University of Alaska
description
Transcript of University of Alaska
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.
© 2011 Lockton, Inc. All rights reserved.
Agenda
2
Demographics Health Cost Analysis
− Financial Analysis Clinical Risk and Conditions
– Population Stratification– Disease States
Appendix
Demographics
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Demographics - Overview
4
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
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,358
$7,9
77
$3,8
93
$5,2
81
$6,2
51
$5,2
50
$2,5
50
$2,8
75
$1,8
60
$-
$2,000
$4,000
$6,000
$8,000
$10,000
2009 2010 Norm
PMPY Costs by Relationship
Employee Spouse Dependent
43% 44% 45%
27% 26% 21%
30% 30% 34%
0%
25%
50%
75%
100%
2009 2010 Norm
Members by Relationship
Employee Spouse Dependent
Demographics – Total Members
5Norm from Lockton InfoLock Book of Business.
Employees Spouses DependentsAverage Age 46 48 12 % Female 57% 48% 50%Average RI 9.60 8.06 3.76Average CGI 1.98 2.17 0.79
Age Category Gender # of
Members# of
Employees# of
Spouses # of Deps % of Members
% of Members
Norm0-1 Female 118 - - 118 1% 0%0-1 Male 123 - - 123 1% 0%2-19 Female 1,249 1 - 1,248 11% 14%
Male 1,275 1 - 1,274 12% 15%20-29 Female 695 325 120 250 6% 6%2-29 Male 535 210 93 232 5% 6%
30-39 Female 930 602 327 1 8% 8%30-39 Male 739 457 282 - 7% 8%40-49 Female 1,011 651 360 - 9% 9%40-49 Male 882 522 358 2 8% 9%50-59 Female 1,234 828 406 - 11% 8%50-59 Male 1,028 564 464 - 9% 8%60-64 Female 356 233 123 - 3% 2%60-64 Male 409 212 197 - 4% 3%65+ Female 149 100 49 - 1% 2%65+ Male 231 110 121 - 2% 2%Total 10,964 4,816 2,900 3,248 100% 100%
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729853
869
7,164
Length of Enrollment (For Current Members)
Less than 12 months
12-23 months
24 -35 months
36 months
47.7% 47.5% 50.7%
52.3% 52.5% 49.3%
0%
25%
50%
75%
100%
2009 2010 Norm
Members by Gender
Male Female
Demographics - Total Members
6Norm from Lockton InfoLock Book of Business.
Jan 09 - Dec 09
Jan 10 - Dec 10 Norm
10,186 9,890 11,328 10,964 122,237 118,676 52,772 52,334
1.12 1.13 1.001.34 1.31 1.171.37 1.35 1.360.56 0.62 0.54
2.32 2.28 2.1736.1 36.7 32.72
52.3% 52.5% 49.3%39.2% 39.0% 41.2%
Employee Age Gender FactorAge Gender Factor
Member to Employee RatioAverage Age% Female% Female in child bearing years
Average Number of Members
Spouse Age Gender FactorDependent Age Gender Factor
Total Number of MembersMember MonthsEmployee Months
Health Cost Analysis
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Medical Financial Analysis Overview
8
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
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Medical Financial Analysis Overview
9
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
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19.0%
9.7%
10.1%
0.0% 10.0% 20.0%
Norm
2010
2009
% Employee Paid
18.1%
12.7%
12.9%
0.0% 10.0% 20.0%
Norm
2010
2009
% Pharmacy of Total Paid
Financial Summary
10Norm from Lockton InfoLock Book of Business.
J an 09 - Dec 09 Jan 10 - Dec 10 % Change Norm
Allowed Amount $52,424,298 $56,015,344 6.8%Plan Paid $47,421,509 $50,827,875 7.2%Plan Paid PMPM $387.95 $428.29 10.4% $246.59Plan Paid PEPM $898.61 $971.22 8.1% $534.70
Allowed Amount $8,138,416 $8,460,767 4.0%Plan Paid $7,011,056 $7,380,833 5.3%Plan Paid PMPM $57.36 $62.19 8.4% $53.80Plan Paid PEPM $132.86 $141.03 6.2% $116.65
Allowed Amount $60,562,715 $64,476,111 6.5%Employee Paid $6,118,046 $6,235,830 1.9%Plan Paid $54,432,566 $58,208,708 6.9%Plan Paid PMPM $445.30 $490.48 10.1% $300.38Plan Paid PEPM $1,031.47 $1,112.25 7.8% $651.35
Medical PMPM $137.58 $157.15 14.2% $83.01Rx PMPM $8.29 $8.27 -0.3% $5.05
Medical Costs
Total Costs
Rx Costs
High Cost Claimants (>50,000 in claims)
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Utilization Summary
11Norm from Lockton InfoLock Book of Business.
Utilization is provided on an incurred basis and lagged three months.
Oct 08 -Sep 09
Oct 09 -Sep 10 % Change Norm
Place of Service Allowed PMPMInpatient Hospital $93.27 $101.40 8.7% $93.92Outpatient Hospital $120.90 $126.48 4.6% $87.02Office $155.38 $153.66 -1.1% $74.02Emergency Room $30.30 $32.30 6.6% $25.65Other $20.21 $18.48 -8.6% $12.14InpatientIP Days/1000 287 237 -17.4% 361Admissions/1000 51 50 -1.5% 74Average Allowed per Admission $21,904 $24,411 11.4% $15,354Average Length of Stay 5.6 4.7 -16.1% 4.9Average Allowed per Day $3,910 $5,194 32.8% $3,134
ER Visits/1000 178 169 -5.0% 218Average Allowed per ER Visit $2,047 $2,297 12.2% $1,416All Office Visits/1000 4,108 4,225 2.8% 4,096
Mental Health Visits/1000 604 639 5.7% 348Preventive Visits/1000 415 427 2.8% 448
Average Allowed per Office Visit (includes ancillary) $475 $452 -4.7% $218
Prescriptions/1000 8,566 9,036 5.5% 9,616Average Allowed per Brand Script $162 $177 9.1% $183Average Allowed per Generic Script $32 $32 1.6% $29% Generic Scripts 53.6% 57.9% 4.3% 64.0%
Outpatient
Prescription Drugs
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Claim Expense Distribution
12Norm from Lockton InfoLock Book of Business.
