Snapshot of IMS LifeLink Claims Database 10% Random Sample Prepared by: Gary W. Moore and Bradley C. Martin Health Data Unit of the UAMS Translational

Snapshot of IMS LifeLink Claims Database 10% Random Sample

Prepared by:Gary W. Moore and Bradley C. Martin

Health Data Unit of the UAMS Translational Research Institute

What is LifeLink?

• LifeLink is an administrative claims database– Captures bills paid to health providers by over 80 insurance

and managed care plans.• Demographic and enrollment information

– Geographic (state and zip3) of member residence

• Diagnostic information (ICD-9-CM) • Procedures (HCPCs CPT-4) and Lab tests• Prescriptions Dispensed

– Adjudicated claims for more than 40 million unique enrollees per year• 2006-2013

– 10% ember random sample obtained by UAMS TRI

Outline of LifeLink Statistics

• Demographic Characteristics • Plan Characteristics – HMO, PPO, Commercial, Medicare

• Geographic Representation• Utilization– Inpatient, Office, Hospital outpatient– Most frequent diagnostic categories treated

IMS LifeLink PharMetrics Plus™ – U.S.Age and Gender Distribution of Plan Members

0-12: Child110836712.359%

13-18: Teen

7232698.065%

19-30: Adult I172935819.284%

31-50: Adult II273495230.497%

51-64: Adult III182566120.357%

65+: Elderly8380409.345%

Missing8419

0.094%

Distribution (N, %) of Enrollees by Age Groups

0-12: Child13-18: Teen19-30: Adult I31-50: Adult II51-64: Adult III65+: ElderlyMissing

Female454832750.717%

Male441368549.216%

Unknown6054

0.068%

Distribution (N, %) of Enrollees by Gender

FemaleMaleUnknown

IMS LifeLink PharMetrics Plus™ – U.S.Gender and Age Distribution of Plan Members

0-12: Child

13-18: Tee

n

19-30: Adult I

31-50: Adult I

I

51-64: Adult I

II

65+: Eld

erly

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

568,131369,311

861,274

1,334,185

880,683

398,211

539,946

353,732

867,126

1,400,229

944,449

439,346

290

226

958

538

529

483

UnknownFemaleMale

Gender by Age Group

IMS LifeLink PharMetrics Plus™ – U.S.LifeLink Members Covered by State

IMS LifeLink PharMetrics Plus™ – U.S.Proportion of Population Enrolled in LifeLink by State

IMS LifeLink PharMetrics Plus™ – U.S.Length of Enrollment of Plan Members

01 -> 06 m

onths

07 -> 12 m

onths

13 -> 18 m

onths

19 -> 24 m

onths

25 -> 30 m

onths

31 -> 36 m

onths

37 -> 42 m

onths

43 -> 48 m

onths

49 -> 54 m

onths

55 -> 60 m

onths

61 -> 66 m

onths

67 -> 72 m

onths

73 -> 78 m

onths

79 -> 84 m

onths

85 -> 90 m

onths0

2

4

6

8

10

12

14

16

14.13 13.94

10.91

8.657.87

6.385.27

6.28

3.81 3.95

6.44

2.1 2.31.69

6.28

Percent of Total Enrollees (8,968,066) by Total Months Enrolled(Jan 2006 - Jul 2013)

Average patient enrollment = 33.31 monthsN (%) patients w/ enrollment > 2 years = 4.7 million (52.37%)

IMS LifeLink PharMetrics Plus™ – U.S.Pharmacy Benefits Enrollment of Plan Members

0 months

01 -> 06 m

onths

07 -> 12 m

onths

13 -> 18 m

onths

19 -> 24 m

onths

25 -> 30 m

onths

31 -> 36 m

onths

37 -> 42 m

onths

43 -> 48 m

onths

49 -> 54 m

onths

55 -> 60 m

onths

61 -> 66 m

onths

67 -> 72 m

onths

73 -> 78 m

onths

79 -> 84 m

onths

85 -> 90 m

onths0

2

4

6

8

10

12

14

16

18

5.78

15.51

13.9

10.57

8.657.53

6.124.92 4.54

3.65 3.62

5.06

1.75 2.01

4.65

1.73

Percent of Total Enrollees (8,968,066) by Total Months Enrolled (Rx Bene-fit)

(Jan 2006 - Jul 2013)Proportion of subjects without pharmacy benefits

Average patient enrollment = 28.99 monthsN (%) patients w/ enrollment > 2 years = 4.09 million (45.59%)

IMS LifeLink PharMetrics Plus™ – ArkansasLifeLink Members by 3 Digit Zip Code Area in Arkansas

