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SFHSS dashboard: specialty drugs and a small group of claimants drive a large share of costs
Summary
HSS presented an all-payer claims dashboard showing stable population health metrics but rising specialty drug costs; 1.8% of members drive roughly 37% of costs and HIV-related drugs account for about 18% of total drug spend and 55% of the top‑15 drug spend.
Marina Coleridge, enterprise systems and analytics manager, presented the San Francisco Health Service System's third-quarter all-payer claims database dashboard covering incurred services from July 2017 through June 2018 (paid through September). She said overall health characteristics for the membership were "fairly consistent" compared with prior reporting periods.
Coleridge highlighted concentration of costs: a very small share of members—about 1.8 percent—drive approximately 37 percent of total costs. She said specialty drugs are the major driver among pharmaceuticals and that 14 of the top 15 drugs are specialty agents; "eight out of the 15 of those top 15 drugs... are HIV related medications," she said, accounting for roughly 18 percent of total drug spend and about 55 percent of top-15 drug spending.
Coleridge and commissioners discussed reporting and benchmarking. She said some labels and comparisons will be corrected in upcoming dashboard updates, describing a reporting error that undercounted Kaiser data in certain fields used to compute "scripts per thousand;" she told the board the issue is a data-capture and algorithm problem rather than an access-to-medication issue. The dashboard team said they will update labels, attempt additional drill-downs by plan type and explore comparisons with other municipalities using the Truven/IBM Watson Health data.
Commissioners asked about preventive-screening rates that appeared low against U.S. benchmarks; staff said those measures use a different methodology than HEDIS and pledged to investigate whether reporting or collection differences drove the gap. Coleridge noted the dashboard is intended to be a baseline to track strategy and quality metrics over time.
The presentation did not include action items; board members requested follow-up clarifications and corrected labels before the next report.