Members Plan Payment
Count % Amount % Count % Amount % % %$0 or less 2,427 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%Members > $50,000 160 1.4% $17,831,049 32.8% 155 1.4% $19,630,637 33.7% 0.8% 29.4%All Members 11,524 100.0% $54,432,566 100.0% 11,131 100.0% $58,208,708 100.0% 100.0% 100.0%
Norm
Plan PaymentPaid Amount Range
Jan 09 - Dec 09 Jan 10 - Dec 10
Members Plan Payment Members
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4%
21% 23%
52%
0%
10%
20%
30%
40%
50%
60%
Members with 0 conditions
Members with 1 condition
Members with 2 conditions
Members with 3 or more conditions
Number of Chronic Conditions per HCC
High Cost Claimants
13
High Cost Claimants Jan 09 - Dec 09 Jan 10 - Dec 10 % Change NormNumber of Members 160 155 -3%% HCC Medical Paid 35.5% 36.7% 1.2% 33.7%% HCC Rx Paid 14.5% 13.3% -1.2% 9.4%Medical Paid for HCCs $16,817,181 $18,649,536 10.9%Rx Paid for HCCs $1,013,867 $981,101 -3.2%Total Paid for HCCs $17,831,049 $19,630,637 10.1%Average Medical Paid per HCC $105,107 $120,320 14.5% $109,930Average Rx Paid per HCC $6,337 $6,330 -0.1% $6,687Average Total Paid per HCC $111,444 $126,649 13.6% $116,617
Norm from Lockton InfoLock Book of Business.
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58% 57%
34% 32%
8% 11%
0%
25%
50%
75%
100%
Members Paid Amount
2010 HCC by Relationship
Dependent
Spouse
Employee
61% 59%
31% 31%
8% 11%
0%
25%
50%
75%
100%
Members Paid Amount
2009 HCC by Relationship
Dependent
Spouse
Employee
High Cost Claimants
14
Diagnosis Group Members Total PaidCancer Therapies 16 1,231,902 Pharmacy 148 981,101 Osteoarthritis 42 950,442 Leukemia 2 880,595 CAD 21 806,240 Renal Failure 7 723,532 Breast Cancer 13 722,328 Intracranial Hemorrhage 5 696,999 Intervertebral Disc Disorders 33 658,769 Cerebrovascular Diseases 10 543,999 Myocardial Infarction 8 468,422 Septicemia 9 428,144 Diabetes Mellitus 33 411,303 Procedure Complications 26 402,821 Atrial Fibrillation 12 336,663 All Others 9,387,378 Total 155 19,630,637
High Cost Claimants by Top 20 Diagnosis GroupsJan 10 - Dec 10
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Emergency Room Utilization
15
# of Members
% on Weekends
% Dependents
# of Members
% on Weekends
% Dependents
1 1,104 34% 33% 1,037 30% 30%2 263 30% 30% 228 33% 31%3 88 32% 34% 65 34% 17%4 21 36% 29% 20 45% 25%5+ 18 29% 0% 24 34% 25%
Visits per Member
Jan 09 - Dec 09 Jan 10 - Dec 10ER Visits by Number of Visits
43% 42%
26% 29%
31% 29%
0%
25%
50%
75%
100%
2009 2010
ER Visits by Relationship
Employees Spouses Dependents
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Emergency Room Utilization
16
Primary Diagnosis Group Visits Paid AmountIntracranial Hemorrhage 4 330,211 Chest Pain 94 227,105 Misc Wounds and Injuries 202 184,498 Pain, not elsewhere classified 83 184,120 Abdominal Pain 80 143,117 ENT and Upper Resp Disorders 130 114,568 Appendicitis 15 113,058 Urinary Stones 26 96,088 Limb Fractures 61 92,735 Headache 55 85,448 Misc Skin Diseases 82 81,729 Musculoskeletal Disorders 95 80,728 Misc Symptoms 24 71,811 Nausea and Vomiting 40 67,477 Gall Bladder Diseases 14 66,800 Pregnancy Complications 40 63,070 Dysrhythmias 31 61,414 Dizziness 26 45,515 Misc Urinary Diseases 53 45,009 Syncope 26 44,153 All Others 741 1,085,566 Total 1922 3,284,221
Emergency Room Visit by Top 20 Diagnosis GroupsJan 10 - Dec 10
151
1771
2010 Potential Non Emergent ER Visits
Potential Non Emergent VisitsOther ER Visits
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Pharmacy Financial Analysis Overview
17
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 Anti-
Inflammatory 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
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Prescription Drugs - Top 20 Therapeutic Classes
18
Paid Paid PMPM Scripts
Cost per
ScriptPaid Paid
PMPM ScriptsCost per
ScriptAntihyperlipidemics $560,152 $4.58 5,639 $99 $644,562 $5.43 5,948 $108 18.5%Antidepressants $550,720 $4.51 7,062 $78 $552,265 $4.65 7,247 $76 3.3%Peptic Ulcer - Antisecretory Agents $527,049 $4.31 3,456 $153 $453,332 $3.82 3,628 $125 -11.4%Multiple Sclerosis Agents $284,500 $2.33 122 $2,332 $368,625 $3.11 137 $2,691 33.5%DMARD - Anti-inflammatory Tumor Necrosis Factor Inhibiting Agents $164,166 $1.34 95 $1,728 $264,635 $2.23 146 $1,813 66.0%Asthma Therapy Combinations $187,127 $1.53 926 $202 $200,969 $1.69 942 $213 10.6%Anticonvulsant $166,430 $1.36 1,863 $89 $150,908 $1.27 2,197 $69 -6.6%Asthma Therapy - Leukotriene Modulators $147,268 $1.20 1,209 $122 $150,800 $1.27 1,064 $142 5.5%Analgesic