The URL can be used to link to this page

Item M11County of Monroe A BOARD OF COUNTY CONMSSIONERS or increased Mayor George Neugent, District 2 The Florida. Key y w) Mayor Pro Tem David Rice, District 4 +$2,261,970 �r Danny L. Kolhage, District 1 Heather Carruthers, District 3 Increased out of pocket maximum from $6,350 to $7,150 $139,669 Sylvia J. Murphy, District 5 County Commission Meeting January 18, 2017 Agenda Item Number: M.11 Agenda Item Summary #2514 BULK ITEM: No DEPARTMENT: Employee Services TIME APPROXIMATE: STAFF CONTACT: Maria Fernandez- Gonzalez (305) 292 -4448 11:00 A.M. AGENDA ITEM WORDING: Presentation by Gallagher on Health Insurance Fund Claims and Projected Balances as of September 31, 2016 (end of FY16) with an update of changes made to date and anticipated analyses to be completed for FYI potential changes and recommendations. ITEM BACKGROUND: As of September 30, 2016, the Health Insurance Fund reserves ended at a Gallagher estimated $61,763 below the Board of County Commission established 6 -month surplus target. Throughout 2016, the Board reviewed the fund projections and on September 19, 2016 made the following changes to the health plan to try to decrease the projected FY17 surplus shortfall of $3,400,000 to $3,800,000. The changes, assuming claims didn't increase more than 8% annually would have brought the shortfall to $235,364 Action Project Savings - $3,400,000 or increased Revenue Increased Department Rate from $885 to $1035 per +$2,261,970 - $1,138,030 employee per month Increased out of pocket maximum from $6,350 to $7,150 $139,669 (the federal max) Increased prescription co pay for retail brand from $35 $143,161 - $743,464 [preferred] /$70 [non - preferred] to $50 [preferred] /$90 [non - preferred] and 90 day retail from $87.50/$175 to $125/$225 Added Teledoc +$19,575 - $723,889 Increased specialty pharmacy cost share to 20% to a $13,967 maximum of $250 Eliminated subsidy for Medicare eligible dependents of $254,448 retirees Required spouses with insurance through their employer to $234,077 -S _23' 5,3' 64 Pay an unsubsidized amount As of September 30, 2016, actual claims have continued to increase at a greater rate than expected. The projected actual loss is now estimated at $670,000 by end of FY17 (see attached document (page 3). Assuming Gallghers projections, at the end of FYI the Health Insurance Fund reserves are projected to be $1,206,085 below the Board of County Commission established 6 -month surplus target. Therefore, we will be working with the Committee on a recommendation to (at a minimum) cut expenses or raise revenue by $1,206,085 We will, of course, track fund performance and update this number as necessary. Staff are currently working on Requests for Proposals (RFPs) for: • Prescriptions • Stop Loss • Fully Insured • Depending on how Fully Insured proposals are received, we may issue an RFP for a new medical TPA In addition, at the December 14, 2017 BOCC meeting a resolution was approved creating a Health Plan Advisory Committee (HPAC) for one year. The committee membership is currently being finalized. HPAC meeting are set for: • February 24, 2017 • March 24, 2017 • April 28, 2017 Gallagher, our consultants, are working on new benefit change scenarios for BOCC consideration during FY 17/18 as follows: The NEW scenarios for consideration by the committee and then BOCC in May or June include: 1. High Option (current plan) and Low Option (HSA plan). This has already been done by the Monroe County School Board, with the difference that they do offer a third plan. Some Commissioners were interested in looking into a progressive pricing, whereby higher paid employees would pay more for insurance. The Low Option participants would have higher deductibles; no copays for office visits (plan would pay 80/20 after annual deductible is satisfied and pharmacy copays would not apply until deductible is satisfied, which would be a cost savings to the plan. The premium for the Low Option would be comparable to the current premium. The High Option plan would be our current plan but with higher premiums. The County currently offers a high /low dental and vision plan. 2. Retiree prescription coverage plan change — the Employer Group Waiver Program (EGWP) is a Medicare Part D wrap around plan that would move your Medicare eligible retirees and their dependents from our current plan to the EGWP. Participation in an EGWP would eliminate the current Medicare subsidy currently received by the County from RDS. This RDS subsidy is approximately $150,000 annually. The preliminary summary of the EGWP vs. RDS analysis could potentially save the plan as much as $294,000. Gallagher recommends looking into this option and obtaining a more solid estimate using data from the pharmacy RFP. Discontinuing all dependent subsidies for new hires. In addition, Gallagher will develop benefit change scenarios recommended by the newly formed committee. It is expected the BOCC will review recommendations in May or June, 2017. PREVIOUS RELEVANT BOCC ACTION: CONTRACT /AGREEMENT CHANGES: n/a STAFF RECOMMENDATION: DOCUMENTATION: MCBCC Report 2016 End of FY Summary of Claims and Projected Fund Balances B0611 Employer Analytics Placemat_Inc Jan2016- Jun2016, Pd thru Aug2016 B0611 Employer Analytics Placemat_Inc Jan2016- Jun2016, Pd thru Aug2016 pg2 FINAL RFP DATES AS OF 10 -31 -16 FINANCIAL IMPACT: Effective Date: N/A Expiration Date: N/A Total Dollar Value of Contract: N/A Total Cost to County: Current Year Portion: Budgeted: Source of Funds: CPI: Indirect Costs: Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: If yes, amount: Grant: County Match: Insurance Required: Additional Details: REVIEWED BY: Christine Hurley Budget and Finance Cynthia Hall Kathy Peters Board of County Commissioners Completed 01/03/2017 11:00 AM Completed 01/03/2017 11:21 AM Completed 01/03/2017 11:32 AM Completed 01/03/2017 11:42 AM Completed 01/18/2017 9:00 AM MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Total Net Paid Prescription Drug and Medical Claim Summary October 1, 