IMS LifeLink PharMetrics Plus™ – TexasLifeLink Members by 3 Digit Zip Code Area in Texas

IMS LifeLink PharMetrics Plus™ – U.S.Distribution of Payer Type of Plan Members

All other Pay Type combinations; 71772; 0.80%

Commercial and Self-Insured; 252039; 2.81%

Commercial only; 5953910; 66.39%

Medicaid and/or SCHIP; 142129; 1.58%

Medicare Cost only; 28258; 0.32%

Medicare Risk and Any Other; 21645; 0.24%

Medicare Risk only; 55477; 0.62% Self-Insured only; 2442836; 27.24%

All other Pay Type combinationsCommercial and Self-InsuredCommercial onlyMedicaid and/or SCHIPMedicare Cost onlyMedicare Risk and Any OtherMedicare Risk onlyRx OnlySelf-Insured only

Number of Enrollees (N, %) by Pay Type Group

IMS LifeLink PharMetrics Plus™ – U.S.Distribution of Payer Type by Children, Adults, and Elderly

0-18: Child 19-64: Adult 65+: Elderly0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

537,138

1,694,763

210,186

1,163,353

4,284,460

500,317

43,940

184,563

23,534

Commercial and Self-InsuredCommercial onlyMedicaid and/or SCHIPMedicare Cost onlyMedicare Risk and Any OtherMedicare Risk onlySelf-Insured onlyAll other Pay Type combinations

Number of Enrollees by Pay Type Group by Age Group

IMS LifeLink PharMetrics Plus™ – U.S.Distribution of Payer Type by Year

2006 2007 2008 2009 2010 2011 2012 20130

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

4,500,000

5,000,000

683,182

1,089,2951,324,241 1,333,725 1,358,286 1,397,108 1,327,074

968,462

37,171

39,827

67,571 73,527 85,139 88,86686,941

60,709

2,371,805

2,776,241

3,218,790 3,050,029

2,642,195 2,547,5022,420,528

2,019,236

12,715

20,331

16,86815,556

19,63314,695

14,653

4,875Commercial and Self-InsuredCommercial onlyMedicaid and/or SCHIPMedicare Cost onlyMedicare Risk and Any OtherMedicare Risk onlyRx OnlySelf-Insured onlyAll other Pay Type combinations

Number of Enrollees by Pay Type Group by Year

IMS LifeLink PharMetrics Plus™ – U.S.Distribution of Insurance Product Type of Plan Members

All other Product Type combinations; 231002; 2.58%Consumer Directed Health Care only; 36417; 0.41%

Health Maintenance Organization (HMO) only; 979005; 10.92%

Indemnity/Traditional only; 267692; 2.98%

Point of Service (POS) only; 545027; 6.08%

Preferred Provider Organization (PPO) and Any Other; 556027; 6.20%

Preferred Provider Organization (PPO) only; 6352896; 70.84%

All other Product Type combinationsConsumer Directed Health Care onlyHealth Maintenance Organization (HMO) onlyIndemnity/Traditional onlyPoint of Service (POS) onlyPreferred Provider Organization (PPO) and Any OtherPreferred Provider Organization (PPO) only

Number of Enrollees (N, %) by Product Type Group

IMS LifeLink PharMetrics Plus™ – U.S.Distribution of Insurance Product Type of Children, Adults, and Elderly

0-18: Child 19-64: Adult 65+: Elderly0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

1,335,843

4,502,659

509,219

94,700

400,175

61,001

109,790

388,376

46,514

211,897

665,580

100,950

Consumer Directed Health Care only

Health Maintenance Organization (HMO) only

Indemnity/Traditional only

Point of Service (POS) only

Preferred Provider Organization (PPO) and Any Other

Preferred Provider Organization (PPO) only

All other Product Type combinations

Number of Enrollees by Product Type by Age Group

IMS LifeLink PharMetrics Plus™ – U.S.Distribution of Insurance Product Type by Year

2006 2007 2008 2009 2010 2011 2012 20130

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

4,500,000

5,000,000

1,970,450

2,692,332

3,263,166 3,265,982 3,231,584 3,242,747 3,117,958

2,454,069

52,997

41,390

49,171 50,885 54,363 29,60828,782

8,698

336,429

357,640

421,386 386,376213,911 207,048

201,374

172,404219,491

227,270

254,661 208,239

112,833 91,97182,991

78,998

518,224

601,864

642,732580,564

514,575 480,602

408,640

320,667

7,995

10,138

14,71118,906

21,44434,013

40,519

39,530Consumer Directed Health Care only

Health Maintenance Organization (HMO) only

Indemnity/Traditional only

Point of Service (POS) only

Preferred Provider Organization (PPO) and Any Other

Preferred Provider Organization (PPO) only

All other Product Type combinations

Number of Enrollees by Product Type Group by Year

IMS LifeLink PharMetrics Plus™ – U.S.Descriptive Statistics for Enrollees with at least one Retail Pharmacy Rx Fill in Year

2006 2007 2008 2009 2010 2011 2012 2013

Retail Pharmcy Rx Fills 17577180 30444424 36120978 36028158 33040719 31387382 29475951 12253831

2,500,000

7,500,000

12,500,000

17,500,000

22,500,000

27,500,000

32,500,000

37,500,000

Number of Retail Pharmcy Rx Fills by Year

NOTE: Year 2013 is limited to the months from January to July.


