24.3%

Colorado Springs 83.9 12.3 2.4 6.5 6.4 24.7

Pueblo 82.2 11.9 2.6 6.2 5.4 28.7

Grand Junction 84.8 8.3 2.8 5.9 5.0 27.4

Fort Collins 82.3 10.7 2.0 4.4 4.5 27.1

Boulder 80.2 9.6 2.6 5.6 7.5 23.2

Greeley 83.4 10.7 2.6 5.9 4.8 27.7

Colorado 83.8 10.9 2.8 6.9 5.8 25.3

NATION 86.4% 12.6% 2.6% 5.3% 7.4% 30.5%

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Mo. 1 Mo. 2 Mo. 3 Mo. 4 Mo. 5 Mo. 648%

61%

74%

87%

100%

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DPP–4 Inhibitors GLP–1 Receptor Agonists GLP–1 + Long-Acting Insulin Insulin Sensitizing Agents SGLT-2 Inhibitors

NOTE: “Persistency” measures whether patients maintain their prescribed therapy. It is calculated by identifying patients who filled a prescription for the reported drug class in the six months prior to the reported year, and then tracking prescription fills for those same patients in each of the months in the current reported year. If patients fill a prescription in a month, they are reported among the patients who have continued or restarted on therapy. Continued means that the patient has filled the drug group in each of the preceding months. Restarted means that the patient did not fill in one or more of the preceding months. Continuing and restarting patients are reported together. “Gen 1” refers to long-acting basal insulins approved through 2014, as well as long-acting insulin follow-on biologics/biosimilar medications approved after 2014. “Gen 2” refers to non-follow-on biologics/biosimilar longer-acting basal insulins approved in 2015 or after.

PERSISTENCY: VARIOUS INSULIN THERAPIES, COLORADO, 2016

Mo. 1 Mo. 2 Mo. 3 Mo. 4 Mo. 5 Mo. 648%

61%

74%

87%

100%

Perc

en

tag

e o

f Pa

tien

ts

Long-Acting Insulin: Gen 1 Long-Acting Insulin: Gen 2 Rapid-Acting Insulin Mixed Insulin

PERSISTENCY: VARIOUS NON-INSULIN ANTIDIABETIC THERAPIES, COLORADO, 2016

Mo. 1 Mo. 2 Mo. 3 Mo. 4 Mo. 5 Mo. 640%

55%

70%

85%

100%

Perc

en

tag

e o

f Pa

tien

ts

DPP–4 Inhibitors GLP–1 Receptor Agonists GLP–1 + Long-Acting Insulin Insulin Sensitizing Agents SGLT-2 Inhibitors


PERSISTENCY: VARIOUS INSULIN THERAPIES, NATION, 2016

PERSISTENCY: VARIOUS NON-INSULIN ANTIDIABETIC THERAPIES, NATION, 2016

Mo. 1 Mo. 2 Mo. 3 Mo. 4 Mo. 5 Mo. 656%

67%

78%

89%

100%

Perc

en

tag

e o

f Pa

tien

ts

Long-Acting Insulin: Gen 1 Long-Acting Insulin: Gen 2 Rapid-Acting Insulin Mixed Insulin

DIABETES: PERSISTENCY

DIA

BETESD

IABETES


DIABETES: CHARGES


PROFESSIONAL INPATIENT CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, BY PAYER, 20161