2013 through September 30, 2016 MCBCC Report 12_2016 2016_12_08 Claims Paid WFTPA BCBSFL Month Enrollees Rx Medical Medical Total Oct -13 1,598 $247,899 $704,368 $952,267 Nov -13 1,614 $220,918 $718,832 $939,750 Dec -13 1,610 $240,404 $842,260 $1,082,664 Jan -14 1,606 $224,245 $638,022 $862,267 Feb -14 1,602 $211,370 $900,504 $1,111,874 Mar -14 1,602 $222,684 $900,367 $1,123,052 Apr -14 1,601 $237,479 $719,946 $957,426 May -14 1,605 $246,035 $756,365 $1,002,399 Jain -14 1,597 $226,400 $732,953 $959,354 Jill -14 1,597 $256,370 $978,097 $1,234,466 Aug -14 1,596 $262,079 $899,497 $1,161,576 Sep-14 1,595 $292,711 $894,864 $1,187,575 Oct -14 1,605 $229,487 $1,148,209 $1,377,697 Nov -14 1,604 $237,026 $833,995 $1,071,021 Dec -14 1,597 $300,612 $882,134 $1,182,746 Jan -15 1,591 $306,699 $832,283 $1,138,982 Feb -15 1,583 $269,368 $670,562 $939,930 Mar -15 1,593 $339,055 $902,384 $1,241,439 Apr -15 1,590 $325,345 $800,592 $1,125,937 May -15 1,598 $329,886 $813,524 $1,143,410 Jain -15 1,592 $329,832 $983,700 $1,313,532 Jill -15 1,592 $348,993 $765,684 $1,114,677 Aug -15 1,581 $283,561 $1,175,399 $1,458,960 Sep-15 1,582 $314,399 $1,111,604 $1,426,003 Oct -15 1,588 $316,611 $1,070,336 $1,386,947 Nov -15 1,588 $289,929 $1,054,951 $1,344,880 Dec -15 1,580 $285,826 $1,128,908 $1,414,734 Jan -16 1,577 $276,866 $728,823 $1,005,689 Feb -16 1,580 $307,561 $758,023 $1,065,584 Mar -16 1,587 $337,615 $1,139,862 $1,477,477 Apr -16 1,584 $288,758 $778,891 $1,067,649 May -16 1,575 $349,196 $1,173,918 $1,523,114 Jain -16 1,572 $330,753 $1,255,417 $1,586,170 Jill -16 1,573 $281,245 $1,079,457 $1,360,702 Aug -16 1,580 $332,618 $1,388,731 $1,721,349 Sep-16 1,588 $340,186 $1,056,087 $1,396,273 2009/10 19,127 $2,288,159 $12,019,314 $0 $14,307,472 2010/11 19,122 $2,502,150 $12,241,475 $0 $14,743,626 2011/12 19,227 $2,285,804 $3,896,996 $7,303,927 $13,486,728 2012/13 19,151 $2,599,582 $13,901 $10,030,926 $12,644,409 2013/14 19,223 $2,888,594 $0 $9,686,074 $12,574,668 2014/15 19,108 $3,614,264 $0 $10,920,069 $14,534,332 2015/16 18,972 $3,737,164 $0 $12,613,404 $16,350,568 Last 12 Mos 18,972 3,737,164 $0 $12,613,404 $16,350,568 PEPM 2009/10 $119.63 $628.40 $0.00 $748.02 2010/11 $130.85 $640.18 $0.00 $771.03 2011/12 $118.89 $202.68 $379.88 $701.45 2012/13 $135.74 $0.73 $523.78 $660.25 2013/14 $150.27 $0.00 $503.88 $654.15 2014/15 $189.15 $0.00 $571.49 $760.64 2015/16 $196.98 $0.00 $664.84 $861.83 Last 12 Mos $196.98 $0.00 $664.84 $861.83 MCBCC Report 12_2016 2016_12_08 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Status Report for 2015116 Plan Year as of September 30, 2016 (1) Based on paid claims through September 30, 2016. (2) Based on fixed rates (3) Based on September 2015 Financial Statements. (4) Based on enrollees multiplied by current funding rates. (5) PPACA - Patient Protection Affordable Care Act (6) Assessed through plan year 2018 MCBCC Report 12_2016 2016_12_08 2 12/13/2016 Employees or Dependents Actual YTD Projected Retirees Per GBS Year End I. Total Gross Paid Claims (1) a. BCBSFL Active 1,161 698 $ 10,053,260 $ 10,053,260 b. BCBSFL Retiree 421 115 $ 2,560,144 $ 2,560,144 c. Envision Active 1,161 698 $ 2,263,980 $ 2,263,980 d. Envision Retiree 421 115 $ 1,473,184 $ 1,473,184 Benefit Changes $ - $ - Total Paid Claims $ 16,350,568 $ 16,350,568 II. Fixed Costs (2) a. BCBSFL 879,954 879,954 b Envision 71,145 71,145 c. Internal Expenses 252,604 252,604 d. PPACA (5) - PCOR Fee (6) 5,357 5,357 e. PPACA (5) - Transitional Reinsurance Fee (7) 74,790 74,790 f. Other (GBS, Life, AD &D, EAP) 300,000 300,000 Total Fixed Costs $ 1,583,850 $ 1,583,850 III. Total Paid Plan Costs $ 17,934,418 $ 17,934,418 IV. Funding a. Contributions (4) 15,413,364 15,413,364 b. Interest (3) $ 36,049 $ 36,049 c. Other (3) $ 156,000 $ 156,000 Total Funding $ 15,605,413 $ 15,605,413 V. Cash Surplus /(Deficit) $ (2,329,004) $ (2,329,004) VI. Change in Claim Reserve a. Starting Reserve $ 927,198 $ 927,198 b. Estimated Closing Reserve $ 1,028,472 $ 1,028,472 c. Change in Reserve $ 101,274 $ 101,274 VII. Incurred Surplus /(Deficit) $ (2,430,278) $ (2,430,278) VIII. Incurred % Surplus /(Deficit) -15.8% -15.8% (1) Based on paid claims through September 30, 2016. (2) Based on fixed rates (3) Based on September 2015 Financial Statements. (4) Based on enrollees multiplied by current funding rates. (5) PPACA - Patient Protection Affordable Care Act (6) Assessed through plan year 2018 MCBCC Report 12_2016 2016_12_08 2 12/13/2016 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Renewal Projections ctober 1 2016 thr Current Enrollment Notes: (1) 2015/16 Net Claims (2) 2015/16 Total Plan Costs from Prior Page (3) Projected 2016/17 Funding $ 16,350,568 Projected Paid Claims 101,274 Reserve Change $ 16,451,842 $ 17,934,418 Total Paid Plan Costs 101,274 Reserve Change $ 18,035,692 $ 18,292,962 $ 192,049 $ 18,100,913 x 1.0000 $ 18,100,913 $ 192,049 $ 18,292,962 Annualized Funding at 2015/16 Rates Less Interest and Other Income Annual Contributions Required 10/1/16 Increase Resulting 2016/17 Contributions Plus Interest and Other Income Total Projected 2016/17 Revenue a a MCBCC Report 12_2016 2016_12_08 3 Actual Assumed Projecl 2015/16 % Change 2016) I. Total Net Incurred Claims (1) $ 16,451,842 &1% $ 17,398,9( II. Fixed Costs (2) a. BCBSFL 879,954 (J.(J% 871,8' b. Envision 71,145 M% 71,4( c. Internal Expenses 252,604 M3% 278,6( d. PPACA - PCOR Fee 5,357 4. 0% 5,6' e. PPACA - Transitional Reinsurance Fee 74,790 16,2 f. Other (GBS, Life, AD &D, EAP) 300,000 7.0% 321,0( Total Fixed Costs 1,583,850 M% 1,564,82 III. Total Incurred Plan Costs (2) $ 18,035,692 $ 18,963,7! IV. Revenue at Current and Adopted Level a. Contributions (4) $ 15,413,364 $ 18,100,9' b. Interest (3) $ 36,049 $ 36,0 c. Other (3) $ 156,000 $ 156,0( Total Revenue at Current Level 15,605,413 M% $ 18,292,9( V. Surplus /(Deficit) With No Change in Funding $ (2,430,278) $ (670,7 Notes: (1) 2015/16 Net Claims (2) 2015/16 Total Plan Costs from Prior Page (3) Projected 2016/17 Funding $ 16,350,568 Projected Paid Claims 101,274 Reserve Change $ 16,451,842 $ 17,934,418 