Narcotic Agonists and Combinations $146,910 $1.20 1,172 $125 $144,058 $1.21 1,280 $113 1.0%Sedative-Hypnotic - Non-Barbiturates $129,479 $1.06 1,713 $76 $132,179 $1.11 1,920 $69 5.1%Contraceptive Oral Combinations $119,327 $0.98 3,719 $32 $114,862 $0.97 3,657 $31 -0.9%Attention Deficit-Hyperact Disorder (ADHD) Therapy $122,247 $1.00 897 $136 $114,845 $0.97 889 $129 -3.2%Inflammatory Bowel Agents $66,883 $0.55 146 $458 $114,694 $0.97 181 $634 76.6%Insulin - Human & Analogs, Short or Rapid Acting $95,183 $0.78 361 $264 $112,568 $0.95 381 $295 21.8%Insulin Response Enhancers $102,913 $0.84 1,799 $57 $111,096 $0.94 1,783 $62 11.2%Migraine Therapy - Serotonin Agonists $124,037 $1.01 666 $186 $110,903 $0.93 719 $154 -7.9%Herpes Agents $146,380 $1.20 805 $182 $108,252 $0.91 888 $122 -23.8%Antipsychotic - Atypical Agents, General $92,954 $0.76 208 $447 $103,668 $0.87 201 $516 14.9%Antipsychotic - Atypical Dopamine-Serotonin Antagonists $85,733 $0.70 365 $235 $102,084 $0.86 437 $234 22.6%Diagnostic - Blood Tests $102,122 $0.84 698 $146 $100,192 $0.84 672 $149 1.1%All Others $3,089,477 $25.27 55,345 $42 $3,225,335 $27.18 56,576 $57 7.5%Total $7,011,056 $57.36 88,266 $79 $7,380,833 $62.19 90,893 $81 8.4%
Therapeutic ClassJan 09 - Dec 09 Jan 10 - Dec 10 % Change
in Paid PMPM
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Prescription Drugs - Top 20 Drugs by Paid Amount
19
Paid Paid PMPM Scripts
Cost per
ScriptPaid Paid
PMPM ScriptsCost per
ScriptLIPITOR Brand Antihyperlipidemics $296,311 $2.42 2,370 $125 $336,646 $2.84 2,389 $141NEXIUM Brand Peptic Ulcer - Antisecretory Agents $275,497 $2.25 1,318 $209 $264,257 $2.23 1,197 $221HUMIRA Brand DMARD - Anti-inflammatory Tumor Necrosis Factor $84,341 $0.69 43 $1,961 $163,463 $1.38 85 $1,923SINGULAIR Brand Asthma Therapy - Leukotriene Modulators $147,268 $1.20 1,209 $122 $150,800 $1.27 1,064 $142ADVAIR DISKUS Brand Asthma Therapy Combinations $146,138 $1.20 679 $215 $142,254 $1.20 641 $222
LEXAPRO Brand Antidepressants $110,837 $0.91 1,147 $97 $126,219 $1.06 1,153 $109
REBIF Brand Multiple Sclerosis Agents $98,636 $0.81 42 $2,348 $121,847 $1.03 47 $2,592COPAXONE Brand Multiple Sclerosis Agents $68,847 $0.56 28 $2,459 $114,006 $0.96 38 $3,000CYMBALTA Brand Antidepressants $92,584 $0.76 542 $171 $113,667 $0.96 639 $178CRESTOR Brand Antihyperlipidemics $83,844 $0.69 712 $118 $109,656 $0.92 812 $135ABILIFY Brand Antipsychotic - Atypical Agents, General $92,954 $0.76 208 $447 $103,668 $0.87 201 $516ENBREL Brand DMARD - Anti-inflammatory Tumor Necrosis Factor $79,825 $0.65 52 $1,535 $101,173 $0.85 61 $1,659EFFEXOR XR Brand Antidepressants $133,364 $1.09 780 $171 $93,564 $0.79 503 $186ONE TOUCH ULTRA TEST Brand Diagnostic - Blood Tests $80,146 $0.66 456 $176 $83,965 $0.71 502 $167ACTOS Brand Insulin Response Enhancers $70,027 $0.57 305 $230 $82,255 $0.69 322 $255HUMALOG Brand Insulin - Human & Analogs, Short or Rapid Acting $58,315 $0.48 231 $252 $76,931 $0.65 272 $283OXYCONTIN Brand Analgesic Narcotic Agonists and Combinations $54,479 $0.45 127 $429 $68,793 $0.58 163 $422BUPROPION XL Generic Antidepressants $59,176 $0.48 632 $94 $68,256 $0.58 907 $75AMBIEN CR Brand Sedative-Hypnotic - Non-Barbiturates $55,422 $0.45 378 $147 $67,842 $0.57 412 $165CELEBREX Brand NSAIDs, Cyclooxygenase-2 (COX-2) Selective
Inhibitors and Combinations$65,924 $0.54 414 $159 $67,481 $0.57 413 $163
All Others $4,857,124 $39.74 76,593 $63 $4,924,093 $41.49 79,072 $62Total $7,011,056 $57.36 88,266 $79 $7,380,833 $62.19 90,893 $81
Drug Name Brand/ Generic Therapeutic Class
Jan 09 - Dec 09 Jan 10 - Dec 10
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Prescription Drugs - Top 20 Drugs by Script Count
20
Paid Paid PMPM Scripts
Cost per
ScriptPaid Paid
PMPM ScriptsCost per
ScriptLIPITOR Brand Antihyperlipidemics $296,311 $2.42 2,370 $125 $336,646 $2.84 2,389 $141HYDROCODONE-ACETAMINOPHEN
Generic Analgesic Narcotic Agonist Combinations $7,663 $0.06 2,139 $4 $8,956 $0.08 2,196 $4
LISINOPRIL Generic ACE Inhibitors and ACE Inhibitor Combinations $16,065 $0.13 1,788 $9 $13,759 $0.12 1,970 $7SYNTHROID Brand Thyroid Hormones and Combinations $3,470 $0.03 1,322 $3 $4,099 $0.03 1,361 $3
LEVOTHYROXINE SODIUM Generic Thyroid Hormones and Combinations $2,156 $0.02 1,201 $2 $1,835 $0.02 1,266 $1
