Asthma Costs for the Medicaid Managed Care (MMC) Asthma Universe Population in New York State, 2012

Costs for the Medicaid Managed Care Asthma Universe* Population, New York State, 2012

Asthma Universe Asthma-Related Cost Total Cost (Asthma-Related and Unrelated Services) Percent of Total Cost Asthma-Related Cost per Member per Year
290,614 $338,834,454 $2,342,564,447 14% $1,166

*12 months continuous enrollment


Total Cost, Average Cost per Service and Average Cost per Enrollee by Type of Asthma-Related Service for the Medicaid Managed Care Asthma Universe* Population, New York State, 2012

Asthma-Related Service Total Costs Percent Total Number of Services Average Cost per Service Number of Enrollees Average Cost per Enrollee
Outpatient Visit $48,844,649 14.4% 468,010 $104 164,203 $297
ED Visit $10,283,626 3.0% 45,422 $226 32,157 $320
Hospitalization $59,276,885 17.5% 8,650 $6,853 6,800 $8,717
Pharmacy $220,429,295 65.1% 2,042,764 $108 250,992 $878

*12 months continuous enrollment


Average Asthma-Related Service Cost per Enrollee by Age Group and Type of Asthma-Related Service for the Medicaid Managed Care Asthma Universe* Population, New York State, 2012

Asthma-Related Service 0-4 5-11 12-50 51-64
Outpatient Visit $278 $290 $281 $395
ED Visit $304 $294 $334 $366
Hospitalization $7,122 $7,159 $9,362 $11,833
Pharmacy $518 $642 $854 $1,570

*12 months continuous enrollment

Average Asthma-Related Service Cost per Enrollee by Age Group for the Medicaid Managed Care Asthma Universe* Population, New York State, 2012

0-4 5-11 12-50 51-64 Total (0-64)
Average Asthma-Related Service Cost per Enrollee $1,010 $934 $1,053 $1,958 $1,166

*12 months continuous enrollment


Average Asthma-Related Service Cost per Enrollee by Gender and Type of Asthma-Related Service for the Medicaid Managed Care Asthma Universe* Population, New York State, 2012

Asthma-Related Service Male Female
Outpatient Visit $286 $307
ED Visit $320 $320
Hospitalization $8,121 $9,196
Pharmacy $806 $933

*12 months continuous enrollment

Average Asthma-Related Service Cost per Enrollee by Gender for the Medicaid Managed Care Asthma Universe* Population, New York State, 2012

Male Female
Average Asthma-Related Service Cost per Enrollee $1,092 $1,223

*12 months continuous enrollmen


Average Asthma-Related Service Cost per Enrollee by Race and Ethnicity and Type of Asthma-Related Service for the Medicaid Managed Care Asthma Universe* Population, New York State, 2012

Asthma-Related Service Non-Hispanic White Non-Hispanic Black Non-Hispanic Other Hispanic
ED Visit $343 $347 $305 $298
Hospitalization $7,557 $9,412 $7,547 $8,834
Outpatient Visit $261 $305 $269 $324
Pharmacy $917 $836 $845 $912

*12 months continuous enrollment

Average Asthma-Related Service Cost per Enrollee by Race and Ethnicity for the Medicaid Managed Care Asthma Universe* Population, New York State, 2012

Non-Hispanic White Non-Hispanic Black Non-Hispanic Other Hispanic
Average Asthma-Related Service Cost per Enrollee $1,038 $1,279 $1,006 $1,254

*12 months continuous enrollment


Total Asthma-Related Service Cost and Number of Enrollees by Region for the Medicaid Managed Care Asthma Universe* Population, New York State, 2012

Service Category New York City Rest of State
Outpatient Visit $33,843,928 $15,000,721
ED Visit $6,967,667 $3,315,958
Hospitalization $48,670,636 $10,606,248
Pharmacy $151,560,512 $68,868,783

*12 months continuous enrollment

MMC Average Asthma-Related Service Cost per Enrollee by Region for the Asthma Universe* Population, New York State, 2012

New York City Rest of State
Average Asthma-Related Service Cost per Enrollee $1,255 $992

*12 months continuous enrollment

Total Asthma-Related Service Cost and Number of Enrollees by Region for the Medicaid Managed Care Asthma Universe* Population, New York State, 2012

New York City Rest of State New York State
Total Asthma-Related Service Cost $241,042,743 (71%) $97,791,711 (29%) $338,834,454
Number of Enrollees 192,049 (66%) 98,565 (34%) 290,614

*12 months continuous enrollment