MARKET Commercial Insurance2 Medicare Medicaid

Denver $3,050 $3,023 $2,599

Colorado Springs 2,584 1,766 1,765

Pueblo 2,678 1,553 1,569

Grand Junction 3,190 1,985 2,841

Fort Collins 2,578 2,079 1,877

Boulder 2,736 2,276 1,727

Greeley 3,725 2,554 1,289

Colorado 2,912 2,509 2,295

NATION $3,323 $2,856 $3,606

PROFESSIONAL CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, 2015–20161

Ambulatory Surgery

Emergency Department

Hospital Inpatient

Hospital Outpatient

Office/ Clinic

MARKET 2015 2016 2015 2016 2015 2016 2015 2016 2015 2016

Denver $2,879 $3,026 $1,244 $1,229 $3,337 $3,584 $1,161 $1,391 $2,256 $2,468

Colorado Springs 3,140 3,278 707 795 2,005 2,455 786 1,063 2,070 2,248

Pueblo 4,948 5,450 650 745 2,199 2,236 746 785 1,324 1,442

Grand Junction 2,643 2,754 499 609 2,999 3,635 1,010 1,169 1,710 2,064

Fort Collins 2,949 3,221 837 1,042 2,424 2,582 841 1,086 1,581 1,557

Boulder 2,474 2,833 866 848 2,183 2,777 876 952 2,086 2,037

Greeley 2,420 3,245 817 1,203 2,401 3,225 898 1,147 1,356 1,508

Colorado 3,030 3,210 1,027 1,079 2,857 3,151 1,015 1,219 1,967 2,142

NATION $2,985 $3,223 $1,549 $1,889 $3,344 $3,681 $1,303 $1,424 $2,180 $2,404

1 Professional charges are those generated by the providers delivering care to Type 2 diabetes patients in various settings. 2 Includes HMOs, PPOs, point-of-service plans, and exclusive provider organizations.3 A complication is defined as a patient condition caused by the Type 2 diabetes of the patient. These conditions are a direct result of having Type 2 diabetes.

Complications of Type 2 diabetes include, but are not limited to, acute myocardial infarction (AMI), cardiovascular (CV) disease, severe hypoglycemia, nephropathy, neuropathy, peripheral artery disease (PAD), stroke, and retinopathy.

HYPOGLYCEMIA DRIVES UP ANNUAL ED PROVIDER CHARGES• In each profiled

Colorado local market and statewide in 2016, average annual provider emergency department (ED) charges for Type 2 diabetes patients with severe hypoglycemia were higher than those for Type 2 diabetes patients overall.

PROFESSIONAL EMERGENCY DEPARTMENT CHARGES PER YEAR FOR TYPE 2 DIABETES PATIENTS, OVERALL VS. TYPE 2 DIABETES PATIENTS WITH A COMPLICATION OF SEVERE HYPOGLYCEMIA, 20161,3

$0

$1,000

$2,000

$3,000

$4,000

Ave

rag

e C

ha

rge

s

$1,229

$2,126

$795

$2,134

$745

$1,245

$609$812

$1,042

$2,359

$848

$1,314 $1,203

$2,037

$1,079

$1,982

Overall w/ Severe Hypoglycemia Nation Overall = $1,889 Nation w/ Severe Hypoglycemia = $3,627



FortCollins

Boulder Greeley Colorado

DIA

BETE

S


MOST COMMON CONCOMITANT DIAGNOSES FOR PATIENTS WITH A PRIMARY DIAGNOSIS OF DIABETES MELLITUS, BY ICD-9 CODE, 2015

ICD-9 Code Description Colorado NATION

401.9 Unspecified Essential Hypertension 13.4% 15.8%

58.49 Unspecified Acute Renal Failure 13.6 13.0

272.4 Other and Unspecified Hyperlipidemia 8.6 10.6

276.1 Hyposmolality and/or Hyponatremia 11.6 9.1

357.2 Polyneuropathy in Diabetes 9.7 8.8

707.15 Ulcer of Other Part of Foot 6.8 8.1

305.1 Nondependent Tobacco Use Disorder 7.0 6.8


NOTE: Inpatient and outpatient case counts come from QuintilesIMS’s Hospital Procedure/Diagnosis (HPD) database and are current as of calendar year 2015. In this report, cases represent a patient discharge from a hospital inpatient or outpatient facility. Patients may have multiple cases in a year. Hospital data are based on all short-term, acute-care hospitals. Psychiatric, rehabilitation, armed forces, and long-term acute-care hospitals are excluded.

