Transcript Reporting Data Analytics - University of Alaska system

University of Alaska
Analysis Period:
January 2009 through December 2010
Paid Basis
Although this report is not intended to contain any individually identifiable health information, it
is possible that some of the information might be considered protected health information under
federal or state privacy laws. As such, you are strictly limited in your ability to use this
information for anything other than plan administrative functions as described in your health
plan document and HIPAA privacy and security policies, as applicable.
Agenda
 Demographics
 Health Cost Analysis
− Financial Analysis
 Clinical Risk and Conditions
– Population Stratification
– Disease States
 Appendix
© 2011 Lockton, Inc. All rights reserved.
1
Demographics
Demographics - Overview
 The University of Alaska has fewer men than the norm with greater male and
female proportions from ages 50 to 64
 Higher employee age/gender factor of 1.13 which translates to above norm per
member per year (pmpy) cost profile of approximately 13%
 Employees are driving the costs of the plan accounting for 46.6% of the costs
whereas the norm has the spouses driving the plan costs.
 0.3% of the University population is driving 16.1% of the costs
 20.0% of the University population is driving 84.4% of the costs
 The University of Alaska has a lower than norm proportion of women in child-
bearing age with lower pregnancy and neonatal related cost than the norm but
neonate UA inpatient cost per neonate per year increased from $2,590 to
$5,053
 Approximately 83.6% of the current members have been enrolled for 2 or more
years
© 2011 Lockton, Inc. All rights reserved.
3
Demographics – Total Members
34%
27%
26%
21%
43%
44%
45%
2009
Employee
2010
Spouse
75%
120
93
327
282
360
358
406
464
123
197
49
121
118
123
1,248
1,274
250
232
1
2
-
1%
1%
11%
12%
6%
5%
8%
7%
9%
8%
11%
9%
3%
4%
1%
2%
0%
0%
14%
15%
6%
6%
8%
8%
9%
9%
8%
8%
2%
3%
2%
2%
10,964
4,816
2,900
3,248
100%
100%
25%
0%
$10,000
Norm
Dependent
PMPY Costs by Relationship
$8,000
$6,000
$4,000
$2,000
$1,860
1
1
325
210
602
457
651
522
828
564
233
212
100
110
$5,250
118
123
1,249
1,275
695
535
930
739
1,011
882
1,234
1,028
356
409
149
231
$3,893
% of
Members
50%
$2,875
# of
# of Deps
Spouses
% of
Members
Norm
$6,251
Total
30%
$7,977
20-29
2-29
30-39
30-39
40-49
40-49
50-59
50-59
60-64
60-64
65+
65+
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
# of
# of
Members Employees
30%
$2,550
0-1
0-1
2-19
Gender
Members by Relationship
100%
$5,281
Age
Category
Spouses
Dependents
48
12
48%
50%
8.06
3.76
2.17
0.79
$7,358
Average Age
% Female
Average RI
Average CGI
Employees
46
57%
9.60
1.98
$2009
Employee
© 2011 Lockton, Inc. All rights reserved.
Norm from Lockton InfoLock Book of Business.
2010
Spouse
Norm
Dependent
4
Demographics - Total Members
Average Number of Members
Total Number of Members
Member Months
Employee Months
Age Gender Factor
Employee Age Gender Factor
Spouse Age Gender Factor
Dependent Age Gender Factor
Member to Employee Ratio
Average Age
% Female
% Female in child bearing years
Jan 09 Jan 10 Dec 09
Dec 10
10,186
9,890
11,328
10,964
122,237
118,676
52,772
52,334
1.12
1.13
1.34
1.31
1.37
1.35
0.56
0.62
2.32
2.28
36.1
36.7
52.3%
52.5%
39.2%
39.0%
Length of Enrollment (For Current Members)
Norm
729
853
1.00
1.17
1.36
0.54
2.17
32.72
49.3%
41.2%
869
Less than 12 months
12-23 months
24 -35 months
36 months
7,164
Members by Gender
100%
75%
52.3%
52.5%
49.3%
47.7%
47.5%
50.7%
2009
2010
Female
Norm
50%
25%
0%
Male
© 2011 Lockton, Inc. All rights reserved.
Norm from Lockton InfoLock Book of Business.
5
Health Cost Analysis
Medical Financial Analysis Overview
 Medical and Pharmacy Costs
 Medical and Pharmacy costs are increasing below Premera Alaska trend of 14.5%
for calendar year 2010
 Inpatient
 Average allowed per Admission increased 11.4% and the average allowed per day
increased 32.8% from $3,910 to $5,194 from calendar year 2009 to 2010; whereas
the average length of stay decreased from 5.6 days to 4.7 days
 Increase in severity of inpatient claims
 Emergency Room
 ER visits per 1,000 decreased from 178 to 169 and the cost per visit increased
indicating that members are utilizing the ER for appropriate services
 Low percentage of (7.86%) of non-emergent like condition ER visits
 Moderate rate of members with 2 ER visits (16.2%) and 3 plus ER visits (8.2%)
 Recommendation: Care manage those with 3 or greater visits to develop solutions
to determine cause and appropriate management thru Alere
© 2011 Lockton, Inc. All rights reserved.
7
Medical Financial Analysis Overview
 Outpatient
 All office visits per 1,000 increased from calendar year 2009 to 2010
 Mental health visits per 1,000 increased 5.7%
 Preventive visits per 1,000 increased 2.8%
 Large claims were a major driver of University costs
 Large claims made up 33.7% of the total University medical/Rx costs compared to
the norm of 29.4%
 The average paid per high cost claimant increased from $111,444 to $126,649
 The cost increase resulted predominately from a $2M increase in costs of claims
greater than $150,000
 52% of the large claimants had 3 or more conditions, e.g. high blood pressure, high
cholesterol and diabetes
 Four categories accounted for the higher costs: Cancer/Cancer therapy,
cardiovascular disease, diabetes & renal failure and back/osteoarthritis
© 2011 Lockton, Inc. All rights reserved.
8
Financial Summary
Jan 09 - Dec 09 Jan 10 - Dec 10
Medical Costs
Allowed Amount
$52,424,298
$56,015,344
Plan Paid
$47,421,509
$50,827,875
Plan Paid PMPM
$387.95
$428.29
Plan Paid PEPM
$898.61
$971.22
Rx Costs
Allowed Amount
$8,138,416
$8,460,767
Plan Paid
$7,011,056
$7,380,833
Plan Paid PMPM
$57.36
$62.19
Plan Paid PEPM
$132.86
$141.03
Total Costs
Allowed Amount
$60,562,715
$64,476,111
Employee Paid
$6,118,046
$6,235,830
Plan Paid
$54,432,566
$58,208,708
Plan Paid PMPM
$445.30
$490.48
Plan Paid PEPM
$1,031.47
$1,112.25
High Cost Claimants (>50,000 in claims)
Medical PMPM
$137.58
$157.15
Rx PMPM
$8.29
$8.27
% Change
6.8%
7.2%
10.4%
8.1%
4.0%
5.3%
8.4%
6.2%
6.5%
1.9%
6.9%
10.1%
7.8%
14.2%
-0.3%
Norm
$246.59
$534.70
% Pharmacy of Total Paid
2009
12.9%
2010
12.7%
Norm
18.1%
0.0%
$53.80
$116.65
20.0%
% Employee Paid
$300.38
$651.35
$83.01
$5.05
2009
10.1%
2010
9.7%
Norm
0.0%
© 2011 Lockton, Inc. All rights reserved.
10.0%
Norm from Lockton InfoLock Book of Business.
19.0%
10.0%
20.0%
9
Utilization Summary
Oct 08 Sep 09
Place of Service Allowed PMPM
Inpatient Hospital
Outpatient Hospital
Office
Emergency Room
Other
Inpatient
IP Days/1000
Admissions/1000
Average Allowed per Admission
Average Length of Stay
Average Allowed per Day
Outpatient
ER Visits/1000
Average Allowed per ER Visit
All Office Visits/1000
Mental Health Visits/1000
Preventive Visits/1000
Average Allowed per Office Visit (includes ancillary)
Prescription Drugs
Prescriptions/1000
Average Allowed per Brand Script
Average Allowed per Generic Script
% Generic Scripts
Oct 09 Sep 10
% Change
Norm
$93.27
$120.90
$155.38
$30.30
$20.21
$101.40
$126.48
$153.66
$32.30
$18.48
8.7%
4.6%
-1.1%
6.6%
-8.6%
$93.92
$87.02
$74.02
$25.65
$12.14
287
51
$21,904
5.6
$3,910
237
50
$24,411
4.7
$5,194
-17.4%
-1.5%
11.4%
-16.1%
32.8%
361
74
$15,354
4.9
$3,134
178
$2,047
4,108
604
415
$475
169
$2,297
4,225
639
427
$452
-5.0%
12.2%
2.8%
5.7%
2.8%
-4.7%
218
$1,416
4,096
348
448
$218
8,566
$162
$32
53.6%
9,036
$177
$32
57.9%
5.5%
9.1%
1.6%
4.3%
9,616
$183
$29
64.0%
Utilization is provided on an incurred basis and lagged three months.
© 2011 Lockton, Inc. All rights reserved.
Norm from Lockton InfoLock Book of Business.