Total Paid Plan Costs 101,274 Reserve Change $ 18,035,692 $ 18,292,962 $ 192,049 $ 18,100,913 x 1.0000 $ 18,100,913 $ 192,049 $ 18,292,962 Annualized Funding at 2015/16 Rates Less Interest and Other Income Annual Contributions Required 10/1/16 Increase Resulting 2016/17 Contributions Plus Interest and Other Income Total Projected 2016/17 Revenue a a MCBCC Report 12_2016 2016_12_08 3 M.11.a Cash Balance at Beginning of Year Cash Surplus /(Deficit) for Year Transfer In /(Out) Cash Balance at End of Year Claim Reserve at Year End (IBNR) (a) Other Amounts Payable at Year End 60 -day Safe Harbor Claim Margin for OIR (b) Total Liability and Surplus Required at Year End Year End Fund Equity Before OIR Margin Year End Equity Net of OIR Margin County Adopted Minimum Fund Balance (6 Months) Actual Surplus Less County Minimum Target Notes MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Projected Fund Balance and Reserve Adequacy As of September 30, 2016 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 $ 17,946,663 $ 16,192,402 $ 14,559,350 $ 12,883,164 $ 12,567,407 $ 13,205,152 $ 11,546,569 $ 9,217,565 $ (1,754,261) $ (1,633,052) $ (1,676,156) $ (15,757) $ 340,745 $ (1,661,253) $ (2,329,004) $ (670,790) $ 16,192,402 $ 14,559,350 $ 12,583,164 $ 12,567,407 $ 13,205,152 $ 11,546,569 $ 9,217,565 $ 5,547,074 $ 1,945,746 $ 2,024,412 $ 1,016,533 $ 965,564 $ 1,043,765 $ 927,195 $ 1,025,472 $ 1,025,472 $ (141,956) $ 258,696 $ 77,753 $ 61,425 $ 92,592 $ 25,235 $ 25,235 $ 25,235 $ 2,352,291 $ 2,502,161 $ 2,741,974 $ 2,297,656 $ 2,101,532 $ 2,741,974 $ 2,899,817 $ 3,135,317 $ 4,159,051 $ 4,515,269 $ 3,536,560 $ 3,324,645 $ 3,238,159 $ 3,694,407 $ 3,953,524 $ 4,159,024 $ 14,385,642 $ 12,246,242 $ 11,758,575 $ 11,540,415 $ 12,071,795 $ 10,594,436 $ 5,164,158 $ 7,493,367 $ 12,033,351 $ 9,744,051 $ 9,046,604 $ 9,542,762 $ 9,969,963 $ 7,552,462 $ 5,264,340 $ 4,358,050 $ 7,153,736 $ 7,056,573 $ 7,506,453 $ 6,374,575 $ 6,305,495 $ 7,267,166 $ 5,225,921 $ 5,699,452 $ 3,327,270 $ (61,763) $ (1,206,055) (a) Actual figures through 2015/16. 2016/17 assumed to equal 2015/16. (b) Estimated at 1/6 of Annual Incurred Claims (1) ( ( _ ( ( ( (5) ( _ ( ( ( _ ( - ( ( _ ( - ( Il MCBCC Report 12_2016 2016_12_08 4 12/13/2016 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Includes claims paid by BCBSFL only a a` a a' { a . a MCBCC Report 12_2016 2016_12_08 Florida Blue Large Claim Summary as of Claimant Number 1 9/30/2016 9/30/2015 9/30/2014 9/30/2013 9/30/2012 9/30/2010 9/30/2009 1 $816,745 $560,607 $503,159 $310,603 $323,462 $338,544 $402,792 2 $436,318 $326,270 $239,090 $291,049 $320,118 $224,043 $290,146 3 $434,671 $321,107 $197,829 $282,573 $268,729 $220,450 $134,646 4 $305,349 $298,995 $177,903 $207,021 $201,912 $148,066 $109,928 5 $228,721 $270,238 $175,983 $178,797 $196,659 $146,906 $85,944 6 $224,272 $235,346 $167,378 $163,122 $117,674 $101,914 $85,706 7 $188,524 $203,001 $146,363 $153,269 $116,592 $91,317 $84,623 8 $179,016 $192,172 $136,212 $118,555 $114,750 $76,118 $76,682 9 $165,197 $170,219 $125,463 $117,803 $94,178 $71,028 $65,374 10 $154,579 $166,412 $124,102 $114,376 $92,001 $68,704 $64,492 11 $142,620 $150,535 $119,792 $111,122 $90,148 $66,763 $61,525 12 $131,735 $143,011 $114,009 $110,962 $86,922 $66,392 $61,158 13 $116,230 $126,615 $109,154 $104,392 $83,772 $63,776 $60,197 14 $113,976 $117,146 $107,906 $101,381 $71,659 $61,416 $58,112 15 $102,571 $115,968 $103,619 $95,807 $70,268 $60,003 $57,051 16 $100,165 $109,866 $102,158 $94,435 $69,931 $57,619 $54,270 17 $97,482 $104,317 $101,228 $94,433 $66,602 $55,504 $54,218 18 $96,507 $94,146 $88,520 $82,169 $66,061 $55,416 $51,334 19 $94,150 $92,932 $85,181 $80,193 $65,531 $52,899 20 $93,985 $91,791 $79,737 $77,282 $64,327 $50,110 21 $89,788 $86,663 $77,940 $75,227 $62,859 22 $87,846 $82,177 $71,837 $72,821 $60,670 23 $86,661 $78,271 $69,605 $71,309 $59,190 24 $83,276 $77,173 $63,734 $71,194 $57,240 25 $82,327 $75,186 $59,738 $70,814 $55,264 26 $81,138 $74,547 $58,581 $66,559 $54,455 27 $80,565 $71,116 $58,087 $65,798 $50,968 28 $79,781 $68,479 $57,977 $65,739 29 $79,178 $66,258 $56,507 $65,399 30 $78,862 $64,204 $54,508 $62,494 31 $73,652 $63,616 $52,800 $57,753 32 $71,407 $62,540 $51,421 $54,300 33 $70,980 $58,688 $51,245 $53,410 34 $70,632 $57,313 $51,170 $52,167 35 $70,583 $56,915 $51,662 36 $70,176 $56,179 37 $69,584 $52,804 38 $68,841 $51,871 39 $64,617 $51,334 40 $63,966 $51,050 41 $60,605 $51,040 42 $59,417 $51,004 43 $56,382 $50,285 44 $56,241 45 $52,184 46 $51,792 47 $51,646 48 $51,427 49 $50,450 50 $50,289 Total $6,287,104 $5,349,407 $3,839 $3 5 845 5 990 $2 5 981 5 942 $2 5 076 5 986 $1 Total YTD Claims Medical & Pharmacy) $ 16,350,568 Large Claims as 38.5% % of Total Includes claims paid by BCBSFL only a a` a a' { a . a MCBCC Report 12_2016 2016_12_08 M.11.b c" Elm PM Trend Population By [Overage Tier Member Sh reasa Percentage of TOtai Spend and Claim Type High Cl. Member lmpacts$50,000 The a9emem6ersh I r9r0ups,n y0 791 is 13% P or 24 4 ) 17 emb 1 j I ,:ac.'� - S MOpulat on 199% 9.72% $ 8,166 $5 $5,096 emb t z = ='� gn lP embers end $2924984 $1893973 . g Spend Per Case $121837 $106116 3].46 ncrease 11,57% G,IG% -e P punt L�;:Ab age AAryg p ByR I t na dG d l S°°K �za% - gn PMPM mpatt $293.59 512657 ',al F "UX�,.,rtnkv`kl`�INM1 , 1�� .. %1`:MSv.G'n `"" - S —K @13% Ill,Fgn C-Mbrs $245.24 $205.91 P Plo 2 a Sg7K�— nt aF 453% 382% y nl d t les 7 3 S'" ?4' ?RYr�\ tt .` \alCkWu'N# ales 9 6 1 ndems S 9 @ 58K $ M. P $ $ g9 K� P d $ $ Is 15 398 S K�74% $ }} $ $ $ II b 8 965 % Ue S % $6K 1 A � $ S @1a 1 PIP $ $ s % r 1 P \ \ 7g.4R M ... b By PaYmentR g aK °�°% $4K } S \ $ f ll, d its $ p dPU Ad— $ $16, $ _ Pr 1, "0" 1-1 11 cM 11 xM s1- $ Kj0 aal Spend 9 $ $ $ $ y11�85 $2K �... I/19 3 % _ s $599 MPM $ $ Top live D g Is Categones With PMPM , $ $ 9 $ 249 m 9Pr or $9K ` $ $ � 51sM P1P9lA l 1 sonm 91A 1 PMP91H55 m7, a t dPer�tt $ stt 9M �S �S nr 1114 391 2 5W $4,999 K T al Spend $ $ Utl /1999 �S , 9 %. $ 9 $6.249 9 ¢ $s99K , ys8i @Saa39 g548,ss \ g ;3sizj $3741( d!d S b S �i High Cl. 5 d P t b CI T 1,223 1,P41 17,G T AA\\ yy g P g Y VPe PM 9 $1nut'i"1 ""' 56 5 69 $0K / If ( ) { P PROF ER V-1 211 22G 2G,9 p d P v s t $ 51 , $ 5 z $ K V F c it tV Ut I t �7 I a, $ - 4 ?f''Yf51 �4,.3fY. i:^: aT: n;; Y. Y: ditS;: Y. iA' tftS;: Y .iA'tftS;:Y.