DIABETES: HOSPITAL CASES

TOTAL NUMBERS OF INPATIENT DIABETES MELLITUS CASES PER YEAR, 2014–2015

Overall w/ Hypoglycemia

MARKET 2014 2015 2014 2015

Denver 23,140 25,134 1,668 1,849

Colorado Springs 10,018 10,849 659 815

Pueblo 3,500 3,940 284 278

Grand Junction 2,067 2,324 125 193

Fort Collins 3,063 3,458 195 178

Boulder 3,460 3,964 308 355

Greeley 1,888 1,985 168 181

Colorado 51,427 56,344 3,647 4,128

NATION 6,121,053 6,208,771 428,857 462,853

TOTAL NUMBERS OF OUTPATIENT DIABETES MELLITUS CASES PER YEAR, 2014–2015

Overall w/ Hypoglycemia

MARKET 2014 2015 2014 2015

Denver 116,542 112,057 3,809 3,127

Colorado Springs 65,524 74,622 1,778 1,520

Pueblo 15,665 13,750 446 358

Grand Junction 17,822 15,790 359 253

Fort Collins 24,437 24,002 730 610

Boulder 19,218 17,337 1,337 452

Greeley 7,554 8,052 298 332

Colorado 326,362 323,264 9,951 7,772

NATION 31,252,109 33,283,977 1,308,354 1,359,343

PRIMARY DIAGNOSIS PERCENTAGE OF TOTAL INPATIENT DIABETES MELLITUS CASES, 2015



Fort Collins Boulder Greeley Colorado2%

4%

6%

8%

10%

Perc

en

tag

e o

f Ca

ses 8.8% 9.0% 9.4% 8.4%

7.3%7.8%

8.6% 8.6%

Nation = 8.9%

COLORADO INPATIENT DIABETES MELLITUS CASE COUNT RISES• The total number of

inpatient (IP) diabetes mellitus cases treated in Colorado hospitals expanded to 56,344 in 2015 from 51,427 in 2014, an increase of 9.6%. Nationally, such case volumes grew just 1.4%. Similarly, the total number of IP diabetes mellitus cases with hypoglycemia rose 13.2% in Colorado (to 4,128 from 3,647), but increased by just 7.9% (to 462,853 from 428,857) across the nation.

DIA

BETESD

IABETES


DIABETES: ALOS/READMISSIONS

PERCENTAGE OF DIABETES MELLITUS INPATIENT CASES, BY DISCHARGE DESTINATION, 2015

MARKETRoutine

Skilled Nursing Facility

Home Health Died Other2

Denver 62.5% 14.3% 17.5% 0.8% 1.6%

Colorado Springs 61.6 14.4 18.4 0.6 2.2

Pueblo 61.6 13.6 18.3 0.8 2.3

Grand Junction 63.8 13.5 17.1 0.9 2.4

Fort Collins 62.0 17.2 12.6 1.3 4.6

Boulder 57.4 15.8 21.9 0.5 0.9

Greeley 61.1 14.6 18.5 0.9 2.0

Colorado 61.4 14.8 17.7 0.9 1.9

NATION 61.8% 13.5% 16.5% 1.1% 2.5%

AVERAGE LENGTH OF STAY (DAYS) AND AVERAGE CHARGES PER INPATIENT DIABETES MELLITUS CASE, 2015

Average Length of Stay Average Charges1

MARKET Overall w/ Hypoglycemia Overall w/ Hypoglycemia

Denver 4.3 5.1 $52,372 $57,308

Colorado Springs 3.2 4.6 28,932 40,791

Pueblo 4.4 5.6 40,947 52,318

Grand Junction 5.5 6.1 44,485 49,108

Fort Collins 4.5 5.3 34,066 42,295

Boulder 4.0 4.8 37,387 42,953

Greeley 4.1 5.1 39,592 45,959

Colorado 4.1 4.9 41,536 48,796

NATION 4.0 5.0 $38,984 $43,385

READMISSION RATES FOR PATIENTS DIAGNOSED WITH TYPE 2 DIABETES, BY TYPE OF THERAPY, 2014–20163,4

Three-Day Readmissions 30-Day Readmissions

MARKETAny Insulin Products

Three Non- Insulin Products

Any Insulin Products

Three Non- Insulin Products

West Region 6.9% 15.2% 15.8% 25.3%

NATION 8.7% 11.9% 18.1% 22.4%

1 Data reflect the total charges billed by the hospital for the entire episode of care, and may include accommodation, pharmacy, laboratory, radiology, and other charges not billed by the physician. Data do not necessarily indicate final amounts paid.

2 “Other” represents mental health/rehabilitation, shelters, hospice (home), and hospice (medical facility).3 Figures reflect the percentages of Type 2 diabetes patients who were readmitted to an inpatient facility in the three-year period between 2014 and 2016. These

percentages include patients who filled multiple prescriptions. Readmissions are not necessarily due to Type 2 diabetes.4 Patients who filled prescriptions for any insulin products may have also filled prescriptions for products in the non-insulin category, and vice versa.

NOTE: Average length of stay, charges per case and discharge destination data come from QuintilesIMS’ Hospital Procedure/Diagnosis (HPD) database and are current as of calendar year 2015. In this report, cases represent a patient discharge from a hospital inpatient or outpatient facility. Patients may have multiple cases in a year. Hospital data are based on all short-term, acute-care hospitals. Psychiatric, rehabilitation, armed forces, and long-term acute-care hospitals are excluded.