10
Claim Expense Distribution
Jan 09 - Dec 09
Paid Amount Range
Members
Count
Plan Payment
Count
Members
Plan
Payment
%
Amount
%
%
%
21.1%
-$71,332
-0.1%
2,120
19.0%
-$166,981
-0.3%
20.5%
-0.2%
$1-$1,999
5,269
45.7%
$3,621,320
6.7%
5,064
45.5%
$3,496,144
6.0%
55.3%
10.6%
$2,000-$4,999
1,721
14.9%
$5,556,920
10.2%
1,756
15.8%
$5,704,336
9.8%
12.4%
13.1%
$5,000-$24,999
1,677
14.6%
$18,490,084
34.0%
1,731
15.6%
$19,007,967
32.7%
10.0%
33.9%
$25,000-$49,999
270
2.3%
$9,004,524
16.5%
305
2.7%
$10,536,606
18.1%
1.2%
13.2%
$50,000-$74,999
71
0.6%
$4,228,981
7.8%
57
0.5%
$3,403,341
5.8%
0.3%
6.8%
$75,000-$99,999
37
0.3%
$3,190,091
5.9%
43
0.4%
$3,706,810
6.4%
0.1%
4.2%
$100,000-$149,999
26
0.2%
$3,077,955
5.7%
27
0.2%
$3,151,309
5.4%
0.1%
5.5%
$150,000+
26
0.2%
$7,334,022
13.5%
28
0.3%
$9,369,177
16.1%
0.1%
12.9%
160
1.4%
$17,831,049
32.8%
155
1.4%
$19,630,637
33.7%
0.8%
29.4%
© 2011 Lockton, Inc. All rights reserved.
%
Plan Payment
2,427
11,524 100.0%
Amount
Members
Norm
$0 or less
Members > $50,000
All Members
%
Jan 10 - Dec 10
$54,432,566 100.0% 11,131 100.0%
Norm from Lockton InfoLock Book of Business.
$58,208,708 100.0% 100.0% 100.0%
11
High Cost Claimants
High Cost Claimants
Number of Members
% HCC Medical Paid
% HCC Rx Paid
Medical Paid for HCCs
Rx Paid for HCCs
Total Paid for HCCs
Average Medical Paid per HCC
Average Rx Paid per HCC
Average Total Paid per HCC
Jan 09 - Dec 09 Jan 10 - Dec 10
160
155
35.5%
36.7%
14.5%
13.3%
$16,817,181
$18,649,536
$1,013,867
$981,101
$17,831,049
$19,630,637
$105,107
$120,320
$6,337
$6,330
$111,444
$126,649
% Change
-3%
1.2%
-1.2%
10.9%
-3.2%
10.1%
14.5%
-0.1%
13.6%
Norm
33.7%
9.4%
$109,930
$6,687
$116,617
Number of Chronic Conditions per HCC
60%
52%
50%
40%
30%
21%
23%
20%
10%
4%
0%
Members with 0
conditions
© 2011 Lockton, Inc. All rights reserved.
Members with 1
condition
Members with 2
conditions
Members with 3 or
more conditions
Norm from Lockton InfoLock Book of Business.
12
High Cost Claimants
High Cost Claimants by Top 20 Diagnosis Groups
Jan 10 - Dec 10
Diagnosis Group
Cancer Therapies
Pharmacy
Osteoarthritis
Leukemia
CAD
Renal Failure
Breast Cancer
Intracranial Hemorrhage
Intervertebral Disc Disorders
Cerebrovascular Diseases
Myocardial Infarction
Septicemia
Diabetes Mellitus
Procedure Complications
Atrial Fibrillation
All Others
Total
© 2011 Lockton, Inc. All rights reserved.
Members Total Paid
16
1,231,902
148
981,101
42
950,442
2
880,595
21
806,240
7
723,532
13
722,328
5
696,999
33
658,769
10
543,999
8
468,422
9
428,144
33
411,303
26
402,821
12
336,663
9,387,378
155 19,630,637
2009 HCC by Relationship
100%
75%
8%
11%
31%
31%
Dependent
50%
Spouse
25%
61%
59%
Members
Paid Amount
Employee
0%
2010 HCC by Relationship
100%
75%
8%
11%
34%
32%
Dependent
50%
Spouse
25%
58%
57%
Members
Paid Amount
Employee
0%
13
Emergency Room Utilization
ER Visits by Number of Visits
Jan 09 - Dec 09
Visits per
Member
1
2
3
4
5+
ER Visits by Relationship
Jan 10 - Dec 10
100%
# of
% on
%
# of
% on
%
Members Weekends Dependents Members Weekends Dependents
1,104
263
88
21
18
34%
30%
32%
36%
29%
© 2011 Lockton, Inc. All rights reserved.
33%
30%
34%
29%
0%
1,037
228
65
20
24
30%
33%
34%
45%
34%
30%
31%
17%
25%
25%
31%
29%
26%
29%
43%
42%
2009
2010
75%
50%
25%
0%
Employees
Spouses
Dependents
14
Emergency Room Utilization
Emergency Room Visit by Top 20 Diagnosis Groups
Jan 10 - Dec 10
Primary Diagnosis Group
Intracranial Hemorrhage
Chest Pain
Misc Wounds and Injuries
Pain, not elsewhere classified
Abdominal Pain
ENT and Upper Resp Disorders
Appendicitis
Urinary Stones
Limb Fractures
Headache
Misc Skin Diseases
Musculoskeletal Disorders
Misc Symptoms
Nausea and Vomiting
Gall Bladder Diseases
Pregnancy Complications
Dysrhythmias
Dizziness
Misc Urinary Diseases
Syncope
All Others
Total
© 2011 Lockton, Inc. All rights reserved.
Visits
4
94
202
83
80
130
15
26
61
55
82
95
24
40
14
40
31
26
53
26
741
1922
Paid Amount
330,211
227,105
184,498
184,120
143,117
114,568
113,058
96,088
92,735
85,448
81,729
80,728
71,811
67,477
66,800
63,070
61,414
45,515
45,009
44,153
1,085,566
3,284,221
2010 Potential Non Emergent
ER Visits
151
1771
Potential Non Emergent Visits
Other ER Visits
15
Pharmacy Financial Analysis Overview
 Generic usage increased from 2009 and 2010 from 53.6% to 57.9%
 For each 1% increase in generic usage the pharmacy plan costs should decrease 1%
 Estimated savings of $300,000 from 2009 to 2010
 Nexium per script usage decreased from 2009 to 2010 from 1,318 to 1,197 &
Simvastatin per script usage increased from 2009 to 2010 from 1,137 to 1,258
 Step Therapy implemented in July 2010
 Four specialty drugs made up 6.8% of the total University pharmacy spend in the
calendar year 2010
 Therapeutic class (condition): Anti-Inflammatory and Multiple Sclerosis
 % paid per member per month increased 33.5% for MS and 66.0% for AntiInflammatory drugs between 2009 and 2010
 Potential savings of $166,351, if 50% of cholesterol scripts moved to Simvastatin
 Potential savings of $129,587, if 50% of PPI scripts moved to Omeprazole
© 2011 Lockton, Inc. All rights reserved.
16
Prescription Drugs - Top 20 Therapeutic Classes
Jan 09 - Dec 09
Therapeutic Class
Antihyperlipidemics
Antidepressants
Peptic Ulcer - Antisecretory Agents
Multiple Sclerosis Agents
DMARD - Anti-inflammatory Tumor Necrosis Factor Inhibiting Agents
Asthma Therapy Combinations
Anticonvulsant
Asthma Therapy - Leukotriene Modulators
Analgesic Narcotic Agonists and Combinations
Sedative-Hypnotic - Non-Barbiturates
Contraceptive Oral Combinations
Attention Deficit-Hyperact Disorder (ADHD) Therapy
Inflammatory Bowel Agents
Insulin - Human & Analogs, Short or Rapid Acting
Insulin Response Enhancers
Migraine Therapy - Serotonin Agonists
Herpes Agents
Antipsychotic - Atypical Agents, General
Antipsychotic - Atypical Dopamine-Serotonin Antagonists
Diagnostic - Blood Tests
All Others
Total
© 2011 Lockton, Inc. All rights reserved.