�AtftS;:Y.i%etS;:Y, t'rs+ vwm 222 1 w d $ s s, 99 549999 :9 ` :'' ' 4' , ' 194 1 -A g 7 l S 1pIH7 f {p{ 1 1 I/ $ $33 $ $58999 -$99,9 ) Kl, Med-1 Center $372,217 P-, �� 41 I tft4{4t } S pA��l 9 1i `�� .�� 1 �°1 M s 'W'rii�HI��lffff ) k n P 1 $ $ 837 .. es 94 %. $199,999, B ) .OfM F"t" & $ $ 416 G1 29% 49 °% 69% 89% Spend Per Service $67 $174 $173 (5) eapist HOSp taI OfMam nc $361897 $494968 92% Taal spend $99,786 585,579 66% (6)FisnermenS —p tat nc $ 66527 $192123 N--k Savingsand Utilization - - - -. - - - -. - - - -. Utl /1c99 199 416 PMPM by Age Range (7)MOUm d er $ 5 679 PMPM $ 11 $69 56.9 (a)5outnMam — Ptal $12 533 Savings% 'IG p-1 m. Group Female p B—Male pB— Female (9) All Cn " IdrensHOSptal nc $ $ 800 %� V ge B s dH05 - $ $87 60.0% e Pte n c p dP Service $ $ $ P M _ a6 $ $ s ($ PI R k V eookb A acker 90.0% �� - ut In999 d a. 67 ° / t \ x 3°xi a°x t°x zo.o %h � °x PMPM $ v m 5 S .... % sox 7°x 1a s .... e - :, albs g _:. % ces 13, !� 24 .e% P O P P f 1 total 4% p dP Service $ $ $ si cc 35 .4% - - - -- -- - - -- -- Taal Spend Utl /1099 $ $ S_ )� 213 , ,,, 45% 4 Networl:5pentl %In Networl: Ut l'zation% 1,119 1,41 7 z 7— S1 11 u s 100.0% _. S" y % 5 epdP stc �!I ) Q- flt�t1t >I1'7 Si 65 Ta Scr pt r�m�s 7% _ P. mss y7$$ .v45 ri1 x 5 X al SP nd s U £ lS S f # � t!Wt t! 1t19��19up 24 % 55 90 0 f i 9, j k IG /IO99 88 IE "94 44%. 99% f i 5,x'°.1 i1s 5 3v 4 $ 236 66 5159 5 685 1 s1e5 3 ", 55.0% " aal Spend $19 $14 F 5125 $ 4n $ 597 $ 419 $ 716 $ 159 $ 546 Inpatient —,ti— Professional Tot 1114 37,9A P.P. $13 $ 199 35,4% Maes -/ Fema es ' BM = Benchmark Book of Business benchmarks are based on claims incurred 01/01/2015- 12/31/2015 and through 03/31/2016 Non Users by A- B,eket 4 15 70% R LLL - -- VI ea dP d Att bt toed,- Idl.gnoss- tego,leslnclude C.nce,(lungov.n.n,- nce,prevennve sixeenln� ),Injury /Poisvning(femu,frac LO VA) Crculatory(cardac d,,,hythmas heart attack /dsease) Musculoskeletal �ntervertebral d- d,d,ders rehab) anc " ") O d l" pp d • g,C ndh d' the current perod under rev ew. Spend related to hg ,cost -me, I the$50K th ", reasdb h pp $1.8M t, $2 j 'd Rf d h' h . .—n the pro, perod. 1 %of the total 'd Rf d hg, (g Coto Y�I ,.,. n m vnmmammm mm 0 Compliance Crkeria: 6reaAZg[eSa ano enro enrollment. Colo A r g ee a g C. C it.1 st,.. • g 1-64whohadc., —c rytology performed every 3 year1 . alr nin ),�te� g p nrmede y y Atlu1We M.11.c Key findings d ue Page 3 P s e er ar (PEP�ar ly $8,1 om %fr the prior period. d35 %, omes331e58to ,74rBenchm.,kPMPM11$280 N aym en r top Py e • The la encrease to PMPMSperlodover perlod are In the Inpatient ( +58 %) and — pa[len[ ( +al %Ja[egory of service. n (un11100 st 0J In sed aaosall -ego, sof service withe p n[ p dally mfes 'Av onal services. li S atlm experi red be highe e arl .dm 61 %ie ce •Top en s fem u, fracture to M ,neonate bom a[30 weeksrq g NICU, - rdiovascul., /- ,di.cv. proceU, —, coronary bypass. (S} eslndudeC3ncer(I -g ov.n.n preventive screens rigs), -,that dy,,hyth......h.b(m --Io -h P o related se C) Ell u ii2amn I, d 20 %overthep,io, period and iswr— ly.1222 vistspe, 1000. FIo,id.Bl- benchm.,kis194 /10 N verage cost per visit remained stable. 