DIABETES MELLITUS INPATIENT CHARGES ARE HIGH IN CO• In 2015, the average

charges for inpatient (IP) diabetes mellitus cases overall ($41,536) and with hypoglycemia ($48,796) in Colorado exceeded the corresponding national means by 6.5% and 12.5%, respectively.


CA

RDIO

VA

SCU

LAR

DIS

EASE


0%

6%

12%

18%

24%

Perc

en

tag

e o

f Pa

tien

ts

Colorado Nation

16.4%

20.9%

11.8%14.7%

17.0%

22.0%

12.8%15.2%

AMI Heart Failure Stroke All-Cause

CARDIOVASCULAR DISEASE IN COLORADO

Data source: QuintilesIMS © 20171 Charge data are per-case averages for inpatients with a particular diagnosis of interest. Charges may be for treatment related to other diagnoses. Data reflect the total

charges billed by the acute-care hospital for the entire episode of care, and may include accommodation, pharmacy, laboratory, radiology, and other charges not billed by the physician. Data do not necessarily indicate final amounts paid.

NOTE: Throughout this report, n/a indicates that data were not available.

NUMBERS OF INPATIENT CASES PER HOSPITAL PER YEAR, 2014–2015

AMI (STEMI) Heart Failure Stroke

MARKET 2014 2015 2014 2015 2014 2015

Denver 67.8 59.1 810.2 937.5 208.3 249.0

Colorado Springs 96.6 97.0 1,043.4 n/a 297.8 n/a

Pueblo 88.0 84.5 941.0 980.0 244.5 245.5

Grand Junction n/a 56.0 439.7 485.3 170.5 129.7

Fort Collins 58.7 53.3 610.8 688.3 125.3 158.3

Boulder 34.4 26.2 502.0 535.0 93.6 94.6

Greeley 105.0 87.0 1,612.0 1,659.0 260.0 262.0

Colorado 52.4 44.7 418.1 462.7 111.2 127.0

NATION 54.1 51.3 810.0 878.2 181.6 190.3

CHARGES PER HOSPITAL INPATIENT CASE, 2014–20151


MARKET 2014 2015 2014 2015 2014 2015

Denver $122,420 $116,981 $55,405 $61,326 $75,302 $80,143

Colorado Springs 90,223 90,583 38,841 37,908 44,672 49,386

Pueblo 97,635 98,566 40,764 43,394 52,187 52,765

Grand Junction 94,576 85,152 32,145 32,108 47,032 46,031

Fort Collins 85,148 77,533 29,306 31,073 35,863 35,921

Boulder 138,828 130,000 48,377 49,795 52,012 52,268

Greeley 98,395 94,504 39,370 39,493 32,277 39,176

Colorado 106,725 102,790 44,280 47,296 58,567 60,956

NATION $97,500 $93,405 $42,734 $43,987 $47,215 $48,875

30-DAY HOSPITAL READMISSION RATES, 2015

AVERAGE LENGTHS OF STAY (DAYS) PER INPATIENT CASE, 2015

0

1.5

3.0

4.5

6.0

Ave

rag

e L

en

gth

of S

tay

(Da

ys)

3.6

5.1

4.1

3.4

4.3

3.13.7

4.84.5

3.83.9

3.6

2.9

3.5

2.9

3.5

5.2

3.53.9

4.5

3.5 3.43.9

3.7 3.8

4.54.1




FortCollins

Boulder Greeley Colorado Nation

ALOS FOR HEART FAILURE TOPS U.S. MEAN IN DENVER• In 2015, the average

length of stay (ALOS) for inpatient (IP) heart failure cases treated in Denver hospitals was 5.1 days, more than half a day longer than the national average (4.5 days) and over a full day longer than the mean for all Colorado facilities (3.9 days). That year, the average charges per IP heart failure case in Denver were $61,326, 29.7% and 39.4% more than those of Colorado overall and the nation, respectively.

DIA

BETESLIPID

DISO

RDERS


LIPID DISORDERS IN COLORADO

Data source: QuintilesIMS © 2017 1 Daily dose lowers LDL–C, on average, by <30%.2 Daily dose lowers LDL–C, on average, by approximately 30% to <50%.3 Daily dose lowers LDL–C, on average, by approximately ≥50%.4 “Combination therapy” includes statin combination products and other non-statin, cholesterol-lowering medications. 5 Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor6 Professional charges are those generated by the providers delivering care to lipid disorder patients in various settings. Charges data are gathered via CMS-1500 forms

(the standard form for submitting physician charges). This form reports charge information only for physician charges directly related to treating lipid disorders.