Paid
Paid
PMPM
$560,152
$4.58
$550,720
$4.51
$527,049
$4.31
$284,500
$2.33
$164,166
$1.34
$187,127
$1.53
$166,430
$1.36
$147,268
$1.20
$146,910
$1.20
$129,479
$1.06
$119,327
$0.98
$122,247
$1.00
$66,883
$0.55
$95,183
$0.78
$102,913
$0.84
$124,037
$1.01
$146,380
$1.20
$92,954
$0.76
$85,733
$0.70
$102,122
$0.84
$3,089,477 $25.27
$7,011,056 $57.36
Scripts
5,639
7,062
3,456
122
95
926
1,863
1,209
1,172
1,713
3,719
897
146
361
1,799
666
805
208
365
698
55,345
88,266
Cost
per
Paid
Script
$99
$644,562
$78
$552,265
$153
$453,332
$2,332
$368,625
$1,728
$264,635
$202
$200,969
$89
$150,908
$122
$150,800
$125
$144,058
$76
$132,179
$32
$114,862
$136
$114,845
$458
$114,694
$264
$112,568
$57
$111,096
$186
$110,903
$182
$108,252
$447
$103,668
$235
$102,084
$146
$100,192
$42 $3,225,335
$79 $7,380,833
Jan 10 - Dec 10
% Change
Cost
in Paid
Paid
Scripts
per
PMPM
PMPM
Script
$5.43
5,948
$108
18.5%
$4.65
7,247
$76
3.3%
$3.82
3,628
$125
-11.4%
$3.11
137 $2,691
33.5%
$2.23
146 $1,813
66.0%
$1.69
942
$213
10.6%
$1.27
2,197
$69
-6.6%
$1.27
1,064
$142
5.5%
$1.21
1,280
$113
1.0%
$1.11
1,920
$69
5.1%
$0.97
3,657
$31
-0.9%
$0.97
889
$129
-3.2%
$0.97
181
$634
76.6%
$0.95
381
$295
21.8%
$0.94
1,783
$62
11.2%
$0.93
719
$154
-7.9%
$0.91
888
$122
-23.8%
$0.87
201
$516
14.9%
$0.86
437
$234
22.6%
$0.84
672
$149
1.1%
$27.18
56,576
$57
7.5%
$62.19 90,893
$81
8.4%
17
Prescription Drugs - Top 20 Drugs by Paid Amount
Jan 09 - Dec 09
Jan 10 - Dec 10
LIPITOR
NEXIUM
HUMIRA
SINGULAIR
ADVAIR DISKUS
Brand
Brand
Brand
Brand
Brand
Antihyperlipidemics
Peptic Ulcer - Antisecretory Agents
DMARD - Anti-inflammatory Tumor Necrosis Factor
Asthma Therapy - Leukotriene Modulators
Asthma Therapy Combinations
$296,311
$275,497
$84,341
$147,268
$146,138
$2.42
$2.25
$0.69
$1.20
$1.20
2,370
1,318
43
1,209
679
Cost
per
Script
$125
$209
$1,961
$122
$215
LEXAPRO
Brand
Antidepressants
$110,837
$0.91
1,147
$97
REBIF
COPAXONE
CYMBALTA
CRESTOR
ABILIFY
ENBREL
EFFEXOR XR
ONE TOUCH ULTRA TEST
ACTOS
HUMALOG
OXYCONTIN
BUPROPION XL
AMBIEN CR
CELEBREX
All Others
Total
Brand
Brand
Brand
Brand
Brand
Brand
Brand
Brand
Brand
Brand
Brand
Generic
Brand
Brand
Multiple Sclerosis Agents
Multiple Sclerosis Agents
Antidepressants
Antihyperlipidemics
Antipsychotic - Atypical Agents, General
DMARD - Anti-inflammatory Tumor Necrosis Factor
Antidepressants
Diagnostic - Blood Tests
Insulin Response Enhancers
Insulin - Human & Analogs, Short or Rapid Acting
Analgesic Narcotic Agonists and Combinations
Antidepressants
Sedative-Hypnotic - Non-Barbiturates
NSAIDs, Cyclooxygenase-2 (COX-2) Selective
Inhibitors and Combinations
$98,636
$0.81
$68,847
$0.56
$92,584
$0.76
$83,844
$0.69
$92,954
$0.76
$79,825
$0.65
$133,364
$1.09
$80,146
$0.66
$70,027
$0.57
$58,315
$0.48
$54,479
$0.45
$59,176
$0.48
$55,422
$0.45
$65,924
$0.54
$4,857,124 $39.74
$7,011,056 $57.36
42
28
542
712
208
52
780
456
305
231
127
632
378
414
76,593
88,266
$2,348
$2,459
$171
$118
$447
$1,535
$171
$176
$230
$252
$429
$94
$147
$159
$63
$79
Drug Name
Brand/
Generic
Therapeutic Class
© 2011 Lockton, Inc. All rights reserved.
Paid
Paid
PMPM
Scripts
$336,646
$264,257
$163,463
$150,800
$142,254
$2.84
$2.23
$1.38
$1.27
$1.20
2,389
1,197
85
1,064
641
Cost
per
Script
$141
$221
$1,923
$142
$222
$126,219
$1.06
1,153
$109
$121,847
$1.03
$114,006
$0.96
$113,667
$0.96
$109,656
$0.92
$103,668
$0.87
$101,173
$0.85
$93,564
$0.79
$83,965
$0.71
$82,255
$0.69
$76,931
$0.65
$68,793
$0.58
$68,256
$0.58
$67,842
$0.57
$67,481
$0.57
$4,924,093 $41.49
$7,380,833 $62.19
47
38
639
812
201
61
503
502
322
272
163
907
412
413
79,072
90,893
$2,592
$3,000
$178
$135
$516
$1,659
$186
$167
$255
$283
$422
$75
$165
$163
$62
$81
Paid
Paid
PMPM
Scripts
18
Prescription Drugs - Top 20 Drugs by Script Count
Jan 09 - Dec 09
Drug Name
Brand/
Generic
Therapeutic Class
LIPITOR
HYDROCODONEACETAMINOPHEN
LISINOPRIL
SYNTHROID
Brand
Antihyperlipidemics
LEVOTHYROXINE SODIUM
Generic Thyroid Hormones and Combinations
SIMVASTATIN
HYDROCHLOROTHIAZIDE
NEXIUM
LEXAPRO
AZITHROMYCIN
ZOLPIDEM TARTRATE
SINGULAIR
METFORMIN HCL
OMEPRAZOLE
BUPROPION XL
AMOXICILLIN
CRESTOR
AMLODIPINE BESYLATE
METOPROLOL SUCCINATE
ALPRAZOLAM
All Others
Total
Generic
Generic
Brand
Brand
Generic
Generic
Brand
Generic
Generic
Generic
Generic
Brand
Generic
Generic
Generic
Generic Analgesic Narcotic Agonist Combinations
Generic ACE Inhibitors and ACE Inhibitor Combinations
Brand
Thyroid Hormones and Combinations
Antihyperlipidemics
Diuretic - Thiazides and Related, and Combinations
Peptic Ulcer - Antisecretory Agents
Antidepressants
Macrolides and Combinations
Sedative-Hypnotic - Non-Barbiturates
Asthma Therapy - Leukotriene Modulators
Insulin Response Enhancers
Peptic Ulcer - Antisecretory Agents
Antidepressants
Penicillins
Antihyperlipidemics
Calcium Channel Blockers
Beta Blockers Cardiac Selective, All
Antianxiety Agents
© 2011 Lockton, Inc. All rights reserved.
Jan 10 - Dec 10
$296,311
$2.42
2,370
Cost
per
Script
$125
$7,663
$0.06
2,139
$4
$8,956
$0.08
2,196
$4
$16,065
$3,470
$0.13
$0.03
1,788
1,322
$9
$3
$13,759
$4,099
$0.12
$0.03
1,970
1,361
$7
$3
$2,156
$0.02
1,201
$2
$1,835
$0.02
1,266
$1
$45,294 $0.37
$720 $0.01
$275,497 $2.25
$110,837 $0.91
$31,574 $0.26
$36,209 $0.30
$147,268 $1.20
$15,109 $0.12
$43,186 $0.35
$59,176 $0.48
$1,511 $0.01
$83,844 $0.69
$16,710 $0.14
$18,263 $0.15
$880 $0.01
$5,799,313 $47.44
$7,011,056 $57.36
1,137
1,130
1,318
1,147
1,144
893
1,209
1,059
675
632
708
712
735
638
665
65,644
88,266
$40
$1
$209
$97
$28
$41
$122
$14
$64
$94
$2
$118
$23
$29
$1
$88
$79
$44,907 $0.38
$891 $0.01
$264,257 $2.23
$126,219 $1.06
$24,872 $0.21
$32,899 $0.28
$150,800 $1.27
$13,321 $0.11
$45,464 $0.38
$68,256 $0.58
$1,944 $0.02
$109,656 $0.92
$15,107 $0.13
$22,736 $0.19
$1,064 $0.01
$6,093,146 $51.34
$7,380,833 $62.19
1,258
1,230
1,197
1,153
1,129
1,105
1,064
1,019
923
907
888
812
787
750
737
66,752
90,893
$36
$1
$221
$109
$22
$30
$142
$13
$49
$75
$2
$135
$19
$30
$1
$91
$81
Paid
Paid
PMPM
Scripts
$336,646
$2.84
2,389
Cost
per
Script
$141
Paid
Paid
PMPM
Scripts
19
Anti-Hyperlipidemics Generic Analysis
Anti-hyperlipidemics
Plan Paid PMPM
Statins
Lipitor
Crestor
Lescol XL
Simvastatin
Lovastatin
Pravastatin Sodium
Jan 09 - Dec 09
$4.58
Jan 10 - Dec 10
$5.43
Jan 09 - Dec 09
Jan 10 - Dec 10
Script
Rx
Script
Rx
Count
PMPM
Count
PMPM
2,370
$2.42
2389
$2.84
712
$0.69
812
$0.92
7
$0.01
4
$0.01
1,137
$0.37
1258
$0.38
77
$0.01
76
$0.01
341
$0.09
421
$0.10
% Change
18.5%
Potential Savings
% Change
If 50% of scripts for:
Lipitor,
Crestor,
and Lescol XL
17.0%
34.7%
-42.0%
2.1%
21.2%
10.5%
moved
to
Simvastatin last year
costs would have
been reduced by
approximately:
$166,351
© 2011 Lockton, Inc. All rights reserved.
20
Peptic Ulcer Generic Analysis
Peptic Ulcer
Plan Paid PMPM
Jan 09 - Dec 09
$4.31
Jan 10 - Dec 10
$3.82
Jan 09 - Dec 09
Jan 10 - Dec 10
Proton-Pump Inhibitor Script
Rx
Script
Rx
Count
PMPM
Count
PMPM
Prevacid
510
$0.96
62
$0.13
Nexium
1318
$2.25
1197
$2.23
Aciphex
122
$0.22
76
$0.14
Protonix
7
$0.01
2
$0.00
Kapidex
17
$0.02
25
$0.03
Prilosec
0
$0.00
1
$0.00
Axid
0
$0.00
0
$0.00
Zantac
0
$0.00
0
$0.00
Pantoprazole Sodium
458
$0.41
518
$0.44
Lansoprazole
43
$0.04
421
$0.34
Omeprazole
675
$0.35
923
$0.38
Ranitidine HCL
244
$0.03
264
$0.03
Cimetidine
8
$0.00
30
$0.00
Famotidine
39
$0.01
33
$0.01
© 2011 Lockton, Inc. All rights reserved.
% Change
-11.4%
% Change
-86.8%
-1.2%
-35.1%
-100.0%
71.8%
0.0%
0.0%
0.0%
9.0%
740.2%
8.4%
-24.6%
9.6%
4.7%
Potential Savings
If 50% of scripts for:
Prevacid, Nexium,
Aciphex, Protonix,
Kapidex, Prilosec,
Axid, and Zantac
moved
to
Omeprazole last year
costs would have
been reduced by
approximately:
$129,587
21
Prescription Drugs - High Cost Scripts (>$1,000)
Number of High Cost Scripts
600
500
498
420
PMPM Paid for High Cost
Scripts
400
$8
300
$6
200
$4
100
$2
0
$0
2009
2010
2009 Rx PMPM Paid
$9.28
$10
$7.70
2009
2010 Rx PMPM Paid
$7.70
© 2011 Lockton, Inc. All rights reserved.
