It's All About The Benjamins
Name one of the 3 top areas of spend increase in 2024 (compared to the same time in 2023).
1. Rx Channel Specialty Drugs
2. Surgical Procedures
3. Medical Channel Specialty Drugs
Specialty drug costs are rising. Is this due to a higher percentage of members taking these drugs or to an increase in the drugs' prices?
We found that most of the increase was driven by higher drug costs, resulting in a 32.4% increase in cost per claim over the past four years.
Which actor's pronunciation of diabetes became comedy fodder?
Wilford Brimley
GI disease spend is increasing. Is medical or Rx spend increasing at a faster rate?
Rx spend for GI diseases has increased 31.7% over the last three years, more than twice as fast as medical
The CDC Social Vulnerability Index (SVI) groups 16 U.S. census variables into four categories related to social vulnerability. Name one.
1. Socioeconomic Status
2. Household Characteristics
3. Racial and Ethnic Minority Status
4. Housing Type and Transportation
What two categories of surgical procedures are driving cost increases the most?
This increase is primarily driven by musculoskeletal and gastrointestinal procedures. But the story isn’t about more patients seeking surgery— rather, the same procedures simply are costing more.
In the last two years, five conditions are responsible for about 2/3 of the increase in Rx PMPM. Name two of those conditions.
Diabetes, Obesity, Psoriasis, Inflammatory Bowel Disease, and Migraine Headache
Which type of diabetes has seen its prevalence rate nearly double over a 4-year period?
The prevalence of members with prediabetes, who are at high risk for developing diabetes, has almost doubled since year 1; this large increase may be due in part to delay in diagnosing members with this condition during early COVID years
GI Joe figurines added a subtitle to their name in 1982. What was that subtitle?
GI Joe: A Real American Hero
What trend was observed with Gaps in Care compliance rates when looking at member's SVI risk category?
Within the Springbuk Book of Business, we find members with the highest risk of social vulnerability have significantly lower compliance rates than those with the lowest risk, and there is often a step-down pattern for risk groups in between. We see this in preventive gaps - such as Preventive Care and Well Child Care - as well as chronic gaps such as Mental Health and Hypertension.
Compared to 2023, are healthcare costs being impacted more by medical or pharmacy costs in 2024?
The overall trend is driven more equally between Medical and Rx spend increases:
⟩ Medical Spend projected to increase by 7.3% (or $30 PMPM)
⟩ Rx Spend projected to increase by 8% (or $11 PMPM)
Two men won the Oscar for Best Original Screenplay in 1997. Name the winning movie.
Good Will Hunting
Are Continuous Glucose Monitors charged through the medical channel or the pharmacy channel?
Continuous Glucose Monitoring may be charged through the medical channel or pharmacy channel.
Name the top GI disease according to cost.
Inflammatory Bowel Disease (IBD) refers to diseases that cause chronic inflammation in your gastrointestinal (GI) tract. Ulcerative colitis and Crohn’s disease are the main conditions which require specialty drug therapy. (Inflammation of the esophagus and Hernias are the second and third most expensive GI condition.)
Members with higher social vulnerability are less likely to meet their A1C goal. What forms of treatment are they less likely to be using to manage their diabetes?
Lower use of GLP-1 agonists and CGMs.
"It's All About The Benjamins" is slang for caring about what?
$100 bills
In the most recent year, what percent of members had claims for GLP-1 agonists?
Just 3%!
The four-year net increase for type 2 claimants is much lower than that of claimants without diabetes. Why?
The four-year net increase for type 2 diabetic claimants is much lower than that of non-diabetic claimants when age-adjusted, since members with T2 tend to be older than members without diabetes. However, much of this difference is due to a large drop in PMPM attributable to COVID for members with diabetes over the four years.
DAILY DOUBLE! Members with any mental health condition are 2.3x's more likely to have any GI condition. Which two mental health conditions are most highly correlated with Irritable Bowel Syndrome in particular?
Anxiety or depression. Members with either of these mental health conditions are 3.5x’s as likely to have IBS compared to members that do not have either condition
The Emergency Room utilization rate (per 1,000 members) is 77% higher in the highest-risk population vs. the lowest. What other data point was shared about how the highest-risk population is seeking care?
Non-Claimants (per 1,000) in the group with the highest social vulnerability risk is almost twice that of the lowest (342.1 vs. 174.2) This is an indicator that the most vulnerable populations are not engaging in basic preventive services which could lead to high risk and costly future claims.
What percent increase to overall healthcare costs do we project for 2024?
We project another 7.4% overall increase ($41 PMPM).
Name one of the top Rx channel drugs (by PMPM) that has or will have a biosimilar by 2030.
⟩ Humira biosimilars were launched in 2023
⟩ At least seven biosimilars for Stelara are expected to launch in 2025, with the first one expected to launch in January
⟩ Biosimilars for Enbrel are expected to launch in 2029
DAILY DOUBLE! GLP-1 agonists may be an appropriate treatment in members with type 2 diabetes AND at least one of the following conditions or goals. Name one.
GLP-1 agonists may be an appropriate treatment in members with type 2 diabetes AND at least one of the following:
⟩ Cardiovascular disease
⟩ A1C (glycosylated hemoglobin) well above goal
⟩ Treatment goal of weight loss
⟩ Treatment goal of hypoglycemia avoidance
⟩ Presence of Chronic Kidney Disease in members with contraindications to SGLT2 inhibitors
Name two possible options to help lower the Rx cost for GI disease treatment.
Biosimilars: Humira and Remicade biosimilars are helping to lower the cost for GI disease treatment—Stelara will have biosimilars available in 2025. ⟩
Steer patients that are utilizing medical channel specialty drug infusions toward lower cost office settings, infusion centers or to home administration when clinically appropriate.
Name the individual with the most followers on Instagram (as of 1/20/2025).
Cristiano Ronaldo has the most followers on Instagram, with over 674 million followers as of January 20, 2025.