19 9 embe,s %ofto[al populatonJvested the ge om(EER)wlth -1,bse tadm -on durgibe period and accountetlf r aal ER Visits. E kPIdyeesa¢ountfor 7D %oft al visits, Children are 20°, an tl Spouses are) cu most often on Fridays for Monroe County BOCC members. em be" have 3 or m ore ER Visits during the 6 -m onth perlod under review accountingfor 43 visits. 3 of these re r — l high —1 m claimants. a %oftal Ell — 1,(5 %ofmtal Ell pend)are poent i .11ydivercible(- kp.in,.cuteuppe, re,p,,Io,y Infections, UTI). T � down l %from the P-1 period. Benchmark is 17% of ER Visits are tlivertble. id otal membe,ship remained U.bleand Is currently 12,239 members. and 50 %female. Average age of Em ployeesls 52.2. • The maU,rcy m em bers have total paid d.lms In the $0$499 range. • The lar nc n M M by age and gender o the Florida Blue book of b-ne snthe Malesages Q} ategory, P Msforth dem graphicfor MO,,o C.,ty BOC Cis$1,518compa,ed,othebenchmark of$634- dhighei V attrbutableld —gh cost memberswiths pentlgreaterth an$45K($696Ktotal). COntlitionsinclutlefemurfracture tluetol Co heart Mack, intervertebral disc disorders, pharyngeal cancer. em her-st share Is wrrenNy at 15.5 %. toed,- Idl.gnoss- tego,leslnclude C.nce,(lungov.n.n,- nce,prevennve sixeenln� ),Injury /Poisvning(femu,frac LO VA) Crculatory(cardac d,,,hythmas heart attack /dsease) Musculoskeletal �ntervertebral d- d,d,ders rehab) anc " ") O d l" pp d • g,C ndh d' the current perod under rev ew. Spend related to hg ,cost -me, I the$50K th ", reasdb h pp $1.8M t, $2 'd Rf d h' h . .—n the pro, perod. 1 %of the total 'd Rf d hg, (g tlrvng of p tl - houtl - er HCCremoved PMPMSwould be$245 versus rhea I$ anc h d'tonbyspend.ndprev.1encewth7h g, cos e, tot.ing$S.SM followed by0 letory cond t, otaing$365K. er (lun ,bone,ph.,ynge.l, colorectal), Crcul.to,y(h ea ttack /dsease, -rd ac dyxhythm as, ur /Poison ng(kmurira dislocation of knee prosthesis, complianons from of artery grak), Oigesnve (tliverncu 6ns, Q! to es bor a weeks g requ" N and "rig o e delve y vith c d-t n s o 3 Kgh cost mem be,, no Ionge, -,vely enrol l ed on the h ealth p I n($191K).1 p em on the h d�ep 0 reportfor both the current tlp" p tl ubscrbers accountfor5l %oftaalb "gh cost case spend The rdtdd populat is for l6 %of totalh"gh p d, Ne[wo,k sav rigs scurre lyp fir g 61.7/ °. a Page 2 W i n f h b sed on- lend., yea, 2015 and 2014. A pp popula[on(14% males /7% fem ales dd not utl2e the, health -,e benefits durngthe eportng P 168 d' mem bers(e /° of total m em be,shpJ ar attr buted to Fl or J. Ilk, e value based pr ow de,. P C) V BM = Benchmark Book of Business benchmarks are based on claims incurred 01/01/2015- 12/31/2015 and through 03/31/2016 M.11.d RENEWAL CONTRACTS M.11.d I