$9.28
$52.91
$49.66
High Cost Scripts PMPM
2010
All Other PMPM
High Cost Scripts PMPM
All Other PMPM
22
Brand versus Generic Analysis
Percentage of Scripts and Plan Paid
100%
18.1%
80%
53.6%
57.9%
64.0%
60%
81.9%
40%
20%
46.4%
19.6%
19.7%
80.4%
80.3%
42.1%
36.0%
0%
Scripts
Plan Paid
Scripts
Jan 09 - Dec 09
Plan Paid
Scripts
Jan 10 - Dec 10
Brand
Plan Paid
Norm
Generic
Cost per Script
$200
$183
$177
$162
$150
$100
$50
$32
$32
$29
$0
Jan 09 - Dec 09
Jan 10 - Dec 10
Average Allowed per Brand Script
© 2011 Lockton, Inc. All rights reserved.
Norm
Average Allowed per Generic Script
Norm from Lockton InfoLock Book of Business.
23
Clinical Risk and Conditions
Members included in this section were active plan participants as of the last month of the
reporting cycle.
Each individual member is assigned a risk score indicating disease burden and a care gap
score quantifying appropriate medical care. Depending upon the prevalence of disease and
the extent of gaps in medical care, the population is stratified into low, moderate, and high
risk for disease burden, and compliant or non-compliant for disease management.
Population Stratification
High Cost
NonCompliant
413 members
$9,527 PMPY
Employee
Population
9615 members
$5,695 PMPY
Compliant
4,030 members
$6,581 PMPY
PRIORITY
141 members
$130,794 PMPY
Intervention
Manage high costs
Help members
navigate system
Case Management
Close gaps in care
Steerage
Disease Management
and
Health Promotion
High Risk
246 members
$13,088 PMPY
Moderate
Risk
167 members
$4,283 PMPY
High Risk
1,251 members
$11,813 PMPY
Moderate
Risk
2,779 members
$4,226 PMPY
Low Risk
5,031 members
$1,164 PMPY
© 2011 Lockton, Inc. All rights reserved.
Goal
Manage risk factors
Reinforce and
monitor compliance
rates
Manage risk factors
Health Promotion
Health Promotion
25
Population Risk
Risk Category
Low Risk, Compliant
Low Risk, Non-Compliant
Moderate Risk, Compliant
Number of
Members
2009 PMPY
2010 PMPY
Member
Average Average
Member
Distribution
RI
CGI
Distribution
Norm
$676
1.52
0.93
52%
48%
Paid PMPY
Norm
5,000
$796
$1,162
31
$966
$1,561
$1,171
2.74
7.26
0%
0%
2,779
$3,832
$4,226
$2,312
9.26
1.59
29%
31%
167
$5,366
$4,283
$2,725
9.92
7.56
2%
2%
1,251
$15,169
$11,813
$7,228
21.59
2.29
13%
14%
High Risk, Non-Compliant
246
$17,449
$13,088
$8,263
26.45
7.78
3%
4%
High Cost
141
$39,722
$130,794
$116,333
32.23
4.43
1%
1%
$4,621
$5,695
$3,372
7.61
1.66
100%
100%
Moderate Risk, Non-Compliant
High Risk, Compliant
Total
9,615
Percent of Members compared to Percent of Cost
100.0%
High Cost, 1.5%
High Risk, 15.6%
High Cost, 33.6%
75.0%
Moderate Risk,
30.6%
50.0%
25.0%
High Risk, 33.6%
Low Risk, 52.3%
Low Risk, 9.6%
0.0%
Membership
© 2011 Lockton, Inc. All rights reserved.
Moderate Risk,
23.2%
Cost
Norm from Lockton InfoLock Book of Business.
26
Population Risk (continued)
Members by Risk Category
60.0%
52.3%
50.0%
48.4%
40.0%
30.6%
32.9%
30.0%
15.6%
20.0%
18.0%
10.0%
1.5%
0.8%
Actual
Norm
0.0%
Actual
Norm
Low Risk
Actual
Norm
Moderate Risk
Actual
Norm
High Risk
High Cost
% of Total Paid by Risk Category
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
39.7%
33.6%
33.6%
27.8%
9.6%
9.7%
Actual
Norm
Low Risk
© 2011 Lockton, Inc. All rights reserved.
23.2%
22.8%
Actual
Norm
Moderate Risk
Actual
Norm
High Risk
Norm from Lockton InfoLock Book of Business.
Actual
Norm
High Cost
27
Cost of Non-Compliance
Moderate Risk - Non-Compliant members on average cost $627* more per
year than Compliant members.
High Risk - Non-Compliant members on average cost $1,035* more per year
than Compliant members.
Moderate Risk
Compliant
Condition
Members
104
Back Pain
835
Neck Pain
459
4
Asthma
COPD
CAD
Depression
Diabetes
High Risk
Non-Compliant
Cost
$3,919
Members
17
$4,932
39
$5,131
23
$3,608
3
10
$3,042
299
23
Compliant
Cost
$3,791
Members
85
$5,367
570
$5,065
334
$7,115
7
6
$5,144
$4,563
13
$2,138
$4,939
83
Non-Compliant
Cost
$12,319
Members
25
Cost
$14,229
$13,177
95
$14,349
$13,425
53
$14,296
$13,271
8
$20,405
27
$10,938
22
$10,314
230
$12,061
35
$15,397
$3,485
76
$14,846
143
$11,417
$11,055
Hyperlipidemia
255
$3,978
12
$1,514
246
$12,090
57
Hypertension
253
$3,573
26
$2,985
265
$10,681
70
$14,592
Osteoarthritis
99
$6,520
4
$4,040
150
$15,114
33
$16,931
Total
2,779
$4,226
167
$4,283
1,251
$11,813
This exhibit excludes high cost claimants. PMPY costs include comorbidities.
© 2011 Lockton, Inc. All rights reserved.
*Norm from the Lockton InfoLock Book of Business.
246
$13,088
28
Chronic Conditions per Member
Paid Amount by Number of Chronic Conditions
Chronic Conditions per Member
70%
60%
18%
65%
58%
50%
40%
30%
19%
20%
17%
Actual
13%
10%
10%
9%
8%
Norm
0%
Members with 0
conditions
Members with 1
condition
Members with 2
conditions
Members with 3 or
more conditions
82%
No Chronic Conditions
1 or more condition
PMPY by Number of Chronic Conditions
$25,000
$22,413
$20,000
$13,667
$15,000
$10,000
$5,000
$8,691
$6,776
$4,129
$1,855 $1,216
Actual
$6,274
Norm
$Members with 0
conditions
Members with 1
condition
© 2011 Lockton, Inc. All rights reserved.
Members with 2
conditions
Members with 3 or
more conditions
29
Top 5 Chronic Conditions
Top 5 Chronic Conditions by Number of Members
Back Pain
442
Neck Pain
224
Hypertension
58
Depression
92
874
482
279
312
387
335
49
265
34
665
109
59
Low Risk
Moderate Risk
High Risk
Hyperlipidemia
58
0
© 2011 Lockton, Inc. All rights reserved.
267
303
500
45
High Cost
1000
1500
2000
2500
30
Cost Adjustment
 1In the ACCRA Cost of Living Index, health care costs in
Alaska’s cities ranged from 30.4% to 44.6% spendier than
the average U.S. city in 2010
 The Norm has not been adjusted for the higher costs in
Alaska
 Analysis Summary will compare UA costs to adjusted norm of norm
plus 37.5%
1http://labor.alaska.gov/research/col/col.pdf
© 2011 Lockton, Inc. All rights reserved.
31
Asthma Summary & Observations
 Asthma
 Prevalence is comparable to the norm but has higher costs of $7,636 per member
per year (pmpy) compared to the adjusted norm of $6,407 pmpy
 81% of the members with asthma are compliant in medication and doctor visits
 Patients with more than one asthma-related emergency room visit is higher than
norm
 18.3% of members with Asthma are without inhaled corticosteroids or leukotriene
inhibitors compared to the norm of 27.2% without inhalers
 Recommendation:
 Alere send communications and out-reach to members with emergency room visits for
Asthma

Provide information on new free generic program if actively engaged in Alere DM Asthma program
© 2011 Lockton, Inc. All rights reserved.
32
Asthma
Members with Asthma
Members by Relationship
Member by Risk Category
48%
7%
20%
32%
46%
42%
Members by Compliance
81%
Number of Comorbidities
42%
3.0%
2.7%
250
2.0%
200
1.5%
150
1.0%
100
0.0%
0
Prevalence
Asthma Only
2 comorbidities
50
34
50 Hyperlipidemia
262
17%
91
Depression
25
Hypertension
22
Norm
20
40
60
80
Norm from Lockton InfoLock Book of Business.
100
Dependents
High Risk
HCC
Non-Compliant
1 comorbidity
3+ comorbidities
Asthma Members - Annual Cost
$9,000
$8,000
$7,000
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
$0
$7,636
$6,621
$4,660
2009 PMPY
0
© 2011 Lockton, Inc. All rights reserved.