NOTE: Throughout this report, n/a indicates that data were not available. LDL-C is low-density lipoprotein cholesterol, and HDL-C is high-density lipoprotein cholesterol.

PERCENTAGE OF LIPID DISORDER PATIENTS, BY THERAPY, 2016

Low-Intensity Statin1

Moderate-Intensity Statin2

High-Intensity Statin3

Combination Therapy4

PCSK9 Inhibitor5

MARKET

Denver 10.4% 62.8% 30.1% 3.7% 0.1%

Colorado Springs 10.6 63.5 29.5 3.9 n/a

Pueblo 11.3 62.7 29.8 3.1 n/a

Grand Junction 12.6 68.7 21.3 2.4 n/a

Fort Collins 14.3 65.3 23.5 3.0 n/a

Boulder 11.2 63.6 28.3 4.9 n/a

Greeley 11.2 65.8 26.3 3.4 n/a

Colorado 11.2 63.4 28.8 3.7 0.1

NATION 12.5% 64.6% 26.8% 4.3% 0.1%

DISTRIBUTION OF LIPID DISORDER PATIENTS, BY LIPOPROTEIN LEVEL (mg/dL), 2016

AverageLDL-C

LDL-C HDL-C Triglycerides

MARKET <70 ≥70 <60 ≥60 <150 ≥150

Denver 95.6 23.8% 76.2% 70.0% 30.0% 65.3% 34.7%

Colorado Springs 96.2 23.7 76.2 74.8 25.2 64.0 36.0

Pueblo 95.8 25.6 74.4 76.2 23.8 55.6 44.4

Grand Junction 102.7 18.7 81.3 72.4 27.6 58.9 41.1

Fort Collins 102.4 17.2 82.8 73.5 26.5 60.2 39.8

Boulder 99.6 21.1 78.9 72.5 27.5 62.1 37.9

Greeley 99.8 17.7 82.3 80.1 19.9 53.4 46.6

Colorado 96.3 23.3 76.7 71.0 29.0 64.2 35.8

NATION 97.9 22.4% 77.6% 72.1% 27.9% 62.9% 37.1%

PROFESSIONAL OUTPATIENT CHARGES FOR LIPID DISORDER PATIENTS, 20166



FortCollins

Boulder Greeley Colorado Nation$0

$500

$1,000

$1,500

$2,000

Ave

rag

e C

ha

rge

s

$1,619

$1,316

$967

$1,633

$1,117

$1,424

$1,249

$1,492

$1,705

OBE

SITY

, DEP

RESS

ION

, AN

D R

HEU

MA

TOID

ART

HRI

TIS


OBESITY, DEPRESSION, AND RA HOSPITAL CASES

Data source: QuintilesIMS © 2017NOTE: Throughout this report, n/a indicates that data were not available.