SIMVASTATIN Generic Antihyperlipidemics $45,294 $0.37 1,137 $40 $44,907 $0.38 1,258 $36HYDROCHLOROTHIAZIDE Generic Diuretic - Thiazides and Related, and Combinations $720 $0.01 1,130 $1 $891 $0.01 1,230 $1NEXIUM Brand Peptic Ulcer - Antisecretory Agents $275,497 $2.25 1,318 $209 $264,257 $2.23 1,197 $221LEXAPRO Brand Antidepressants $110,837 $0.91 1,147 $97 $126,219 $1.06 1,153 $109AZITHROMYCIN Generic Macrolides and Combinations $31,574 $0.26 1,144 $28 $24,872 $0.21 1,129 $22ZOLPIDEM TARTRATE Generic Sedative-Hypnotic - Non-Barbiturates $36,209 $0.30 893 $41 $32,899 $0.28 1,105 $30SINGULAIR Brand Asthma Therapy - Leukotriene Modulators $147,268 $1.20 1,209 $122 $150,800 $1.27 1,064 $142METFORMIN HCL Generic Insulin Response Enhancers $15,109 $0.12 1,059 $14 $13,321 $0.11 1,019 $13OMEPRAZOLE Generic Peptic Ulcer - Antisecretory Agents $43,186 $0.35 675 $64 $45,464 $0.38 923 $49BUPROPION XL Generic Antidepressants $59,176 $0.48 632 $94 $68,256 $0.58 907 $75AMOXICILLIN Generic Penicillins $1,511 $0.01 708 $2 $1,944 $0.02 888 $2CRESTOR Brand Antihyperlipidemics $83,844 $0.69 712 $118 $109,656 $0.92 812 $135AMLODIPINE BESYLATE Generic Calcium Channel Blockers $16,710 $0.14 735 $23 $15,107 $0.13 787 $19METOPROLOL SUCCINATE Generic Beta Blockers Cardiac Selective, All $18,263 $0.15 638 $29 $22,736 $0.19 750 $30ALPRAZOLAM Generic Antianxiety Agents $880 $0.01 665 $1 $1,064 $0.01 737 $1All Others $5,799,313 $47.44 65,644 $88 $6,093,146 $51.34 66,752 $91Total $7,011,056 $57.36 88,266 $79 $7,380,833 $62.19 90,893 $81
Drug Name Brand/ Generic Therapeutic Class
Jan 09 - Dec 09 Jan 10 - Dec 10
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$166,351
Anti-Hyperlipidemics Generic Analysis
21
Potential SavingsIf 50% of scripts
for:Lipitor,
Crestor, and Lescol XL
moved to
Simvastatin last year
costs would have been reduced by approximately:
Anti-hyperlipidemics % ChangePlan Paid PMPM $4.58 $5.43 18.5%
Statins Script Count
RxPMPM
Script Count
Rx PMPM
% Change
Lipitor 2,370 $2.42 2389 $2.84 17.0%Crestor 712 $0.69 812 $0.92 34.7%Lescol XL 7 $0.01 4 $0.01 -42.0%Simvastatin 1,137 $0.37 1258 $0.38 2.1%Lovastatin 77 $0.01 76 $0.01 21.2%Pravastatin Sodium 341 $0.09 421 $0.10 10.5%
Jan 09 - Dec 09 Jan 10 - Dec 10
Jan 09 - Dec 09 Jan 10 - Dec 10
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Peptic Ulcer Generic Analysis
22
Potential SavingsIf 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:
Peptic Ulcer % ChangePlan Paid PMPM $4.31 $3.82 -11.4%
Proton-Pump Inhibitor Script Count
Rx PMPM
Script Count
Rx PMPM
% Change
Prevacid 510 $0.96 62 $0.13 -86.8%Nexium 1318 $2.25 1197 $2.23 -1.2%Aciphex 122 $0.22 76 $0.14 -35.1%Protonix 7 $0.01 2 $0.00 -100.0%Kapidex 17 $0.02 25 $0.03 71.8%Prilosec 0 $0.00 1 $0.00 0.0%Axid 0 $0.00 0 $0.00 0.0%Zantac 0 $0.00 0 $0.00 0.0%Pantoprazole Sodium 458 $0.41 518 $0.44 9.0%Lansoprazole 43 $0.04 421 $0.34 740.2%Omeprazole 675 $0.35 923 $0.38 8.4%Ranitidine HCL 244 $0.03 264 $0.03 -24.6%Cimetidine 8 $0.00 30 $0.00 9.6%Famotidine 39 $0.01 33 $0.01 4.7%
Jan 09 - Dec 09 Jan 10 - Dec 10
Jan 09 - Dec 09 Jan 10 - Dec 10
$129,587
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$9.28
$52.91
2010 Rx PMPM Paid
High Cost Scripts PMPM All Other PMPM
$7.70
$49.66
2009 Rx PMPM Paid
High Cost Scripts PMPM All Other PMPM
$7.70$9.28
$0
$2
$4
$6
$8
$10
2009 2010
PMPM Paid for High Cost Scripts
420498
0
100
200
300
400
500
600
2009 2010
Number of High Cost Scripts
Prescription Drugs - High Cost Scripts (>$1,000)
23
© 2011 Lockton, Inc. All rights reserved.
$162$177 $183
$32 $32 $29
$0
$50
$100
$150
$200
Jan 09 - Dec 09 Jan 10 - Dec 10 Norm
Cost per Script
Average Allowed per Brand Script Average Allowed per Generic Script
Brand versus Generic Analysis
24Norm from Lockton InfoLock Book of Business.
46.4%
81.9%
42.1%
80.3%
36.0%
80.4%
53.6%
18.1%
57.9%
19.7%
64.0%
19.6%
0%
20%
40%
60%
80%
100%
Scripts Plan Paid Scripts Plan Paid Scripts Plan Paid
Jan 09 - Dec 09 Jan 10 - Dec 10 Norm
Percentage of Scripts and Plan Paid
Brand Generic
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.
© 2011 Lockton, Inc. All rights reserved.
Employee Population
Low Risk
High Risk
Moderate Risk
High Risk
Non-Compliant
26
Compliant
Moderate Risk
High Cost
PRIO
RITY
Goal InterventionManage high
costsHelp members
navigate systemCase Management
Close gaps in careSteerage
Disease Management and Health Promotion
Manage risk factors
Reinforce and monitor
compliance rates
Health Promotion
Manage risk factors Health Promotion
9615 members$5,695 PMPY
141 members$130,794 PMPY
5,031 members$1,164 PMPY
413 members$9,527 PMPY
4,030 members$6,581 PMPY
167 members$4,283 PMPY
246 members$13,088 PMPY
2,779 members$4,226 PMPY
1,251 members$11,813 PMPY
Population Stratification
© 2011 Lockton, Inc. All rights reserved.