Moderate Risk
Compliant
Back Pain
Neck Pain
Spouses
19%
300
2.5%
0.5%
22%
Low Risk
5%
Top 5 Comorbidities by Number of Members
Asthma Prevalence
2.8%
19%
Employees
2010 PMPY
Norm
Excludes High Cost Claimants
33
Asthma Quality and Risk Measures
Risk Measures
Criteria
Asthma
Asthma
Asthma
Asthma
#
262
262
262
262
Description
Patients
Patients
Patients
Patients
Actual %
with more than one asthma-related ER visit in the analysis period
with more than one asthma-related hospitalization in the analysis period
with asthma-related ER visit in the analysis period
with asthma-related hospitalization in the analysis period
4.2%
0.4%
10.7%
2.3%
Norm % Variance
3.0%
0.4%
11.8%
3.2%
1.2%
0.0%
-1.1%
-0.9%
Quality Care Measures
Criteria
Asthma-related ER visit
Asthma-related admission
Asthma
#
40
6
262
Description
Actual %
Patients without office visit in the analysis period
Patients without office visit in the analysis period
Patients without inhaled corticosteroids or leukotriene inhibitors in the analysis period
© 2011 Lockton, Inc. All rights reserved.
Norm from the Lockton InfoLock Book of Business.
Norm % Variance
0.0%
0.0%
2.8%
1.3%
-2.8%
-1.3%
18.3%
27.2%
-8.9%
34
COPD Summary & Observations
 COPD
 Prevalence is below the norm with higher UA costs of $12,692 pmpy compared to
the adjusted norm of $11,390 pmpy
 47% of the members with COPD are non-compliant due to doctor visits
 40% have 3 or more co-morbidities
 Low percentage of hospitalizations to due to COPD compared to the norm
 The number of members with COPD with an ER visit is comparable to the norm
 Typically COPD is related to smoking
 Communicate smoking cessation programs
© 2011 Lockton, Inc. All rights reserved.
35
COPD
Members with COPD
Members by Relationship
40%
Member by Risk Category 3%
60%0%
23%
50%
Members by Compliance
Number of Comorbidities
27%
1.0%
47%
23%
0.8%
30
25
0.6%
20
10
0.2%
5
30
0.0%
0
Prevalence
10
Asthma
$10,000
8
$12,692
$7,806
$2,000
$0
6
2009 PMPY 2010 PMPY
2
4
6
$8,284
$4,000
Norm
© 2011 Lockton, Inc. All rights reserved.
1 comorbidity
3+ comorbidities
$6,000
8
0
HCC
COPD Members - Annual Cost
$8,000
Diabetes
High Risk
$12,000
8
Neck Pain
Dependents
Non-Compliant
$14,000
Back Pain
15Hypertension
0.3%
Moderate Risk
COPD Only
2 comorbidities
40%
35
0.8%
Spouses
Compliant
Top 5 Comorbidities by Number of Members
COPD Prevalence
0.4%
Low Risk
23%
53%
10%
Employees
8
10
12
Norm from the Lockton InfoLock Book of Business.
Norm
Excludes High Cost Claimants
36
COPD Quality and Risk Measures
Risk Measures
Criteria
COPD
COPD
COPD
COPD
#
30
30
30
30
Description
Patients with COPD-related ER visit in the analysis period
Patients with more than one hospitalization in the analysis period
Patients with more than one COPD-related ER visit in the analysis period
Patients with COPD-related hospitalization in the analysis period
Actual %
13.3%
10.0%
0.0%
6.7%
Norm % Variance
13.4%
-0.1%
23.4%
-13.4%
3.9%
-3.9%
10.9%
-4.2%
#
8
2
30
Description
Patients without office visit in the analysis period
Patients without office visit in the analysis period
COPD without Office visit in last 12 months
Actual %
0.0%
0.0%
3.3%
Norm % Variance
0.0%
0.0%
0.0%
0.0%
5.9%
-2.5%
Quality Care Measures
Criteria
COPD-related ER visit
COPD-related admission
COPD
This exhibit excludes high cost claimants. PMPY costs include comorbidities.
© 2011 Lockton, Inc. All rights reserved.
Norm from the Lockton InfoLock Book of Business.
37
CAD Summary & Observations
 CAD (Coronary Artery Disease)
 Prevalence is below the norm with lower UA costs of $8,787 pmpy compared to the
adjusted norm of $11,647 pmpy
 Greater percentage of spouses than employees with CAD
 High Risk members make up 50% of the group
 Higher than the norm CAD-related hospitals, cardiac catheterizations and cardiac
stentings
 This relates to higher intensity of CAD related services
 There is significant non-compliance with only 54% of members being complaint
 8.6% of the CAD population did not have hypertensive drugs and the norm is 5.6%
 July 1, 2011 implementation of new disease management program for actively engaged
members and free generic drugs
© 2011 Lockton, Inc. All rights reserved.
38
CAD
Members with CAD
Members by Relationship
Member by Risk Category2%
48%
16%
50%
Members by Compliance
16%
32%
Low Risk
80
1.5%
60
1.0%
1.0%
17%
35%
CAD Only
2 comorbidities
35
Back Pain
98
0.0%
Prevalence
20
Diabetes
0
Neck Pain
High Risk
31
Non-Compliant
1 comorbidity
3+ comorbidities
$8,907
$8,787
$4,000
26
$2,000
$0
16
2009 PMPY 2010 PMPY
10
20
$8,471
$6,000
27
0
HCC
$8,000
Norm
© 2011 Lockton, Inc. All rights reserved.
Dependents
CAD Members - Annual Cost
$10,000
40
0.5%
Moderate Risk
Compliant
Hypertension
Hyperlipidemia
Spouses
46%
120
100
2.0%
Employees
Top 5 Comorbidities by Number of Members
CAD Prevalence
2.1%
0%
32%
54%
Number of Comorbidities
2.5%
52%
30
40
Norm
Excludes High Cost Claimants
39
CAD Quality and Risk Measures
Risk Measures
Criteria
CAD
CAD
CAD
CAD
CAD
CAD
CAD
CAD
CAD
CAD
CAD
CAD
#
98
98
98
98
98
98
98
98
98
98
98
98
Description
Patients with cardiac catheterization in the analysis period
Patients with CABG in the analysis period
Patients with cerebrovascular disease (CVD)
Patients with MI-related hospitalization in the analysis period
Patients with peripheral vascular disease (PVD)
Patients with CAD-related ER visit in the analysis period
Patients with depression
Patients with CAD-related hospitalization in the analysis period
Patients with obesity
Patients with more than one hospitalization in the analysis period
Patients with cardiac stenting in the analysis period
Patients with hyperlipidemia
Actual %
42.9%
6.1%
9.2%
4.1%
4.1%
12.2%
3.1%
23.5%
1.0%
17.3%
24.5%
27.6%
Norm % Variance
37.7%
5.1%
5.0%
1.1%
12.9%
-3.7%
5.0%
-0.9%
6.7%
-2.6%
14.2%
-2.0%
5.0%
-1.9%
19.3%
4.2%
1.1%
0.0%
19.5%
-2.2%
14.5%
10.0%
50.6%
-23.0%
CABG – Coronary Artery Bypass Graft
Quality Care Measures
Criteria
CAD and Hypertension
CAD-related ER visit
CAD-related admission
CAD
#
35
13
24
98
Description
Patients without antihypertensive drugs in the analysis period
Patients without office visit in the analysis period
Patients without office visit in the analysis period
Patients without office visit in the last 12 months
© 2011 Lockton, Inc. All rights reserved.
Norm from Lockton InfoLock Book of Business.
Actual %
8.6%
0.0%
0.0%
2.0%
Norm % Variance
5.6%
2.9%
0.6%
-0.6%
0.4%
-0.4%
3.8%
-1.8%
40
Depression Summary & Observations
 Depression
 Prevalence is significantly above the norm and UA costs are lower at $7,258 pmpy
compared to the adjusted norm of $7,661 pmpy
 Employees make up 60% of the depressed population
 Back and Neck pain are the top 2 co-morbidities
 There is a high compliance rate of 92%
 Anti-depressants are number two out the top 20 therapeutic drug classes by paid amount
and number one by script count
© 2011 Lockton, Inc. All rights reserved.
41
Depression
Members with Depression
Members by Relationship
Member by Risk Category
60%
13%
23%
44%
92%
Number of Comorbidities
37%
3.6%
703
Prevalence
Low Risk
27%
18%
8%
800
Back Pain
700
600
Neck Pain
500
400
Hyperlipidemia
300
200
Headache
100
0
Hypertension
Moderate Risk
270
163
HCC
1 comorbidity
3+ comorbidities
Depression Members - Annual
Costs
$8,000
$6,629
$7,258
$5,572
69
$4,000
68
$2,000
$0
2009 PMPY
50
High Risk
$6,000
60
0
Dependents
Non-Compliant
Depression Only
2 comorbidities
18%
Norm
© 2011 Lockton, Inc. All rights reserved.
Spouses
Compliant
Top 5 Comorbidities by Number of Members
Depression Prevalence
7.3%
Employees
38% 5%
Members by Compliance
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0.0%
17%
100
150
200
250
Norm from Lockton InfoLock Book of Business.
300
2010 PMPY
Norm
Excludes High Cost Claimants
42
Depression Quality and Risk Measures
Risk Measures
Criteria
Depression
Depression
#
703
703
Description
Patients with more than one hospitalization in the analysis period
Patients with depression-related ER visit in the analysis period
Actual %
3.3%
3.1%
Norm % Variance
7.6%
-4.4%
4.7%
-1.6%
#
703
Description
Patients without office visit in the last 12 months
Actual %
4.6%
Norm % Variance
4.4%
0.2%
Quality Care Measures
Criteria
Depression
Depression-related
admission
22
Patients without mental health office visit within 14 days of discharge
© 2011 Lockton, Inc. All rights reserved.
Norm from Lockton InfoLock Book of Business.