AVERAGE NUMBER OF OBESITY CASES PER HOSPITAL PER YEAR, 2014–2015

Inpatient Outpatient

MARKET 2014 2015 2014 2015

Denver 365.5 410.1 952.4 1,206.6

Colorado Springs 515.0 n/a 1,439.5 n/a

Pueblo 353.0 404.5 814.5 894.5

Grand Junction 174.0 188.7 632.0 659.0

Fort Collins 146.5 198.0 468.3 626.3

Boulder 224.0 248.6 761.8 550.2

Greeley 450.0 432.0 1,110.0 1,313.0

Colorado 199.9 198.1 491.1 594.5

NATION 293.4 301.2 795.1 872.6

AVERAGE NUMBER OF DEPRESSION CASES PER HOSPITAL PER YEAR, 2014–2015


MARKET 2014 2015 2014 2015

Denver 425.9 467.2 1,329.9 1,048.2

Colorado Springs 336.2 n/a 1,633.5 n/a

Pueblo 478.5 502.5 1,301.0 926.5

Grand Junction 229.5 189.3 514.0 497.7

Fort Collins 147.0 188.3 754.0 665.8

Boulder 246.2 245.6 980.4 787.6

Greeley 226.0 197.0 1,225.0 1,025.0

Colorado 200.6 215.6 651.6 551.5

NATION 345.4 373.7 810.5 839.4

AVERAGE NUMBER OF RHEUMATOID ARTHRITIS CASES PER HOSPITAL PER YEAR, 2014–2015


MARKET 2014 2015 2014 2015

Denver 119.6 117.7 588.5 675.2

Colorado Springs 136.6 179.0 1,094.5 1,444.7

Pueblo 150.5 157.5 621.0 540.0

Grand Junction 53.3 60.7 787.0 770.3

Fort Collins 64.3 82.3 752.8 827.5

Boulder 51.8 61.8 267.8 266.6

Greeley 135.0 120.0 412.0 543.0

Colorado 63.6 60.5 377.1 406.8

NATION 73.6 71.6 397.9 436.0

OUTPATIENT RA CASE COUNTS RISE ACROSS COLORADO• The number of

outpatient rheumatoid arthritis (RA) cases per Colorado hospital grew 7.9%, to 406.8 in 2015 from 377.1 in 2014. By local market profiled, such case counts also increased in Denver, Colorado Springs, Fort Collins, and Greeley during this period.

DIA

BETES


CH

RON

IC D

ISEASE SPEN

DIN

GCHRONIC DISEASE SPENDING

Data source: Colorado Business Group on Health © 2017

SPENDING AS A PERCENTAGE OF THE TOTAL ANNUAL HEALTH CARE COST, COLORADO SPRINGS ANNUAL AVERAGE, 2013–Q2 2016

DIAGNOSIS Percentage of Total Annual Cost Annual Cost

Asthma 5% $4,357,833

COPD 5 4,453,206

Coronary Artery Disease 20 17,627,270

Diabetes Mellitus 18 15,555,826

GERD 6 5,331,421

Hypertension 14 11,827,973

Other 32 27,428,524

SPENDING ASSOCIATED WITH POTENTIALLY AVOIDABLE COMPLICATIONS, COLORADO SPRINGS, ANNUAL AVERAGE, 2013–Q2 2016

DIAGNOSIS Percentage of Total Annual Cost Annual Cost

Asthma 5% $235,666

COPD 7 348,621

Coronary Artery Disease 35 1,689,420

Diabetes Mellitus 37 1,789,757

GERD 7 306,865

Hypertension 9 418,100

ONE-FIFTH OF COLORADO SPRINGS SPENDING IS ON CAD• Between 2013 and

Q2 of 2016, 20% of all health care spending by employers and purchasers in Colorado Springs was on coronary artery disease (CAD); more than two-thirds of such spending was accounted for by the six profiled chronic diseases.

$0

$5,000

$10,000

$15,000

$20,000

Ave

rag

e S

pe

nd

ing

$19,138

$17,179$18,150

$14,385

$17,103$16,218

$10,376 $10,515

$8,066

Diabetes Mellitus Coronary Artery Disease Hypertension

2013/2014 2014/2015 2015/2016

AVERAGE SPENDING PER MEMBER PER YEAR ON THREE CHRONIC CONDITIONS, COLORADO SPRINGS, Q3 2013–Q2 2016


CH

RON

IC D

ISEA

SE S

PEN

DIN

GCHRONIC DISEASE SPENDING

THREE CO COUNTIES SPEND >$5,000 PER PATIENT PER YEAR• Out of the 64 counties

in Colorado, together, health plans and patients in three—Mesa, Pitkin, and Rio Blanco—spent more than $5,000 per patient per year (PPPY) on the treatment of chronic diseases in 2015. Another six counties (Grand, Jefferson, Las Animas, Montrose, Phillips, and Pueblo) spend between $4,400 and $5,000 PPPY.

DIABETES RISK-ADJUSTED READMISSIONS INDEX, 2014–20161

Data source: Quantros, Inc. © 2017

Data source: Center for Improving Value in Health Care © 2017

DenverHospitals

ColoradoSprings

Hospitals

GrandJunctionHospitals

Fort CollinsHospitals

ColoradoHospitals

0.0

0.3

0.6

0.9

1.2

Risk

-Ad

just

ed

Re

ad

miss

ion

s In

de

x

1.10

1.01

0.60

0.84

1.01

Hospitals Index National Hospitals Index = 1.00

PuebloHospitals

0.92

$2,600–$3,200 $3,201–$3,800 $3,801–$4,400 $4,401–$5,000 $5,001–$5,600

SPENDING PER PATIENT PER YEAR, BY COUNTY, 2015

1 These are the Centers for Medicare and Medicaid Services (CMS) inpatient discharges from Q1 2014 through Q3 2016 with one of 85 ICD-10-CM principal diagnosis codes of diabetes. This index is the ratio of the risk-adjusted observed readmission rate to the risk-adjusted expected readmission rate.