Low Risk, 52.3%
Low Risk, 9.6%
Moderate Risk, 30.6%
Moderate Risk, 23.2%
High Risk, 15.6%
High Risk, 33.6%
High Cost, 1.5%
High Cost, 33.6%
0.0%
25.0%
50.0%
75.0%
100.0%
Membership Cost
Percent of Members compared to Percent of Cost
Population Risk
27Norm from Lockton InfoLock Book of Business.
Risk Category Number of Members 2009 PMPY 2010 PMPY Paid PMPY
NormAverage
RIAverage
CGIMember
DistributionMember
Distribution Norm
Low Risk, Compliant 5,000 $796 $1,162 $676 1.52 0.93 52% 48%Low Risk, Non-Compliant 31 $966 $1,561 $1,171 2.74 7.26 0% 0%Moderate Risk, Compliant 2,779 $3,832 $4,226 $2,312 9.26 1.59 29% 31%Moderate Risk, Non-Compliant 167 $5,366 $4,283 $2,725 9.92 7.56 2% 2%High Risk, Compliant 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%Total 9,615 $4,621 $5,695 $3,372 7.61 1.66 100% 100%
© 2011 Lockton, Inc. All rights reserved.
9.6% 9.7%
23.2% 22.8%
33.6%
39.7%
33.6%
27.8%
0%5%
10%15%20%25%30%35%40%45%
Actual Norm Actual Norm Actual Norm Actual Norm
Low Risk Moderate Risk High Risk High Cost
% of Total Paid by Risk Category
Population Risk (continued)
28Norm from Lockton InfoLock Book of Business.
52.3%48.4%
30.6% 32.9%
15.6% 18.0%
1.5% 0.8%0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Actual Norm Actual Norm Actual Norm Actual Norm
Low Risk Moderate Risk High Risk High Cost
Members by Risk Category
© 2011 Lockton, Inc. All rights reserved.
Cost of Non-Compliance
29
Condition Members Cost Members Cost Members Cost Members CostAsthma 104 $3,919 17 $3,791 85 $12,319 25 $14,229 Back Pain 835 $4,932 39 $5,367 570 $13,177 95 $14,349 Neck Pain 459 $5,131 23 $5,065 334 $13,425 53 $14,296 COPD 4 $3,608 3 $7,115 7 $13,271 8 $20,405 CAD 10 $3,042 6 $5,144 27 $10,938 22 $10,314 Depression 299 $4,563 13 $2,138 230 $12,061 35 $15,397 Diabetes 23 $4,939 83 $3,485 76 $14,846 143 $11,417 Hyperlipidemia 255 $3,978 12 $1,514 246 $12,090 57 $11,055 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 $11,813 246 $13,088
Compliant Non-Compliant Compliant Non-CompliantModerate Risk High Risk
This exhibit excludes high cost claimants. PMPY costs include comorbidities. *Norm from the Lockton InfoLock Book of Business.
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.
© 2011 Lockton, Inc. All rights reserved.
18%
82%
Paid Amount by Number of Chronic Conditions
No Chronic Conditions 1 or more condition
Chronic Conditions per Member
30
58%
19%13% 10%
65%
17%9% 8%
0%10%20%30%40%50%60%70%
Members with 0 conditions
Members with 1 condition
Members with 2 conditions
Members with 3 or more conditions
Chronic Conditions per Member
Actual
Norm
$1,855
$6,776 $8,691
$22,413
$1,216$4,129
$6,274
$13,667
$-
$5,000
$10,000
$15,000
$20,000
$25,000
Members with 0 conditions
Members with 1 condition
Members with 2 conditions
Members with 3 or more conditions
PMPY by Number of Chronic Conditions
Actual
Norm
© 2011 Lockton, Inc. All rights reserved.
Top 5 Chronic Conditions
31
58
92
58
224
442
267
312
279
482
874
303
265
335
387
665
45
34
49
59
109
0 500 1000 1500 2000 2500
Hyperlipidemia
Depression
Hypertension
Neck Pain
Back Pain
Top 5 Chronic Conditions by Number of Members
Low Risk
Moderate Risk
High Risk
High Cost
© 2011 Lockton, Inc. All rights reserved.
Cost Adjustment
32
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.
Asthma Summary & Observations
33
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.
$6,621$7,636
$4,660
$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000$9,000
2009 PMPY 2010 PMPY Norm
Asthma Members - Annual Cost2.7% 2.8%
2620
50
100
150
200
250
300
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
Prevalence Norm
Asthma Prevalence
22
25
34
50
91
0 20 40 60 80 100
Hypertension
Hyperlipidemia
Depression
Neck Pain
Back Pain
Top 5 Comorbidities by Number of Members
Asthma
34
Members with Asthma
48% 20% 32%Members by Relationship Employees Spouses Dependents
7% 46% 42% 5%Member by Risk Category Low Risk Moderate Risk High Risk HCC
81% 19%Members by Compliance Compliant Non-Compliant
42% 19% 22% 17%Number of Comorbidities Asthma Only 1 comorbidity2 comorbidities 3+ comorbidities
Excludes High Cost Claimants
Norm from Lockton InfoLock Book of Business.
© 2011 Lockton, Inc. All rights reserved.
Asthma Quality and Risk Measures
35
Quality Care Measures
Risk Measures
Norm from the Lockton InfoLock Book of Business.
Criteria # Description Actual % Norm % VarianceAsthma 262 Patients with more than one asthma-related ER visit in the analysis period 4.2% 3.0% 1.2%Asthma 262 Patients with more than one asthma-related hospitalization in the analysis period 0.4% 0.4% 0.0%Asthma 262 Patients with asthma-related ER visit in the analysis period 10.7% 11.8% -1.1%Asthma 262 Patients with asthma-related hospitalization in the analysis period 2.3% 3.2% -0.9%
Criteria # Description Actual % Norm % VarianceAsthma-related ER visit 40 Patients without office visit in the analysis period 0.0% 2.8% -2.8%Asthma-related admission 6 Patients without office visit in the analysis period 0.0% 1.3% -1.3%
Asthma 262 Patients without inhaled corticosteroids or leukotriene inhibitors in the analysis period 18.3% 27.2% -8.9%
© 2011 Lockton, Inc. All rights reserved.
