MNCM News

"The two words ‘information’ and ‘communication’ are often used interchangeably, but they signify quite different things. Information is giving out; communication is getting through." -- Sydney J. Harris

Total Cost of Care Results Released: Total Cost Increased Nearly 6 Percent from Previous Year

New information published by MN Community Measurement (MNCM) allows consumers to compare the cost of care at medical groups across the state. The total cost of medical care in Minnesota increased 5.6 percent from 2014 to 2015 for commercially-insured patients, according to the latest data released by MNCM. View complete results for 2014 and 2015 in the 2016 Cost & Utilization Report 

“This increase is more than the previous year and greater than the average increase in people’s income in Minnesota,” said Jim Chase, MNCM President.

The MNCM data shows an increase for commercially-insured patients per month from $449 in 2014 to $474 in 2015. The increase was 3.2 percent between 2013 and 2014.

This is the third release of overall total cost of care (TCOC) information by MNCM. The first TCOC report occurred in 2014 and reported a TCOC in 2013 of $435 per commercially-insured patient per month. The data is available at MNCM’s public reporting website MNHealthScores.org.

“This data not only informs consumers,” said Chase, “the availability of these results provide useful information for our community about what is driving cost increases by medical group and by region.”

Total Cost of Care and much more

The data now available features TCOC and Average Cost per Procedure measures. The results of these measures are based on 2015 health insurance claims of more than 1.5 million commercially-insured patients enrolled with four Minnesota health plans: Blue Cross and Blue Shield of Minnesota, HealthPartners, Medica and PreferredOne.

In addition to statewide 2015 TCOC results, MNCM tracks the cost of 90 common medical procedures. These procedures can be searched by – and compared across – medical groups at MNHealthScores.org. Average procedure costs are available on MNHealthScores.org for 200 unique medical groups. TCOC is available on MNHealthScores.org for 120 medical groups, representing 1,030 clinics across Minnesota and neighboring communities.

Individual medical group TCOC for 2015 results vary widely and range from $365 to $914 per patient per month. The TCOC amounts are risk-adjusted and outlier costs are removed to level the playing field for all medical groups so true cost variation can be evaluated.

“There are certainly differences in the types of patients seen across medical groups,” said Chase. “There are reasons why groups are higher or lower cost, but the cost differences are real.”

The average 2015 TCOC for adult patients age 18-64 was $558 per month and for pediatric patients age 1-17 was $238 per month.

“We hope this data helps inform medical groups about opportunities to reduce cost for their patients,” added Chase.

Year-to-year comparisons track the change in TCOC for patients by types of service received. Take home Pharmacy costs, for example, increased the most, more than 9% between 2014 and 2015 (see Table 1).

Table 1: Changes in Total Cost of Care, 2014-2015, By Type of Service

0%          Hospital Inpatient
5.8%      Hospital Outpatient
6.0%      Professional
9.3%      Take Home Pharmacy

5.6%      Overall increase in TCOC, 2014-2015

TCOC measures a variety of different costs associated with treating commercially-insured patients, including professional, facility inpatient and outpatient, pharmacy, lab, radiology, behavioral health and other ancillary costs. TCOC is the full cost that is paid by both patients and health insurance companies. Patients are attributed to medical groups based on the majority of their primary care claims. The primary measure is the Total Cost Index, which is the medical clinic’s risk adjusted average cost per patient divided by the market’s average cost per patient. The cost is defined as the total allowed amount – both insurance payment and patient responsibility. TCOC is a National Quality Forum (NQF) endorsed methodology. NQF is considered the gold standard of health care measures.

Average Cost per Procedure

The 2015 data includes the MNCM Average Cost per Procedure results, showing the average amount paid to each medical group by commercial health plans for 90 common medical procedures. Four new procedures were added this year, including Cardiac Stress Test; Colorectal cancer screening, fecal blood test; Lower Extremity CT (also called computed tomography) without contrast; and Vasectomy.

For example, a Glucose or blood sugar test can cost from $6 to $51, a knee x-ray can cost from $20 to $219, and a 15-minute office visit can cost from $75 to $210 for commercially-insured patients, depending on where one seeks medical care. Each of the 90 medical procedures measured can be viewed, and sorted by medical group, at MNHealthScores.org.

Average Cost per Procedure information allows consumers to compare the amount they might pay for a procedure among different providers. MNCM urges consumers to check with their health plan and provider to verify actual costs at time of service, and note that the amount paid for a procedure is only one aspect of the cost of care. Consumers should consider the total cost of their care and not just the individual price of any one service or procedure.

For more detail: 2015 Average Cost per Procedure Spreadsheet

View complete results for 2014 and 2015 in the 2016 Cost & Utilization Report