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5 Slide Series

Our 5 Slide Series allows us to regularly present objective analyses and trends on issues we believe are of interest and share our findings through data tabulations and visualizations.

This edition conveys tabulations on overall death rates and COVID death rates by state, including grouping states by the Governor’s political party.

This edition looks at the progression of COVID deaths and death rates by year in different cohorts (e.g., age and race/ethnicity).

This edition looks at the progression of capitation contracting in the Medicaid program at the national and state levels. As s a percentage of total Medicaid spending, capitation contracting has grown 31.1% in FFY2013 to 55.9% in FFY2021. National Medicaid spending via capitation was 47% larger than fee-for-service payments during FFY2021. In two states, Iowa and Hawaii, capitation payments represented more than 90% of overall Medicaid expenditures during FFY2021.

This edition looks at the collective financial performance of a large group of MCOs across the 2018-2021 timeframe. Our key findings are that the health plans performed quite well during the COVID-impacted years of 2020 and 2021 – better than they had performed during the pre-COVID years of 2018 and 2019. Revenues and operating margins grew particularly sharply across these health plans’ Medicaid line of business during 2020 and 2021.

This edition presents the progression of large publicly traded health companies’ stock prices from January 1, 2019 through July 1, 2022. Our key purpose was to summarize stock prices through the COVID pandemic relative to the year before the pandemic began. While the pandemic has been devastating to thousands of small business, the large publicly traded companies fared pretty well as a group during the pandemic. Large health companies stock prices fared even better. Health insurance companies’ stock prices rose faster still, averaging a 55% increase from January 1, 2020 to July 1, 2022).

This edition presents our tabulations of Medicaid pharmacy cost and price trends. Some of our key findings:

Nationwide Medicaid pre-rebate costs per prescription increased at an annual average rate of 5.6% from 2012-2021, led by an 11.9% annual rate of increase for brand drugs. Average costs per brand drugs rose particularly sharply during recent years, rising 56 % (16% per year) from 2018-2021.
Keeping the mix of drugs constant so that price changes could be assessed, we found that drug prices rose 64% across all drugs that were on the market throughout the 2012-2021 timeframe.
During 2021, 52.1% of Medicaid’s pre-rebate prescription drug spending were attributable to medications with an average cost above $1,000 per prescription. This proportion was “only” 21.5% during 2012.

This edition quantifies the decrease in Medicaid prescription volume that has occurred during COVID, comparing usage during calendar years 2019, 2020, and 2021. The large decrease that has occurred – 16.4% from 2019 to 2021 on a per covered person basis — is highly concerning regarding its implications regarding the poverty population’s access to needed medications during the pandemic.

We were enlisted by the Anthem Public Policy Institute to assess the cost-effectiveness of different states’ approaches to managing Medicaid prescription drug benefit.  States were grouped into five cohorts depending on the degree to which their Medicaid prescriptions are paid for by MCOs or via the fee-for-service (FFS) setting – and by the degree of latitude MCOs have to manage the mix of drugs. We assessed 100% of Medicaid prescriptions across federal fiscal years 2018, 2019, and 2020.

This edition of our 5 Slide Series examines excess deaths at the state level during the pandemic. Taking the difference of average monthly deaths during the pandemic and a pre-pandemic average, we find that states in the South and Southwest have experienced the largest percentage increase in deaths above normal. In addition, despite experiencing a particularly deadly first wave in the spring of 2020, New England states have collectively experienced the lowest number of excess deaths per capita; we find that 5 of the 11 states with the least number of excess deaths per capita are in this region. Second, we estimate excess deaths among different cohorts, including age, race/ethnicity, and cause of death. For age, we find that the 25–44 age bracket experienced the sharpest percentage increase in all-cause observed deaths in 2020 and 2021 compared to its 2015-2019 historical average. For race, we find that Hispanics experienced the sharpest percentage increase in all-cause observed deaths in 2020 and 2021, followed by American Indians/Alaska Natives and Asians. Lastly, we use cause of death data to confirm that deaths from Alzheimer’s disease/dementia increased the most during the pandemic, followed by deaths from circulatory disease. This latter finding dovetails with our February 4th edition, which showed that COVID deaths have likely been substantially undercounted. The spike in Alzheimer’s deaths could involve COVID death categorization dynamics.

This edition examines the impact of the pandemic on overall deaths in 2020 and 2021. Comparing excess deaths (deaths above the pre-COVID annual average) at the national level from April 2020 to December 2021, we find that annual deaths in the US were more than one-fifth higher in 2020 and 2021 than they were on average between 2017 and 2019. We calculate 1.09 million excess deaths have occurred during the pandemic to date, which is about 264,000 (32%) above the number of COVID-confirmed deaths during this time (831,000). We also find the population-adjusted per capita death rate increased by 18% during the pandemic years compared to the pre-pandemic baseline – well above the second largest annual death increase in the last twenty years experienced between 2014 and 2015 (2.5%).

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