COPD Summary & Observations
36
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.
$7,806
$12,692
$8,284
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
2009 PMPY 2010 PMPY Norm
COPD Members - Annual Cost
0.3%
0.8%
300
5
10
15
20
25
30
35
0.0%
0.2%
0.4%
0.6%
0.8%
1.0%
Prevalence Norm
COPD Prevalence
6
8
8
8
10
0 2 4 6 8 10 12
Diabetes
Neck Pain
Hypertension
Asthma
Back Pain
Top 5 Comorbidities by Number of Members
COPD
37
Members with COPD
40% 60%0%Members by Relationship Employees Spouses Dependents
3% 23% 50% 23%Member by Risk Category Low Risk Moderate Risk High Risk HCC
53% 47%Members by Compliance Compliant Non-Compliant
10% 27% 23% 40%Number of Comorbidities COPD Only 1 comorbidity2 comorbidities 3+ comorbidities
Excludes High Cost Claimants
Norm from the Lockton InfoLock Book of Business.
© 2011 Lockton, Inc. All rights reserved.
COPD Quality and Risk Measures
38This exhibit excludes high cost claimants. PMPY costs include comorbidities. Norm from the Lockton InfoLock Book of Business.
Risk Measures
Quality Care Measures
Criteria # Description Actual % Norm % VarianceCOPD 30 Patients with COPD-related ER visit in the analysis period 13.3% 13.4% -0.1%COPD 30 Patients with more than one hospitalization in the analysis period 10.0% 23.4% -13.4%COPD 30 Patients with more than one COPD-related ER visit in the analysis period 0.0% 3.9% -3.9%COPD 30 Patients with COPD-related hospitalization in the analysis period 6.7% 10.9% -4.2%
Criteria # Description Actual % Norm % VarianceCOPD-related ER visit 8 Patients without office visit in the analysis period 0.0% 0.0% 0.0%COPD-related admission 2 Patients without office visit in the analysis period 0.0% 0.0% 0.0%COPD 30 COPD without Office visit in last 12 months 3.3% 5.9% -2.5%
© 2011 Lockton, Inc. All rights reserved.
CAD Summary & Observations
39
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.
$8,907 $8,787 $8,471
$0
$2,000
$4,000
$6,000
$8,000
$10,000
2009 PMPY 2010 PMPY Norm
CAD Members - Annual Cost
1.0%
2.1%
980
20
40
60
80
100
120
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
Prevalence Norm
CAD Prevalence
16
26
27
31
35
0 10 20 30 40
Neck Pain
Diabetes
Hyperlipidemia
Back Pain
Hypertension
Top 5 Comorbidities by Number of Members
CAD
40
Members with CAD
48% 52% 0%Members by Relationship Employees Spouses Dependents
2% 16% 50% 32%Member by Risk Category Low Risk Moderate Risk High Risk HCC
54% 46%Members by Compliance Compliant Non-Compliant
16% 32% 17% 35%Number of Comorbidities CAD Only 1 comorbidity2 comorbidities 3+ comorbidities
Excludes High Cost Claimants
© 2011 Lockton, Inc. All rights reserved.
CAD Quality and Risk Measures
41Norm from Lockton InfoLock Book of Business.
Risk Measures
Quality Care Measures
Criteria # Description Actual % Norm % VarianceCAD 98 Patients with cardiac catheterization in the analysis period 42.9% 37.7% 5.1%CAD 98 Patients with CABG in the analysis period 6.1% 5.0% 1.1%CAD 98 Patients with cerebrovascular disease (CVD) 9.2% 12.9% -3.7%CAD 98 Patients with MI-related hospitalization in the analysis period 4.1% 5.0% -0.9%CAD 98 Patients with peripheral vascular disease (PVD) 4.1% 6.7% -2.6%CAD 98 Patients with CAD-related ER visit in the analysis period 12.2% 14.2% -2.0%CAD 98 Patients with depression 3.1% 5.0% -1.9%CAD 98 Patients with CAD-related hospitalization in the analysis period 23.5% 19.3% 4.2%CAD 98 Patients with obesity 1.0% 1.1% 0.0%CAD 98 Patients with more than one hospitalization in the analysis period 17.3% 19.5% -2.2%CAD 98 Patients with cardiac stenting in the analysis period 24.5% 14.5% 10.0%CAD 98 Patients with hyperlipidemia 27.6% 50.6% -23.0%
Criteria # Description Actual % Norm % VarianceCAD and Hypertension 35 Patients without antihypertensive drugs in the analysis period 8.6% 5.6% 2.9%CAD-related ER visit 13 Patients without office visit in the analysis period 0.0% 0.6% -0.6%CAD-related admission 24 Patients without office visit in the analysis period 0.0% 0.4% -0.4%CAD 98 Patients without office visit in the last 12 months 2.0% 3.8% -1.8%
CABG – Coronary Artery Bypass Graft
© 2011 Lockton, Inc. All rights reserved.
Depression Summary & Observations
42
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.
$6,629$7,258
$5,572
$0
$2,000
$4,000
$6,000
$8,000
2009 PMPY 2010 PMPY Norm
Depression Members - Annual Costs7.3%
3.6%
7030100200300400500600700800
0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%
Prevalence Norm
Depression Prevalence
60
68
69
163
270
0 50 100 150 200 250 300
Hypertension
Headache
Hyperlipidemia
Neck Pain
Back Pain
Top 5 Comorbidities by Number of Members
Depression
43
Members with Depression
60% 23% 17%Members by Relationship Employees Spouses Dependents
13% 44% 38% 5%Member by Risk Category Low Risk Moderate Risk High Risk HCC
92% 8%Members by Compliance Compliant Non-Compliant
37% 27% 18% 18%Number of Comorbidities Depression Only 1 comorbidity2 comorbidities 3+ comorbidities
Excludes High Cost Claimants
Norm from Lockton InfoLock Book of Business.
© 2011 Lockton, Inc. All rights reserved.