81.8%
77.0%
4.8%
43
Diabetes Summary & Observations
 Diabetes
 Prevalence is slightly below the norm with UA costs of $9,459 pmpy higher than the
adjusted norm of $8,984 pmpy
 71% of the population is non-compliant
 There is significant non-compliance in this population with 56% falling in the high risk
category
 Patients with diabetes-related ER visit is above the norm at 4.6% compared to 4.1%
 Patients without a retinal exam is higher than the norm as InfoLock does not collect
third party vision information
 Currently VSP and Alere and working on a data exchange to better identify these
individuals
 Obesity is an issue within this group and percent of the diabetes population that is
obese is greater than the norm
© 2011 Lockton, Inc. All rights reserved.
44
Diabetes
Members with Diabetes
Members by Relationship
60%
Member by Risk Category3%
27%
Members by Compliance
29%
Number of Comorbidities
29%
4.7%
56%
25%
4%
Employees
Low Risk
14%
21%
25%
Diabetes Only
2 comorbidities
Back Pain
4.0%
400
3.0%
300
2.0%
200Hyperlipidemia
1.0%
100
137
Hypertension
0
Prevalence
96
High Risk
HCC
Non-Compliant
1 comorbidity
3+ comorbidities
Diabetes Members - Annual Costs
$9,459
$10,000
$8,045
$6,534
$6,000
82
$4,000
Neck Pain
65
$2,000
Depression
42
$0
Norm
0
© 2011 Lockton, Inc. All rights reserved.
Dependents
$8,000
390
0.0%
Moderate Risk
Compliant
500
4.1%
Spouses
71%
Top 5 Comorbidities by Number of Members
Diabetes Prevalence
5.0%
36%
50
100
Norm from Lockton InfoLock Book of Business.
150
2009 PMPY 2010 PMPY
Excludes High Cost Claimants
Norm
45
Diabetes Quality and Risk Measures
Risk Measures
Criteria
Diabetes-related admission
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes-related ER visit
Diabetes
Diabetes
Diabetes
#
6
390
390
390
390
390
390
390
390
390
19
390
390
390
Description
Patients
Patients
Patients
Patients
Patients
Patients
Patients
Patients
Patients
Patients
Patients
Patients
Patients
Patients
Actual %
without diabetes-related office visit in the analysis period
with dialysis in the analysis period
with diabetes-related hospitalization in the analysis period
with ulcer or open wound
with CAD
with obesity
with hyperlipidemia
with hypertension or taking antihypertensive drugs
with peripheral vascular disease (PVD)
with retinopathy
without office visit in the analysis period
with diabetes-related ER visit in the analysis period
with renal failure
with more than one hospitalization in the analysis period
0.0%
1.0%
1.5%
11.0%
6.7%
3.8%
21.0%
66.4%
1.0%
2.3%
0.0%
4.6%
4.1%
5.6%
Norm % Variance
8.5%
2.6%
2.3%
8.7%
13.4%
2.0%
36.3%
76.0%
2.6%
3.6%
1.1%
4.1%
4.7%
8.9%
-8.5%
-1.5%
-0.8%
2.3%
-6.7%
1.9%
-15.2%
-9.5%
-1.5%
-1.3%
-1.1%
0.5%
-0.6%
-3.2%
Quality Care Measures
Criteria
#
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes
Diabetes
390
390
346
346
390
390
390
346
Description
Actual %
Patients without micro or macroalbumin screening test in the last 12 months
Patients without semiannual HbA1c test
Diabetes without Office Visit in Analysis Period
Diabetes without Lab Test in Analysis Period
Patients without HbA1c test in the last 12 months
Patients without claims for home glucose testing supplies in the last 12 months
Patients without retinal eye exam in the last 12 months
Diabetes without Lab Test in Last 12 Months
© 2011 Lockton, Inc. All rights reserved.
Norm from Lockton InfoLock Book of Business.
42.3%
85.4%
0.3%
1.2%
22.6%
47.4%
90.0%
9.0%
Norm % Variance
41.8%
88.8%
0.8%
2.3%
27.5%
49.9%
72.8%
10.7%
0.5%
-3.4%
-0.5%
-1.2%
-4.9%
-2.4%
17.2%
-1.7%
46
Hyperlipidemia Summary & Observations
 Hyperlipidemia (High Cholesterol)
 Lower prevalence to the norm with higher UA costs of $7,493 pmpy compared to
the adjusted norm of $6,792
 66% of the population are employees
 45% of the population is high risk but has significant compliance of 88%
 Hyperlipidemics are the number one therapeutic drug class by paid amount and
number two by script count
© 2011 Lockton, Inc. All rights reserved.
47
Hyperlipidemia
Members with Hyperlipidemia
Members by Relationship
Member by Risk Category
66%
9%
34%
40%
45%
Members by Compliance
88%
Number of Comorbidities
27%
9.6%
10.0%
8.0%
7.0%
6.0%
4.0%
2.0%
673
0.0%
Prevalence
21%
800
Back Pain
700
600
500 Hypertension
400
Neck Pain
300
200
Diabetes
100
0 Osteoarthritis
12%
Compliant
Spouses
269
182
Non-Compliant
1 comorbidity
3+ comorbidities
Hyperlipidemia Members - Annual
Cost
$8,000
$6,799
$7,493
$4,940
$2,000
$0
74
2009 PMPY
100
HCC
$4,000
82
50
High Risk
$6,000
157
0
Dependents
Moderate Risk
Hyperlipidemia Only
2 comorbidities
25%
Norm
© 2011 Lockton, Inc. All rights reserved.
Employees
Low Risk
7%
Top 5 Comorbidities by Number of Members
Hyperlipidemia Prevalence
12.0%
27%
0%
150
200
250
Norm from Lockton InfoLock Book of Business.
300
2010 PMPY
Norm
Excludes High Cost Claimants
48
Hypertension Summary & Observations
 Hypertension
 Prevalence is significantly lower the norm and UA costs of $7,335 pmpy are higher
than the adjusted norm of $7,034 pmpy
 46% of the population is high risk but with a high compliance rate of 84%
© 2011 Lockton, Inc. All rights reserved.
49
Hypertension
Members with Hypertension
Members by Relationship
Member by Risk Category
61%
8%
38%
39%
46%
Members by Compliance
84%
Number of Comorbidities
32%
11.0%
10.0%
8.0%
7.5%
6.0%
2.0%
721
0.0%
Prevalence
800
Back Pain
700
600
500Hyperlipidemia
182
Non-Compliant
1 comorbidity
3+ comorbidities
Hypertension Members - Annual
Cost
$8,000
$6,541
$7,335
$5,116
$2,000
$0
91
2009 PMPY
100
HCC
$4,000
96
50
High Risk
$6,000
140
0
Dependents
Moderate Risk
Hypertension Only
2 comorbidities
23%
Norm
© 2011 Lockton, Inc. All rights reserved.
Spouses
Compliant
256
400
Neck Pain
300
200
Diabetes
100
0
Osteoarthritis
4.0%
16%
17%
Employees
Low Risk
7%
Top 5 Comorbidities by Number of Members
Hypertension Prevalence
12.0%
28%
1%
150
200
250
Norm from Lockton InfoLock Book of Business.
300
2010 PMPY
Norm
Excludes High Cost Claimants
50
Hypertension Quality and Risk Measures
Risk Measures
Criteria
Hypertension
Hypertension
Hypertension
#
721
721
721
Description
Hypertension Related ER Visit in Analysis Period
Hypertension Related Hospitalization
Patients with more than one hospitalization in the analysis period
Actual %
35.8%
0.1%
3.9%
Norm % Variance
37.5%
-1.8%
0.7%
-0.5%
7.0%
-3.1%
Description
Actual %
Norm % Variance
Quality Care Measures
Criteria
Hypertension-related ER
visit
Hypertension-related
admission
Hypertension
Hypertension
#
14
Patients without office visit in the analysis period
0.0%
1.8%
-1.8%
1
721
721
Patients without office visit in the analysis period
Patients without office visit in the last 12 months
Patients without office visit in the analysis period
0.0%
3.7%
0.0%
0.9%
4.9%
0.6%
-0.9%
-1.1%
-0.6%
© 2011 Lockton, Inc. All rights reserved.
Norm from Lockton InfoLock Book of Business.
51
Cancer & Screenings Summary & Observations
 Malignant Neoplasms & Cancer Screenings
 Cancer screenings (e.g. mammogram) are better than the norm
 45% of the cancers are early-identifiable cancers such as breast and colon
 Recommendation:
 Communication to all members that there is no cost for preventive care and
screenings
© 2011 Lockton, Inc. All rights reserved.
52
Malignant Neoplasms/ Cancer Screenings
Top 5 Malignant Neoplasms Diagnoses by Paid Amount
Jan 10 - Dec 10
Cancer Screenings
60%
55% 53%
50%
50%
38%
40%
29%
25%
Breast Cancer
20%
Colorectal Cancer
10%
Upper GI Cancer
24%
7%
35%
30%
Leukemia
6%
44%
Lymphoma and Lymphosarcoma
All Others
9%
0%
Women >49 y/o with
mammogram in last 12
months
Women>20 y/o with
Patients >49 y/o with
pap smear in the last
any colorectal cancer
two years
screening in the analysis
period
Actual
Norm
Early-Identifiable Cancers as a % of Total
Paid
9%
55%
45%
5%
24%
5%
2%
Non-Early Identifiable
Colorectal Cancer
Prostate Cancer
© 2011 Lockton, Inc. All rights reserved.
Breast Cancer
Female Genital Organ Cancer
Skin Cancer
Norm from Lockton InfoLock Book of Business.
53
Back & Neck Pain Summary & Observations
 Back & Neck Pain
 Significantly higher prevalence to the norm with UA costs of $7,092 pmpy
comparable to the adjusted norm cost of $7,156 pmpy
 58% of the members with back pain were employees
 Approximately 50% of back pain members had associated neck pain
 Significantly higher utilization of chiropractic and physical therapy care compare to
the norm
 Chiropractic units/1,000 for UA at 1,261.5 compared to the norm of 439.4
 Physical Therapy units/1,000 for UA at 3,720.3 compared to the norm of 786.2
 MRI Scan is slightly above the norm for utilization and CT Scan is significantly below
the norm
© 2011 Lockton, Inc. All rights reserved.
