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Blue Cross Blue Shield of Vermont: coding intensity, utilization and unit‑cost increases drive higher health spending
Summary
Blue Cross Blue Shield of Vermont staff told a legislative committee that rising utilization and unit‑cost increases are the primary drivers of recent health‑care spending growth, while coding intensity contributes a smaller but measurable share.
Ella Sodal, product owner for Provider Financials and Performance at Blue Cross Blue Shield of Vermont, told a legislative committee that the insurer’s analysis separates health‑care spending growth into three components: unit cost, utilization and coding intensity.
"When we look at health care costs, we try to break it down into 3 different elements," Sodal said. "So there's unit cost... utilization... and intensity." She said intensity — which captures the relative complexity or severity of services provided — is the hardest component to measure.
Sodal presented several findings from Blue Cross’ internal data covering 2019–2024 commercial claims (excluding Medicare primary and Medicare Advantage). At the inpatient level, she said case‑mix indices rose at the UVM Medical Center (UVMMC) by about 13% from 2021 to 2024 and rose about 10% at Dartmouth‑Hitchcock Medical Center (Mary Hitchcock was cited in the presentation as the Dartmouth…
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