DIA

BETES


IBI DISA

BILITY C

LAIM

SIBI DISABILITY CLAIMS

HALF OF CO DIABETES LTD CLAIMS TAKE 10+ YEARS TO CLOSE• Of the 118 diabetes

long-term disability (LTD) claims filed in Colorado between 2011 and 2015, 50% of them took 10 years or longer to close. Such LTD claims cost an average of $117,246 each. Meanwhile, the average duration of short-term disability (STD) claims for diabetes in Colorado was 72.8 days, and cost employers an average of $4,004 per claim. Of all such STD claims, 15.0% reached the maximum duration.

AVERAGE DURATION (DAYS) OF SHORT-TERM DIABETES DISABILITY CLAIMS AND PERCENTAGE OF CLAIMS REACHING MAXIMUM BENEFIT DURATION, 2011–20151

AVERAGE COSTS OF SHORT- AND LONG-TERM DIABETES DISABILITY CLAIMS, 2011–20151

DISTRIBUTION OF LONG-TERM DIABETES DISABILITY CLAIMS, BY TIME TO CLOSE, 2011–2015

Colorado0

20

40

60

80

0%

4%

8%

12%

16%

Du

ratio

n o

f Cla

ims

(Da

ys) Pe

rce

nta

ge

of C

laim

s

72.8 15.0%

Duration of Claims (Days) Percentage of Claims Reaching Maximum Benefit Duration

Colorado$0

$1,100

$2,200

$3,300

$4,400

$0

$30,000

$60,000

$90,000

$120,000

Co

st o

f Sh

ort

-Te

rm C

laim

s Co

st of Lo

ng

-Term

Cla

ims

$4,004$117,246

Short Term Long Term

Colorado(118 Claims)

Percentage of Claims

0%

8.0% 8.0% 20.0% 14.0% 27.0% 23.0%

25% 50% 75% 100%

6 Months 1 Year 3 Years 5 Years 10 Years >10 Years

1 Closed claims only.

DATA DESCRIPTIONAll analyses on this page were conducted using disability claims data from Integrated Benefits Institute’s (IBI’s) Lost Productivity benchmarking

data. Each year, 14 major U.S. disability insurers and absence management firms provide IBI with more than 3 million short-term disability (STD),

long-term disability (LTD), Worker’s Compensation (WC), and federal Family and Medical Leave Act (FMLA) claims from more than 45,000

employer disability policies.

This analysis used STD and LTD claims that were on suppliers’ books of business in calendar years 2011 through 2015. The database contains

2,643 Colorado employers’ STD policies and 3,269 Colorado employers’ LTD policies.

The data contain claims for which payments were ceased by the end of calendar year 2015 (i.e., closed claims) and claims for which payments

continued to be paid at the end of 2015 (i.e., open claims). These claims include information on costs and durations of disability, as well as claim

and claimant characteristics such as industry, plan design, the primary diagnosis (International Classification of Diseases, 9th Revision [ICD-9] or

10th Revision [ICD-10]), date of birth and sex. Within this data set, an STD claim is considered closed when an employee returns to work or when

the claim reaches its maximum duration of benefits (whether or not an employee returned to work), whichever comes sooner; LTD claims can

remain open until an employee reaches social security retirement age, receives a lump sum payout from a policy carrier, or returns to work.

Data source: Integrated Benefits Institute © 2017


MET

HO

DO

LOG

Y/PO

SITI

ON

STA

TEM

ENT

METHODOLOGY/POSITION STATEMENT

Monotherapy Efficacy* Hypo risk Weight Side effects Costs*

Dual therapy†

Efficacy* Hypo risk Weight Side effects Costs*

Triple therapy

Combinationinjectabletherapy‡

Healthy eating, weight control, increased physical activity, and diabetes education