54
Musculoskeletal
Back Pain
Members with Back Pain
Members by Relationship
Member by Risk Category
58%
21%
32%
42%
32%
Members by Compliance
92%
Number of Comorbidities
24%
21%
Low Risk
5%
8%
20.0%
2000
12.0%
10.0%
5.0%
1108
Depression
270
1000Hyperlipidemia
269
500
Hypertension
256
0
Osteoarthritis
1500
2090
0.0%
Prevalence
208
Norm
© 2011 Lockton, Inc. All rights reserved.
200
400
600
800
1000
1200
Norm from the Lockton InfoLock Book of Business.
High Risk
HCC
Non-Compliant
1 comorbidity
3+ comorbidities
Back Pain Members - Annual Cost
$8,000
$7,000
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
$0
$7,092
$6,140
$5,205
2009 PMPY
0
Dependents
Moderate Risk
Back Pain Only
2 comorbidities
16%
Neck Pain
Spouses
Compliant
2500
21.7%
15.0%
39%
Employees
Top 5 Comorbidities by Number of Members
Back Pain Prevalence
25.0%
9%
2010 PMPY
Norm
Excludes High Cost Claimants
55
Musculoskeletal
Back Pain Quality and Risk Measures
Risk Measures
Criteria
Back Pain
Back Pain
Back Pain
#
2,090
2,090
2,090
Description
Back Pain Related Hospitalization in Analysis Period
Back Pain Related ER Visit in Analysis Period
Back Pain with >1 Hospitalizations in Analysis Period
Actual %
0.8%
32.2%
2.3%
Norm % Variance
1.3%
-0.5%
39.3%
-7.1%
5.2%
-2.9%
Description
Patients without office visit in the analysis period
Actual %
1.1%
Norm % Variance
4.3%
-3.2%
Quality Care Measures
Criteria
Back Pain-related ER visit
#
93
© 2011 Lockton, Inc. All rights reserved.
Norm from the Lockton InfoLock Book of Business.
56
Musculoskeletal
Back Pain, Neck Pain, and Intervertebral Disc Disorders Utilization
Primary Procedure Group
Physical Therapy
Orthopedic Surgery, exclude endoscopic
Neurosurgery
Chiropractic
MRI Scan
Other Anesthesia
Rehab
Office Visit - Established Patient
Durable Medical Equipment
Neurology
X-ray
Musculoskeletal Procedures
All Others
Total
Category
Chiropractic
Physical Therapy
CT Scan
MRI Scan
© 2011 Lockton, Inc. All rights reserved.
Visits
7,797
13
22
5,050
172
82
928
1,007
70
48
288
30
731
16,238
Paid
$1,266,947
$579,723
$393,289
$337,860
$314,691
$197,861
$137,227
$130,556
$112,603
$99,218
$94,404
$40,010
$175,997
$3,880,385
Jan 10 - Dec 10
Units/1000
Paid/Unit
1,261.5
$43
3,720.3
$32
2.1
$1,071
20.8
$1,585
Avg Paid
Per Visit
$162
$44,594
$17,877
$67
$1,830
$2,413
$148
$130
$1,609
$2,067
$328
$1,334
$241
$239
Norm
Units/1000 Paid/Unit
439.4
$16
786.2
$14
6.7
$344
17.3
$502
Norm from Lockton InfoLock Book of Business.
57
Musculoskeletal
Neck Pain
Members with Neck Pain
Members by Relationship
Member by Risk Category
61%
19%
29%
42%
34%
Members by Compliance
92%
Number of Comorbidities 2%
46%
12.0%
1200
10.0%
1000
8.0%
600 Hyperlipidemia
157
200
1152
0.0%
0
Hypertension
120
Norm
200
400
600
800
1000
1200
Norm from the Lockton InfoLock Book of Business.
Dependents
High Risk
HCC
Non-Compliant
1 comorbidity
3+ comorbidities
Neck Pain Members - Annual Cost
$8,000
$7,000
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
$0
$7,493
$6,611
$5,423
2009 PMPY
0
© 2011 Lockton, Inc. All rights reserved.
Moderate Risk
Neck Pain Only
2 comorbidities
22%
140
Osteoarthritis
Spouses
Compliant
1108
163
400
Prevalence
8%
Back Pain
Depression
800
5.3%
4.0%
2.0%
Low Risk
5%
1400
12.0%
6.0%
30%
Employees
Top 5 Comorbidities by Number of Members
Neck Pain Prevalence
14.0%
9%
2010 PMPY
Norm
Excludes High Cost Claimants
58
Musculoskeletal
Osteoarthritis
Members with Osteoarthritis
Members by Relationship
62%
Member by Risk Category
6%
37%
28%
50%
Members by Compliance
84%
Number of Comorbidities
16%
27%
4.0%
3.8%
3.3%
3.0%
2.0%
1.0%
369
0.0%
Prevalence
400
Back Pain
350
300
Neck Pain
250
200
Hypertension
150
100
Hyperlipidemia
50
0
Depression
16%
Spouses
Moderate Risk
Compliant
208
91
74
51
High Risk
1 comorbidity
3+ comorbidities
$10,603
$11,513
$8,357
2009 PMPY 2010 PMPY
0
50
100
150
200
Norm from Lockton InfoLock Book of Business.
250
HCC
Osteoarthritis Members - Annual
Cost
$14,000
$12,000
$10,000
$8,000
$6,000
$4,000
$2,000
$0
120
Dependents
Non-Compliant
Osteoarthritis Only
2 comorbidities
32%
Norm
© 2011 Lockton, Inc. All rights reserved.
Employees
Low Risk
16%
Top 5 Comorbidities by Number of Members
Osteoarthritis Prevalence
5.0%
25%
0%
Norm
Excludes High Cost Claimants
59
Musculoskeletal
Osteoarthritis Quality and Risk Measures
Risk Measures
Criteria
Osteoarthritis
Osteoarthritis
Osteoarthritis
Osteoarthritis
#
369
369
369
369
Description
Patients with continuous use of opiates across the last 12 months
Osteoarthritis Related ER Visit in Analysis Period
Osteoarthritis with >1 Hospitalizations in Analysis Period
Osteoarthritis Related Hospitalization in Analysis Period
Actual %
9.2%
41.5%
6.8%
16.0%
Norm % Variance
11.4%
-2.2%
44.3%
-2.8%
12.1%
-5.3%
12.3%
3.7%
#
Description
Actual %
Norm % Variance
1
Patients without office visit in the analysis period
0.0%
2.3%
-2.3%
63
Patients without office visit in the analysis period
0.0%
0.1%
-0.1%
Quality Care Measures
Criteria
Osteoarthritis-related ER
visit
Osteoarthritis-related
admission
© 2011 Lockton, Inc. All rights reserved.
Norm from Lockton InfoLock Book of Business.
60
Pregnancy & Neonates Summary & Observations
 Pregnancy
 Pregnancy and neonatal cost as a % of total paid claims is lower than the norm
 Pregnant women delivering with fewer than 6 prenatal visits is significantly worse
than the norm
 90.5% of the pregnant women in the UA population had less than 6 prenatal visits
 16.8% of the women within the child-bearing age had babies
 Neonates
 Inpatient cost per neonate from 2009 to 2010 increased 95% from $2,590 to $5,053
© 2011 Lockton, Inc. All rights reserved.
61
Pregnancy
Pregnancy-Related Claimants of Total
Childbearing Aged Females
Pregnancy-Related Cost
$1,267,30 $1,222,68
2
2
$1,400,000
143
1686
120
20
Pregnancy-Related Claimants
$1,200,000
120
$1,000,000
100
$800,000
80
$600,000
60
$400,000
40
$200,000
$53,676
$82,610
Pregnancy Claimants - Employee
2009
2010
Pregnancy Claimants - Spouse
ER Cost
37
40
2009
2010
2009
2010
Inpatient Cost
ER Claimants
Risk Measures
# Actual %
263
90.5%
2009
2010
65.0%
Inpatient Claimants
Pregnancy as a % of Total Paid
Norm %Variance
25.5%
117
0
Pregnancy Claimants - Dependent
Description
Pregnant women delivered with fewer than six prenatal
visits
117
20
$-
Child Bearing Age - No Pregnancy Claims
140
Actual
3.7%
Norm
4.7%
Quality Care Measures
Description
Women with hospitalization for pregnancy-related
diagnosis other than delivery
Women with pregnancy-related ER visit in the analysis
period
© 2011 Lockton, Inc. All rights reserved.
# Actual %
Norm %Variance
263
4.9%
6.4%
-1.5%
263
16.0%
16.6%
-0.6%
Norm from Lockton InfoLock Book of Business.
0.0%
50.0%
All Others
100.0%
Pregnancy
62
Neonates
Neonates-Related Claimants
Neonates-Related Cost
140
$700,000
$601,323
119
100
$500,000
80
$400,000
$284,907
$300,000
60
$200,000
$100,000
110
120
$600,000
40
$2,983
$2,081
2009
2010
20
$-
ER Cost
2009
6
5
2009
2010
0
2010
Inpatient Cost
ER Claimants
2009
2010
Inpatient Claimants
Neonates as a % of Total Paid
Actual
1.8%
Norm
4.1%
0.0%
50.0%
All Others
© 2011 Lockton, Inc. All rights reserved.
Neonates
100.0%
63
Recommendations
 Medical
 ER - Specific communication on using alternative care setting for non-emergent care
 ER - Care manage those members thru Premera with three or greater ER visits to
determine cause and appropriate resources and tools for the employee
 Is primary care physician located close and are they seeing their primary care doctor
 Neonates – provide communication on importance of prenatal vitamins and visits
 Chiropractic – Reduce the number of visits from 26 a year to 12 visits a year
 Pharmacy
 Covering generic only PPIs – was not supported by JHCC for FY 2012
© 2011 Lockton, Inc. All rights reserved.