2006 2007 2008 2009 2010 2011 2012 2013

Enrollees 1711184 2273077 2651154 2610649 2398059 2348464 2272620 1597936

250,000

750,000

1,250,000

1,750,000

2,250,000

2,750,000

Number of Enrollees with at least one Retail Pharmacy Rx Fill in Year



2006 2007 2008 2009 2010 2011 2012 2013

Median 5 7 7 7 7 7 7 5

Mean 10.2719403640988

13.3934855704404

13.6246245974395

13.8004603453011

13.7781092958931

13.3650684021556

12.9700306254455

7.66853678745582

StdDev 14.0289402979716

18.0111389248931

18.3181267803365

18.4463385035431

18.2097070707641

17.8857731916937

17.3562926915648

8.93411138818292

1

3

5

7

9

11

13

15

17

19

Median, Mean, and Standard Deviation for Retail Pharmacy Rx Fills Per Enrollee per Year


IMS LifeLink PharMetrics Plus™ – U.S.25 Most Frequent Retail Pharmacy Rx Fills of LifeLink Members by Drug Group

36 - ANTIHYPERTENSIVES58 - ANTIDEPRESSANTS39 - ANTIHYPERLIPIDEMICS65 - ANALGESICS - OPIOID27 - ANTIDIABETICS49 - ULCER DRUGS25 - CONTRACEPTIVES33 - BETA BLOCKERS44 - ANTIASTHMATIC AND BRONCHODILATOR AGENTS28 - THYROID AGENTS90 - DERMATOLOGICALS37 - DIURETICS66 - ANALGESICS - ANTI-INFLAMMATORY72 - ANTICONVULSANTS01 - PENICILLINS57 - ANTIANXIETY AGENTS34 - CALCIUM CHANNEL BLOCKERS03 - MACROLIDES61 - ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS42 - NASAL AGENTS - SYSTEMIC AND TOPICAL60 - HYPNOTICS22 - CORTICOSTEROIDS43 - COUGH/COLD/ALLERGY86 - OPHTHALMIC AGENTS41 - ANTIHISTAMINES

0 2,000,000 4,000,000 6,000,000 8,000,000 10,000,000 12,000,000 14,000,000 16,000,000 18,000,000

Overall (January 2006 -> July 2013) Top 25 Retail Pharmacy Rx Fills by Drug Group (GPI-2)(decreasing order of frequency)

IMS LifeLink PharMetrics Plus™ – U.S.25 Most Frequent Retail Pharmacy Rx Fills of LifeLink Members by Drug Name

65991702 - HYDROCODONE COMBINATION28100010 - LEVOTHYROXINE39400075 - SIMVASTATIN36100030 - LISINOPRIL33200030 - METOPROLOL03400010 - AZITHROMYCIN25990002 - ETHINYL ESTRADIOL ORAL CONTRACEPTIVE39400010 - ATORVASTATIN01200010 - AMOXICILLIN27250050 - METFORMIN49270060 - OMEPRAZOLE37600040 - HYDROCHLOROTHIAZIDE44201010 - ALBUTEROL34000003 - AMLODIPINE57100010 - ALPRAZOLAM60204080 - ZOLPIDEM58160070 - SERTRALINE36994002 - ARB DIURETIC COMBINATION33200020 - ATENOLOL58300040 - BUPROPION42200032 - FLUTICASONE25992002 - TRIPHASIC OC44505050 - MONTELUKAST58160020 - CITALOPRAM49270025 - ESOMEPRAZOLE

0 1000000 2000000 3000000 4000000 5000000 6000000 7000000

Overall (January 2006 -> July 2013) Top 25 Retail Pharmacy Rx Fills by Drug Name (GPI-8) (decreasing order of frequency)

IMS LifeLink PharMetrics Plus™ – U.S.Inpatient Hospitalizations by Year

20062007

20082009

20102011

20122013

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

Frequency of Inpatient Hospitalizations by Year

IMS LifeLink PharMetrics Plus™ – U.S.Primary Discharge Diagnosis Types of Inpatient Hospitalizations

