Midwest Health Initiative (MHI), a regional health improvement collaborative, has released its 7th annual St. Louis Health Stats community scorecard, which summarizes measures of population health, health care utilization, and costs for services provided to commercially insured St. Louisans from 2019 to 2023. This resource aids community leaders in identifying areas of focus for population health improvement and tracking trends in population health over time. MHI’s latest Health Stats suggests utilization and cost data from the St. Louis region largely mirrors broader healthcare trends across the U.S, from increasing costs to declining opioid prescriptions.
Pharmacy Costs Driving Increased Health Care Spending
The St. Louis commercial population has experienced a rise in total annual health care spending from 2019 to 2023, fueled largely by accelerated growth in pharmacy spending. MHI estimates that annual pharmacy spending per person has increased by nearly 70% since 2019 and now represents a third of all healthcare expenditures in the region. During the same period, the rate of total prescriptions filled per 100 people has remained essentially unchanged (1,008.6 in 2019 vs 1,005.5 in 2023), suggesting that either drug prices are increasing or St. Louisans are now using more high-cost drugs than before, or both. Increased pharmacy spending remains a concern across the U.S. and has been attributed to high-priced brand name specialty drugs, as well as the introduction and rapid emergence of GLP-1 medications, such as semaglutides, as some of the most popular drugs on the market. When it comes to employer plan expenses, Judith Muck, Executive Director, Missouri Consolidated Health Care Plan and an MHI board member, noted “It isn’t medical costs that keep me up at night, increasingly, it’s pharmacy costs.”
Although rising health care spending presents a concern for all of St. Louis, the burden is especially felt by patients with the highest costs. In 2023, the rate of commercially insured St. Louisans whose total annual health care expenditures exceeded $50,000 was 30% higher than in 2019, indicating that a greater number of people are spending more money on health care annually. This shift is particularly noticeable at the top end, as the rates of those who spend more than $250,000, $500,000, and $1 million all increased by more than 50% since 2019.
Urgent Care: A Return to Normal?
Urgent care visits for the commercially insured in the St. Louis MSA dropped for the second year in a row, decreasing to 287.4 visits per 1,000 in 2023 (compared to 359.7 in 2021). While urgent care utilization remains higher than levels recorded pre-COVID, this developing trend may indicate a slow “return to normal” following a large spike in urgent care utilization throughout the COVID-19 pandemic through late 2021. Nationally, much of the surge in urgent care use over the past couple of years is attributable to COVID-19 related visits. As we continue to move away from the COVID pandemic in the coming years, we may see limited growth, or even a decline, in urgent care utilization.
Moving Away From Opioids
Efforts to raise awareness and limit the use of opioids are evident in St. Louis as the rate of opioid prescriptions filled per 100 has decreased in 3 of the past 4 years and is down over 25% from 2019. Similarly, the overall national opioid dispensing rate has declined steadily in recent years, driven in part by changes to clinical guidelines and widespread prescription drug monitoring programs (PDMPs). Common prescription opioids are attributed to a declining share of overall overdose deaths compared to the use of fentanyl and other synthetic opioids. While just one component in addressing and combating the opioid epidemic, more cautious dispensing of prescription opioids represents a positive step forward.
Hip and Knee Replacements for Adults Under 65
Hip and knee replacements among the commercially insured in St. Louis increased in each of the last 3 years and has grown by 47% since 2019. The noted uptick in St. Louis is in line with national trends that show a steep rise in hip and knee replacements among working-age adults over the past two decades. Although joint replacements may typically be associated with an elderly population, there may be several factors pushing the average age for these procedures lower and lower. More Americans are obese than ever before, which means there are more joints that must bear excess weight and risk needing replacement sooner. Meanwhile, advancements in technology have allowed an increasing number of hip and knee replacements to be performed in an outpatient setting, and higher quality implants can now last decades longer than earlier models. The rise in procedures may also be attributed to finances as hospitals lean on orthopedic surgeries to maintain revenue streams.
Notable Scorecard Changes
The 2024 edition of the St. Louis Health Stats scorecard also features some changes compared to previous reports. In partnership with the National Kidney Foundation, MHI introduced a new measure to the 2024 scorecard that tracks how many people with hypertension received the two tests recommended for kidney health screening. Kidney Health Evaluation for Adults with Hypertension measures the percentage of adults diagnosed with hypertension who received both the eGFR and uACR tests screening for kidney disease in each calendar year. Although rates have increased, only 18.5% of eligible patients with hypertension received the recommended tests in 2023. By adding this measure to its Health Stats Scorecard, MHI hopes to raise awareness and drive increased screening rates and early detection of CKD.
Previous versions of the St. Louis Health Stats scorecard included metrics measuring HbA1C testing and timely blood pressure medication refills for patients with diabetes. The newest versions of these evidence-based measures rely heavily on the use of Category II Current Procedural Terminology (CPT) codes to obtain quality rates which are supplemental and not always added to claims. If these codes are not documented, measures relying on Category II codes may underestimate the quality of care actually provided in the community. MHI continues to track these measures internally to monitor progress in the use of Category II CPT codes and encourages health systems and medical groups in St. Louis to consider increasing utilization of these codes for quality performance measurement.
Check out the 2024 St. Louis Health Stats scorecard for a full look at cost, utilization, and care quality trends for the region’s commercially insured population: https://www.midwesthealthinitiative.org/health-stats
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