64
Recommendations
 Wellness
 Provide Alere with list of individuals in the compliant and non-compliant high and
moderate risk to see how many have been contacted by Alere and if any are actively
engaged in the Alere programs
 Gather metabolic syndrome cluster data through IHPs and Mass Screening events to
identify those that are progressing to moderate and high risk – Keep the health
employees healthy
 Establish incentives for employees to provide biometric information
 Communicate to employees no cost preventive care and screenings
 Continue to provide and promote nutrition management and improved physical
activity/ergonomics at work thru WIN and targeted communications
 Obesity is a significant risk at the University
 Continue programs that address obesity and nutrition
 Currently have WIN weight management and IHPs
© 2011 Lockton, Inc. All rights reserved.
65
Appendix
Chronic Condition Reference
Asthma
Asthma is quite common. It can be triggered by environmental triggers such as allergies to pets or pollens, infections, cold temperatures, stress, and
sometimes exercise. It is a common reason for emergency room visits and sometimes hospital admissions. It is best managed by avoidance of triggers when
possible and regular use of medication. The number one reason for poor asthma control is lack of adherence to a medication regimen that includes an
inhaled steroid in addition to a bronchodilator. Educating patients about the triggers and the importance of medication compliance are key to controlling this
condition.
Back Pain and Neck Pain
Back injury prevention programs and core strengthening programs are effective in preventing injury and getting individuals back to work. In the workplace,
attention to ergonomics of workstations is important in reducing back and neck pain. Monitoring the trend in high cost radiology for back pain, and surgery
for herniated discs is important to establish the need for low back pain condition management programs and pre-certification programs in high cost
radiology. Evaluation along with proper treatment of back pain and neck pain should limit the early use of high cost radiology including MRI and CT
scans and early back surgery for herniated discs and other back ailments. Preventive practices in postural alignment, availability of therapeutic alternative
treatments such as PT, acupuncture, pain treatment, and steroid injections help promote lower cost, higher efficacy solutions.
COPD
The most common cause of COPD is smoking. Unfortunately about 23% of American adults still smoke. COPD commonly includes chronic emphysema and
bronchitis. The condition is associated with significant lost work time and high health costs. It is progressive and remains the fourth leading cause of death
in the U.S. There is no cure. Treatment is aimed at managing exacerbations of the disease. The most important step in treatment is to encourage those who
are still smoking to stop. This can be aided by implementing a smoking cessation program that combines behavioral modification with medication.
CAD
This the most common type of chronic heart disease. It is caused by the build up of plaque in the arteries supplying oxygen and nutrients to the heart
muscle. Plaque consists of a number of substances, including cholesterol, other fats, and calcium. CAD can result in chest pain (angina), heart attacks,
abnormal heart rhythms, and congestive heart failure. It can be minimized or ameliorated by implementing healthy lifestyle habits that include regular
exercise, a healthy diet, and successful work-life balance. Medications also play a significant role, so compliance with a medication regimen is important.
Depression
Depression is common, whether it is mild, moderate, or severe. It is often associated with other chronic conditions such as heart disease, diabetes, and
chronic pain. It is most commonly managed with medication. These drugs are expensive so employees should be aware of several good generic
antidepressants that are now available. Several studies indicate that regular sleep and exercise, combined with a strong social network can reduce the
incidence and severity of depression and also reduce the need for medication.
© 2011 Lockton, Inc. All rights reserved.
67
Chronic Condition Reference (continued)
Diabetes
Type 2 diabetes continues to increase in the U.S. The prevalence is a direct result of poor lifestyle choices including inactivity and poor dietary choices that
result in obesity and diabetes. This a particularly serious chronic disease because it affects so many different body systems including the heart, the eyes, the
kidneys, and the blood vessels. Poorly controlled diabetes results in accelerated decline in these body systems, a decline in quality of life, and high health
costs. Like many of the other chronic conditions, it is best managed by implementing healthy lifestyle habits that include regular exercise, a healthy diet, and
successful work-life balance. For those with established type 2 diabetes, it is very important that regular monitoring of the condition is done in order to avoid
some of the serious complications.
Hyperlipidemia
An abnormally elevated lipid profile is a risk factor for heart disease. The lipid profile includes measurement of cholesterol, triglycerides, and LDL and HLD
cholesterol. There is a genetic component to lipid levels that can make it more challenging for some individuals to control their lipid levels. But for most
people lipid levels can be managed by implementing healthy lifestyle habits that include regular exercise, a healthy diet, and successful work-life balance.
But many people now are prescribed medication to help control lipids. These medications are called “statins” and a variety of medication options are now
available.
Hypertension
High blood pressure is very common. Sometimes there is an increased risk for an individual due to genetic makeup. For most people blood pressure
gradually rises with age. Hypertension is a significant risk factor for heart attack, stroke, impaired vision, kidney damage, and congestive heart failure.
Hypertension can be ameliorated by implementing healthy lifestyle habits that include regular exercise, a healthy diet, and successful work-life balance. Also
for many a diet low in sodium is helpful. There are many medications that can help control blood pressure. As with any treatment for chronic disease,
compliance is essential for effective management.
Osteoarthritis
About 21 million Americans have osteoarthritis. The incidence increases with age. It is associated with a breakdown of cartilage in joints and can occur in
almost any joint in the body. It most commonly occurs in the weight bearing joints of the hips, knees, and spine. Factors associated with its onset include
obesity, injury, joint overuse, and heredity. Osteoarthritis generates a lot of medical expense due to the cost of pain medications, diagnostic imaging, and
surgical procedures (especially of the hip and lower back). Exercise and physical therapy are important restorative and preventive measures. Weight
management and good nutrition are often helpful as well.
© 2011 Lockton, Inc. All rights reserved.
68
Glossary
Adjusted Risk Index (ARI)
Measurement of an individual's disease burden and compliance with D2Hawkeye's Quality and Risk Measures. The Quality and Risk Measures are designed to
identify potential gaps in care and care management opportunities.
Allowed Amount
Total paid amount, this includes both the employee and employer paid amount.
Co-morbidities
A medical condition that exists simultaneously with and usually independently of another medical condition.
Compliant Members
Members with a Care Gap Index of 5 or less.
Current Members
Individuals who are eligible with the plan as of the end of the reporting period.
Employee Paid
Employee paid consists of co-pays, coinsurances, and deductibles paid by an enrollee, the spouses, and their dependents.
Employer Paid
Employer paid includes total paid by the plan for enrollee, the spouses, and their dependents.
Emergency Room Visit
Distinct service dates for members with claims that have HCFA (Health Care Financing Administration) Place of Service code of 23.
Emergency Room Visits, Potential Non Emergent – Potential non emergent ER visits are visits which based on the diagnoses potentially should have
been treated in a physician’s office. These include visits for general symptoms, sinusitis, influenza, general medical examinations, etc.
Full Cycle
Time period that corresponds to date range of data included in the data warehouse (typically 36 months).
High Cost Claimants (HCC)
Claimants with plan payment of $50,000 or more during either the current or previous 12 months.
© 2011 Lockton, Inc. All rights reserved.
69
Glossary (continued)
High Risk Claimants
Claimants with plan payment of less than $50,000 during the most recent 12 months and a Risk Index greater than or equal to 15.
High Cost Script
Script with a plan paid amount of $1,000 or more.
Homegrown Codes
Non-standard codes found in the dataset being reported.
Incurred Basis
Claim expenses reported based on the service date.
Inpatient
All claims paid for hospital inpatient services base on HCFA Place of Service code 21, 51, and 61.
Low Risk Claimants
Claimants with plan payment of less than $50,000 during the most recent 12 months and a Risk Index of 4 or less.
MDC
Major Diagnostic Category
Member Months
Total number of members eligible for the time period.
Moderate Risk Claimants
Claimants with plan payment of less than $50,000 during the most recent 12 months and a Risk Index between 5-14.
Non-Compliant Members
Members with a Care Gap Index of 6 or more.
Norm
Norms from the Lockton InfoLock Book of Business are derived from claims paid for the 12 months ending 12/31/2010 from Lockton’s Normative Database
comprised of 2 million member lives from self-insured, commercial plans.
© 2011 Lockton, Inc. All rights reserved.
70
Glossary (continued)
Office Visit
Distinct service dates for members with claims that have HCFA Place of Service code of 11.
Outpatient
Services which take place outside of an inpatient place of service are defined as outpatient.
Paid Basis
Claim expenses reported based on the date the claim was paid.
PEPM
Per Employee per Month.
PMPM
Per Member per Month.
Plan Payment
Plan payment includes total paid by the plan for enrollee, the spouses, and their dependents. Also referred to as Employer Paid.
Quality and Risk Measures
The Quality and Risk measures are designed to identify potential gaps in care and care management opportunities.
Risk Index (RI)
Measurement of an individual's disease burden. The higher the RI the more likely that member is to experience a negative health event in the next 24 months.
Therapeutic Class
Grouping of drugs into categories defined by First Data Banks.
Total Members
Number of unique members in the time period.
Units per 1,000
The average number of units (days, members, emergency room visits, etc.) per 1,000 members per year.
© 2011 Lockton, Inc. All rights reserved.
71
Our Mission
To be the worldwide value and service leader in insurance brokerage, employee benefits, and risk management
Our Goal
To be the best place to do business and to work
This document contains the proprietary work product of Lockton Companies, LLC, and is provided on a
confidential basis. Any reproduction, disclosure or distribution to any third party without first securing written
permission from Lockton Companies, LLC is expressly prohibited.
www.lockton.com
© 2010 Lockton, Inc. All rights reserved.
Images © 2010 Thinkstock. All rights reserved.
© 2011 Lockton, Inc. All rights reserved.