1 - Infectious and parasitic diseases

2 - Neoplasms

3 - Endocrine; nutritional; and metabolic diseases and immunity disorders

4 - Diseases of the blood and blood-forming organs

5 - Mental Illness

6 - Diseases of the nervous system and sense organs

7 - Diseases of the circulatory system

8 - Diseases of the respiratory system

9 - Diseases of the digestive system

10 - Diseases of the genitourinary system

11 - Complications of pregnancy; childbirth; and the puerperium

12 - Diseases of the skin and subcutaneous tissue

13 - Diseases of the musculoskeletal system and connective tissue

14 - Congenital anomalies

15 - Certain conditions originating in the perinatal period

16 - Injury and poisoning

17 - Symptoms; signs; and ill-defined conditions and factors influencing health status

18 - Residual codes; unclassified; all E codes [259. and 260.]

0 50,000 100,000 150,000 200,000 250,000 300,000

Number of Inpatient Hospitalizations by CCS Level I Category of Primary Discharge Dx

IMS LifeLink PharMetrics Plus™ – U.S.12 Most Frequent Discharge Diagnosis Types of Inpatient

Hospitalizations

7.2 - Diseases of the heart

15.1 - Liveborn [218.]

11.3 - Complications mainly related to pregnancy

11.4 - Indications for care in pregnancy; labor; and delivery

9.6 - Lower gastrointestinal disorders

13.2 - Non-traumatic joint disorders

11.5 - Complications during labor

8.1 - Respiratory infections

16.10 - Complications

10.1 - Diseases of the urinary system

5.8 - Mood disorders [657]

13.3 - Spondylosis; intervertebral disc disorders; other back problems [205.]

All Other CCS Level II Dx Categories

0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 200,000

Number of Inpatient Hospitalizations by CCS Level II Category of Primary Discharge Dx(Top 12 CCS Level II Dx Categories in decreasing order of frequency)

863.925

IMS LifeLink PharMetrics Plus™ – U.S.Outpatient Office Encounters by Year

20062007

20082009

20102011

20122013

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

Outpatient Office Encounters by Year

IMS LifeLink PharMetrics Plus™ – U.S.Primary Diagnosis Types of Outpatient Office Encounters


2 - Neoplasms



5 - Mental Illness














0 5,000,000 10,000,000 15,000,000 20,000,000 25,000,000 30,000,000

Number of Outpatient Office Encounters by CCS Level I Category of Primary Discharge Dx

IMS LifeLink PharMetrics Plus™ – U.S.12 Most Frequent Discharge Diagnosis Types of Outpatient Office

Encounters

17.2 - Factors influencing health care



13.9 - Other bone disease and musculoskeletal deformities [212.]

6.7 - Eye disorders


5.8 - Mood disorders [657]

8.9 - Other upper respiratory disease [134.]

13.8 - Other connective tissue disease [211.]

17.1 - Symptoms; signs; and ill-defined conditions

7.1 - Hypertension

6.8 - Ear conditions


0 2,000,000 4,000,000 6,000,000 8,000,000 10,000,000 12,000,000

Number of Outpatient Office Encounters by CCS Level II Category of Primary Dx(Top 12 CCS Level II Dx Categories in decreasing order of frequency)

54.578

IMS LifeLink PharMetrics Plus™ – U.S.Outpatient Facility / Hospital Encounter by Year

20062007

20082009

20102011

20122013

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

4,500,000

Outpatient Facility / Hospital Encounters by Year

IMS LifeLink PharMetrics Plus™ – U.S.Primary Diagnoses of Outpatient Facility / Hospital Encounters


2 - Neoplasms



5 - Mental Illness














0 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000

Number of Outpatient Facility / Hospital Encounters by CCS Level I Category of Primary Dx

IMS LifeLink PharMetrics Plus™ – U.S.12 Most Frequent Primary Diagnoses of Outpatient Facility / Hospital

Encounters

17.2 - Factors influencing health care

17.1 - Symptoms; signs; and ill-defined conditions

7.2 - Diseases of the heart

10.1 - Diseases of the urinary system



16.7 - Sprains and strains [232.]


10.3 - Diseases of female genital organs

13.8 - Other connective tissue disease [211.]

16.6 - Open wounds

6.7 - Eye disorders


0 200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2,000,000

Number of Outpatient Facility / Hospital Encounters by CCS Level II Category of Primary Discharge Dx(Top 12 CCS Level II Dx Categories in decreasing order of frequency)

13,858.122

Documents

Snapshot of IMS LifeLink Claims Database 10% Random Sample Prepared by: Gary W. Moore and Bradley C. Martin Health Data Unit of the UAMS Translational