Depression Quality and Risk Measures
44
Risk Measures
Quality Care Measures
Norm from Lockton InfoLock Book of Business.
Criteria # Description Actual % Norm % VarianceDepression 703 Patients with more than one hospitalization in the analysis period 3.3% 7.6% -4.4%Depression 703 Patients with depression-related ER visit in the analysis period 3.1% 4.7% -1.6%
Criteria # Description Actual % Norm % VarianceDepression 703 Patients without office visit in the last 12 months 4.6% 4.4% 0.2%Depression-related admission 22 Patients without mental health office visit within 14 days of discharge 81.8% 77.0% 4.8%
© 2011 Lockton, Inc. All rights reserved.
Diabetes Summary & Observations
45
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.
$8,045
$9,459
$6,534
$0
$2,000
$4,000
$6,000
$8,000
$10,000
2009 PMPY 2010 PMPY Norm
Diabetes Members - Annual Costs
4.1%4.7%
3900
100
200
300
400
500
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
Prevalence Norm
Diabetes Prevalence
42
65
82
96
137
0 50 100 150
Depression
Neck Pain
Hyperlipidemia
Hypertension
Back Pain
Top 5 Comorbidities by Number of Members
Diabetes
46
Members with Diabetes
60% 36% 4%Members by Relationship Employees Spouses Dependents
3% 27% 56% 14%Member by Risk Category Low Risk Moderate Risk High Risk HCC
29% 71%Members by Compliance Compliant Non-Compliant
29% 25% 21% 25%Number of Comorbidities Diabetes Only 1 comorbidity2 comorbidities 3+ comorbidities
Excludes High Cost Claimants
Norm from Lockton InfoLock Book of Business.
© 2011 Lockton, Inc. All rights reserved.
Diabetes Quality and Risk Measures
47Norm from Lockton InfoLock Book of Business.
Quality Care Measures
Risk MeasuresCriteria # Description Actual % Norm % VarianceDiabetes-related admission 6 Patients without diabetes-related office visit in the analysis period 0.0% 8.5% -8.5%Diabetes 390 Patients with dialysis in the analysis period 1.0% 2.6% -1.5%Diabetes 390 Patients with diabetes-related hospitalization in the analysis period 1.5% 2.3% -0.8%Diabetes 390 Patients with ulcer or open wound 11.0% 8.7% 2.3%Diabetes 390 Patients with CAD 6.7% 13.4% -6.7%Diabetes 390 Patients with obesity 3.8% 2.0% 1.9%Diabetes 390 Patients with hyperlipidemia 21.0% 36.3% -15.2%Diabetes 390 Patients with hypertension or taking antihypertensive drugs 66.4% 76.0% -9.5%Diabetes 390 Patients with peripheral vascular disease (PVD) 1.0% 2.6% -1.5%Diabetes 390 Patients with retinopathy 2.3% 3.6% -1.3%Diabetes-related ER visit 19 Patients without office visit in the analysis period 0.0% 1.1% -1.1%Diabetes 390 Patients with diabetes-related ER visit in the analysis period 4.6% 4.1% 0.5%Diabetes 390 Patients with renal failure 4.1% 4.7% -0.6%Diabetes 390 Patients with more than one hospitalization in the analysis period 5.6% 8.9% -3.2%
Criteria # Description Actual % Norm % VarianceDiabetes 390 Patients without micro or macroalbumin screening test in the last 12 months 42.3% 41.8% 0.5%Diabetes 390 Patients without semiannual HbA1c test 85.4% 88.8% -3.4%Diabetes 346 Diabetes without Office Visit in Analysis Period 0.3% 0.8% -0.5%Diabetes 346 Diabetes without Lab Test in Analysis Period 1.2% 2.3% -1.2%Diabetes 390 Patients without HbA1c test in the last 12 months 22.6% 27.5% -4.9%Diabetes 390 Patients without claims for home glucose testing supplies in the last 12 months 47.4% 49.9% -2.4%Diabetes 390 Patients without retinal eye exam in the last 12 months 90.0% 72.8% 17.2%Diabetes 346 Diabetes without Lab Test in Last 12 Months 9.0% 10.7% -1.7%
© 2011 Lockton, Inc. All rights reserved.
Hyperlipidemia Summary & Observations
48
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.
$6,799$7,493
$4,940
$0
$2,000
$4,000
$6,000
$8,000
2009 PMPY 2010 PMPY Norm
Hyperlipidemia Members - Annual Cost
7.0%
9.6%
6730100200300400500600700800
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
Prevalence Norm
Hyperlipidemia Prevalence
74
82
157
182
269
0 50 100 150 200 250 300
Osteoarthritis
Diabetes
Neck Pain
Hypertension
Back Pain
Top 5 Comorbidities by Number of Members
Hyperlipidemia
49
Members with Hyperlipidemia
66% 34% 0%Members by Relationship Employees Spouses Dependents
9% 40% 45% 7%Member by Risk Category Low Risk Moderate Risk High Risk HCC
88% 12%Members by Compliance Compliant Non-Compliant
27% 27% 21% 25%Number of Comorbidities Hyperlipidemia Only 1 comorbidity2 comorbidities 3+ comorbidities
Excludes High Cost Claimants
Norm from Lockton InfoLock Book of Business.
© 2011 Lockton, Inc. All rights reserved.
Hypertension Summary & Observations
50
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.
$6,541$7,335
$5,116
$0
$2,000
$4,000
$6,000
$8,000
2009 PMPY 2010 PMPY Norm
Hypertension Members - Annual Cost
7.5%
11.0%
7210100200300400500600700800
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
Prevalence Norm
Hypertension Prevalence
91
96
140
182
256
0 50 100 150 200 250 300
Osteoarthritis
Diabetes
Neck Pain
Hyperlipidemia
Back Pain
Top 5 Comorbidities by Number of Members
Hypertension
51
Members with Hypertension
61% 38% 1%Members by Relationship Employees Spouses Dependents
Excludes High Cost Claimants
Norm from Lockton InfoLock Book of Business.