Metforminhigh

low riskneutral/loss

GI/lactic acidosislow

Metformin+

Sulfonylureahigh

moderate riskgain

hypoglycemialow

Metformin+

Thiazolidinedionehigh

low riskgain

edema, HF, fxslow

Metformin+

DPP-4 Inhibitorintermediate

low riskneutral

rarehigh

Metformin+

GLP-1 Receptor Agonisthigh

low risklossGI

high

Metformin+

Insulin (basal)highesthigh risk

gainhypoglycemia

variable

Metformin+

Sulfonylurea+

TZDor DPP-4-ior SGLT2-i

or GLP-1-RAor Insulin§

Metformin+

Thiazolidinedione+SU

or DPP-4-ior SGLT2-i

or GLP-1-RAor Insulin§

Metformin+

DPP-4 Inhibitor+SU

or TZDor SGLT2-ior Insulin§

Metformin+

GLP-1 Receptor Agonist+SU

or TZDor Insulin§

Metformin+

Insulin (basal)+

TZDor DPP-4-ior SGLT2-i

or GLP-1-RA

Metformin+

Basal insulin + Mealtime insulin or GLP-1-RA

Metformin+

SGLT2 Inhibitorintermediate

low riskloss

GU, dehydrationhigh

Metformin+

SGLT2 Inhibitor+SU

or TZDor DPP-4-ior Insulin§

If A1C target not achieved after ~3 months of monotherapy, proceed to 2-drug combination (order not meant to denoteany specific preference—choice dependent on a variety of patient- and disease-specific factors):

If A1C target not achieved after ~3 months of dual therapy, proceed to 3-drug combination (order not meant to denoteany specific preference—choice dependent on a variety of patient- and disease-specific factors):

If A1C target not achieved after ~3 months of triple therapy and patient (1) on oral combination, move to injectables; (2) on GLP-1-RA, add basal insulin; or (3) on optimally titrated basal insulin, add GLP-1-RA or mealtime insulin. In refractory patients consider adding TZD or SGLT2-i:

Antihyperglycemic therapy in Type 2 diabetes: general recommendations (see Reference). The order in the chart was determined by historical availability and the route of administration, with injectibles to the right; it is not meant to denote any specific preference. Potential sequences of antihyperglycemic therapy for patients with Type 2 diabetes are displayed, with the usual transition moving vertically from top to bottom (although horizontal movement within therapy stages is also possible, depending on the circumstances). DPP-4-i, DPP-4 inhibitor; fxs, fractures; GI, gastrointestinal; GLP-1-RA, GLP-1 receptor agonist; GU, genitourinary; HF, heart failure; Hypo, hypoglycemia; SGLT2-i, SGLT2 inhibitor; SU, sulfonylurea; TZD, thiazolidinedione. *See Reference for description of efficacy categorization. † Consider starting at this stage when A1C is ≥9%. ‡ Consider starting at this stage when blood glucose is ≥300–350 mg/dL (16.7–19.4 mmol/L) and/or A1C is ≥10–12%, especially if symptomatic or catabolic features are present, in which case basal insulin + mealtime insulin is the preferred initial regimen. § Usually a basal insulin (NPH, glargine, detemir, degludec). Adapted with permission from Inzucchi et al. (see Reference).

Reference: Inzucchi, S. E., et al. (2015). Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. Retrieved from http://care.diabetesjournals.org/content/38/1/140.full.pdf+html

Adapted From the 2015 ADA/EASD Position Statement

MethodologyQuintilesIMS generated most of the Type 2 diabetes data for this report out of health care professional (837p) and institutional (837i) insurance claims. The data represent more than 9.7 million unique Type 2 diabetes patients nationally in 2016 with a diagnosis of Type 2 diabetes (ICD-9 codes 249.00–250.92; ICD-10 codes E08, E09, E11, E13), and nearly 21 million unique patients nationally in 2016 with a diagnosis of lipid disorders (272.0–4; E78.0–5). Data from physicians of all specialties and from all hospital types are included.

QuintilesIMS also gathers data on prescription activity from the National Council for Prescription Drug Programs (NCPDP). These data account for some 2 billion prescription claims annually, or more than 86% of the prescription universe. These prescription data represent the sampling of prescription activity from a variety of sources, including retail chains, mass merchandisers, and pharmacy benefit managers. Cash, Medicaid, and third-party transactions are tracked.

DATA INTEGRITYData arriving into QuintilesIMS are put through a rigorous process to ensure that data elements match to valid references, such as product codes, ICD-9/10 (diagnosis) and CPT-4 (procedure) codes, and provider and facility data.

Claims undergo a careful de-duplication process to ensure that when multiple, voided, or adjusted claims are assigned to a patient encounter, they are applied to the database, but only for a single, unique patient.

Through its patient encryption methods, IMS Health creates a unique, random numerical identifier for every patient, and then strips away all patient-specific health information that is protected under the Health Insurance Portability and Accountability Act (HIPAA). The identifier allows QuintilesIMS to track disease-specific diagnosis and procedure activity across the various settings where patient care is provided (hospital inpatient, hospital outpatient, emergency rooms, clinics, doctors’ offices, and pharmacies), while protecting the privacy of each patient.

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