Analysis of Colon Cancer PMPM Data Trends 2020-2024
Explore the data on Colon Cancer PMPM Allowed vs. Paid, Total Claims, Per Member Per Month, and more from 2020 to Q3 of 2024. Understand the total allowed and paid amounts, number of claims, trends in different age groups, and insightful data notes.
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Colon Cancer PMPM Allowed vs Paid 2020 2024 Q3 Rate and Form Compliance Division Commissioner Vicki Schmidt Director Julie Holmes Anthony Depner Research Analyst 6/10/2025
Query Information The data pulled was from 2020 through the third quarter of 2024. The data is any claim within the years stated that has a primary, secondary, or third diagnosis that matches with the following code: C18 malignant neoplasm of colon There is a further breakdown of patients aged 40 and younger. 2
Total Allowed and Paid $60,000,000.00 $50,000,000.00 $40,000,000.00 COST($) $30,000,000.00 $20,000,000.00 $10,000,000.00 $- 2020 2021 2022 2023 2024 Total Allowed Total Paid $47,634,179.11 $25,478,423.55 $46,738,199.77 $28,163,704.26 $42,458,555.32 $28,143,741.25 YEAR $43,209,597.50 $26,919,521.91 $29,818,852.36 $17,299,604.21 Total Allowed Total Paid 3
Total Claims 180,000 160,000 152,839 140,000 126,436 120,000 NUMBER OF CLAIMS 102,281 100,000 92,471 88,980 80,000 60,000 40,000 20,000 - 2020 2021 2022 YEAR 2023 2024 4
Per Member Per Month Total $1,142.44 $1,200.00 $1,061.17 $985.91 $978.79 $946.34 $1,000.00 $800.00 COST($) $600.00 $400.00 $200.00 $- 2019 2020 2021 2022 YEAR 2023 2024 2025 *Note: PMPM = Total Allowed / Total Months 5
Data Notes The total claims has had a steady increase every year from 2020 to 2023, though so far in 2024 it appears it will not continue the trend. The per member per month was highest in 2021 at $1142.44. 6
Total Allowed and Paid Under 40 $1,800,000.00 $1,600,000.00 $1,400,000.00 $1,200,000.00 COST($) $1,000,000.00 $800,000.00 $600,000.00 $400,000.00 $200,000.00 $- 2020 2021 2022 2023 2024 Total Allowed Total Paid $993,319.70 $945,645.81 $1,593,940.27 $1,516,029.91 $1,135,905.90 $1,047,326.47 YEAR $1,307,565.97 $1,207,454.93 $1,404,664.24 $1,385,203.44 Total Allowed Total Paid 7
Total Claims Under 40 5,000 4,505 4,500 4,000 3,500 NUMBER OF CLAIMS 3,000 2,716 2,571 2,448 2,500 2,030 2,000 1,500 1,000 500 - 2020 2021 2022 YEAR 2023 2024 8
Per Member Per Month Under 40 $2,000.00 $1,749.66 $1,745.73 $1,800.00 $1,582.04 $1,528.47 $1,600.00 $1,400.00 $1,180.11 $1,200.00 COST($) $1,000.00 $800.00 $600.00 $400.00 $200.00 $- 2020 2021 2022 YEAR 2023 2024 *Note: PMPM = Total Allowed / Total Months 9
Percentage of Claims for Patients Under 40 Years Old 3.500% PERCENTAGE OF CLAIMS (<40 YEARS OLD) 2.948% 2.889% 3.000% 2.393% 2.500% 2.195% 2.148% 2.000% 1.500% 1.000% 0.500% 0.000% 2020 2021 2022 YEAR 2023 2024 *Note: average percentage for 2020-2024: 2.535% 10
Data Notes For Under 40 The claims for patients under 40 years old has also had a steady increase every year from 2020 to 2023, though so far in 2024 it appears it will not continue the trend. Per member per month (PMPM) was highest is 2021 with $1,008.68. The percentage of claims for patients under 40 has been increasing every year from 2020-2023. The highest percentage of claims for members under 40 was in 2023, with a 2.948%. 11
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