West Valley - Mission Community College District PPO Claim - - PowerPoint PPT Presentation

Presented by: Gallagher Benefit Services, Inc.

A Subsidiary of Arthur J. Gallagher & Co.

West Valley - Mission Community College District

PPO Claim Experience & Plan Utilization

September 9, 2008

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PPO Utilization

Costs:

• Expense for employee benefits will increase by 13.6% for 2008/2009 to a

total of $16.4 M in annual premium Cost Drivers:

• Blue Shield PPO demographics, utilization, and claims experience
• Plan average age of 61 (actives and retirees combined)
• Top 5 paid claim categories - impatient facility, inpatient hospital, outpatient facility,

professional office visits, and emergency room

• Claim payments exclude Medicare claims where Medicare is primary payer
• Expense loss ratio of 111%
• 46 individual claims between $15,000 - $99,999
• 6 individual claims in excess of $100,000

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PPO Utilization

• Utilization Drivers for comparing 12 month periods May 2006 through April

2007 to May 2007 through April 2008 are as follows:

• Facility Inpatient paid claims increased 104.7%
• From $735,714 to $1,506,264
• Professional Inpatient paid claims increased 66.3%,
• From $151,934 to $252,665
• Facility Outpatient paid claims increased 27.9%,
• From $1,170,449 to $1,496,640
• Professional Outpatient paid claims increased 3.0%,
• From $2,086,792 to $2,148,773
• The data above was provided by Blue Shield. This data includes all claims paid and does not adjust for

pooled claims in excess of $100,000.

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PPO Claims - 12 Months

Blue Shield Medical PPO ALL

MONTH COVERED COVERED PAID PAID UBH PAID TOTAL BLUE SHILED TOTAL MONTHLY CUMULATIVE PARTICIPANTS MEMBERS PREMIUM CAPITATION CLAIMS PAID RETENTION EXPENSE LOSS RATIO LOSS RATIO

August-07 732 1,530 $520,482 $5,460 $634,938 $640,399 $65,530 $705,929 135.6% 135.6% September-07 734 1,536 $522,464 $5,482 $592,142 $597,623 $65,787 $663,410 127.0% 131.3% October-07 734 1,539 $522,822 $5,492 $824,612 $830,105 $65,915 $896,020 171.4% 144.7% November-07 735 1,536 $523,409 $5,482 $513,177 $518,659 $65,787 $584,445 111.7% 136.4% December-07 739 1,546 $526,697 $5,517 $363,358 $368,876 $66,215 $435,091 82.6% 125.6% January-08 709 1,481 $507,841 $5,937 $531,186 $537,123 $63,431 $600,554 118.3% 124.4% February-08 710 1,486 $508,898 $5,960 $345,469 $351,429 $63,645 $415,074 81.6% 118.4% March-08 710 1,486 $504,486 $5,962 $410,121 $416,084 $63,645 $479,729 95.1% 115.5% April-08 711 1,485 $505,308 $5,960 $457,655 $463,615 $63,603 $527,217 104.3% 114.3% May-08 710 1,488 $505,079 $5,976 $558,743 $564,720 $63,731 $628,451 124.4% 115.3% June-08 710 1,488 $504,836 $5,972 $423,869 $429,841 $63,731 $493,572 97.8% 113.7% July-08 711 1,493 $595,976 $5,995 $356,474 $362,469 $66,901 $429,370 72.0% 109.8% 12 MONTH TOTAL 8,645 18,094 $6,248,297 $69,196 $6,011,745 $6,080,941 $777,922 $6,858,863

LESS POOLED CLAIMS

($778,227) ADJUSTED TOTAL 8,645 18,094 $6,248,297 $69,196 $5,233,518 $5,302,714 $777,922 $6,080,636 97.3% AVERAGE COVERED 720 1,508

Walgreen’s Prescription Drug Cost

Number of Percent

• Avg. Cost

Annual Percent Scripts

• f Total

Per Script Total Cost

• f Total

Generic 13,014 47.9% $32.72 $425,818 15.6% Multi-Source 1,262 4.6% $88.66 $111,889 4.1% Single-Source 12,907 47.5% $169.61 $2,189,156 80.3% TOTAL 27,183 $2,726,863

Pharmacy Claims - 12 Months

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Pharmacy Request for Proposal

• Sent 12 months WVMCCD pharmacy Data

to 6 vendors

• Used Gallagher’s Pharm D. Consultant to

complete analysis -- subject matter expert

• Saving Results with NO plan changes

– Walgreen’s ($134,693) – Rx Solutions ($264,049) – Medco ($326,609) – EnVision Rx ($370,103)

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