8% 39% 46% 7%Member by Risk Category Low Risk Moderate Risk High Risk HCC
84% 16%Members by Compliance Compliant Non-Compliant
32% 28% 17% 23%Number of Comorbidities Hypertension Only 1 comorbidity2 comorbidities 3+ comorbidities
© 2011 Lockton, Inc. All rights reserved.
Hypertension Quality and Risk Measures
52
Risk Measures
Quality Care Measures
Norm from Lockton InfoLock Book of Business.
Criteria # Description Actual % Norm % VarianceHypertension 721 Hypertension Related ER Visit in Analysis Period 35.8% 37.5% -1.8%Hypertension 721 Hypertension Related Hospitalization 0.1% 0.7% -0.5%Hypertension 721 Patients with more than one hospitalization in the analysis period 3.9% 7.0% -3.1%
Criteria # Description Actual % Norm % VarianceHypertension-related ER visit 14 Patients without office visit in the analysis period 0.0% 1.8% -1.8%Hypertension-related admission 1 Patients without office visit in the analysis period 0.0% 0.9% -0.9%Hypertension 721 Patients without office visit in the last 12 months 3.7% 4.9% -1.1%Hypertension 721 Patients without office visit in the analysis period 0.0% 0.6% -0.6%
© 2011 Lockton, Inc. All rights reserved.
Cancer & Screenings Summary & Observations
53
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.
50%55%
38%44%
53%
35%
0%
10%
20%
30%
40%
50%
60%
Women >49 y/o with mammogram in last 12
months
Women>20 y/o with pap smear in the last
two years
Patients >49 y/o with any colorectal cancer
screening in the analysis period
Cancer Screenings
Actual Norm
Malignant Neoplasms/ Cancer Screenings
54
55%24%
9%
5%
5%
2%
45%
Early-Identifiable Cancers as a % of Total Paid
Non-Early Identifiable Breast CancerColorectal Cancer Female Genital Organ CancerProstate Cancer Skin Cancer
25%
24%
9%7%
6%
29%
Top 5 Malignant Neoplasms Diagnoses by Paid AmountJan 10 - Dec 10
Breast Cancer
Leukemia
Colorectal Cancer
Upper GI Cancer
Lymphoma and Lymphosarcoma
All Others
Norm from Lockton InfoLock Book of Business.
© 2011 Lockton, Inc. All rights reserved.
Back & Neck Pain Summary & Observations
55
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.
$6,140$7,092
$5,205
$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000
2009 PMPY 2010 PMPY Norm
Back Pain Members - Annual Cost
208
256
269
270
1108
0 200 400 600 800 1000 1200
Osteoarthritis
Hypertension
Hyperlipidemia
Depression
Neck Pain
Top 5 Comorbidities by Number of Members
21.7%
12.0%
20900
500
1000
1500
2000
2500
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Prevalence Norm
Back Pain Prevalence
MusculoskeletalBack Pain
56
Members with Back Pain
58% 32% 9%Members by Relationship Employees Spouses Dependents
21% 42% 32% 5%Member by Risk Category Low Risk Moderate Risk High Risk HCC
92% 8%Members by Compliance Compliant Non-Compliant
24% 39% 21% 16%Number of Comorbidities Back Pain Only 1 comorbidity2 comorbidities 3+ comorbidities
Norm from the Lockton InfoLock Book of Business.
Excludes High Cost Claimants
© 2011 Lockton, Inc. All rights reserved.
MusculoskeletalBack Pain Quality and Risk Measures
57Norm from the Lockton InfoLock Book of Business.
Risk Measures
Quality Care Measures
Criteria # Description Actual % Norm % VarianceBack Pain 2,090 Back Pain Related Hospitalization in Analysis Period 0.8% 1.3% -0.5%Back Pain 2,090 Back Pain Related ER Visit in Analysis Period 32.2% 39.3% -7.1%Back Pain 2,090 Back Pain with >1 Hospitalizations in Analysis Period 2.3% 5.2% -2.9%
Criteria # Description Actual % Norm % VarianceBack Pain-related ER visit 93 Patients without office visit in the analysis period 1.1% 4.3% -3.2%
© 2011 Lockton, Inc. All rights reserved.
MusculoskeletalBack Pain, Neck Pain, and Intervertebral Disc Disorders Utilization
58Norm from Lockton InfoLock Book of Business.
Primary Procedure Group Visits Paid Avg Paid Per Visit
Physical Therapy 7,797 $1,266,947 $162Orthopedic Surgery, exclude endoscopic 13 $579,723 $44,594Neurosurgery 22 $393,289 $17,877Chiropractic 5,050 $337,860 $67MRI Scan 172 $314,691 $1,830Other Anesthesia 82 $197,861 $2,413Rehab 928 $137,227 $148Office Visit - Established Patient 1,007 $130,556 $130Durable Medical Equipment 70 $112,603 $1,609Neurology 48 $99,218 $2,067X-ray 288 $94,404 $328Musculoskeletal Procedures 30 $40,010 $1,334All Others 731 $175,997 $241Total 16,238 $3,880,385 $239
Units/ 1000 Paid/ Unit Units/ 1000 Paid/ UnitChiropractic 1,261.5 $43 439.4 $16Physical Therapy 3,720.3 $32 786.2 $14CT Scan 2.1 $1,071 6.7 $344MRI Scan 20.8 $1,585 17.3 $502
Category Jan 10 - Dec 10 Norm
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$6,611$7,493
$5,423
$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000
2009 PMPY 2010 PMPY Norm
Neck Pain Members - Annual Cost
12.0%
5.3%
11520
200
400
600
800
1000
1200
1400
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
Prevalence Norm
Neck Pain Prevalence
120
140
157
163
1108
0 200 400 600 800 1000 1200
Osteoarthritis
Hypertension
Hyperlipidemia
Depression
Back Pain
Top 5 Comorbidities by Number of Members
MusculoskeletalNeck Pain
59
Members with Neck Pain
61% 29% 9%Members by Relationship Employees Spouses Dependents
19% 42% 34% 5%Member by Risk Category Low Risk Moderate Risk High Risk HCC
92% 8%Members by Compliance Compliant Non-Compliant
2% 46% 30% 22%Number of Comorbidities Neck Pain Only 1 comorbidity2 comorbidities 3+ comorbidities
Excludes High Cost Claimants
Norm from the Lockton InfoLock Book of Business.
© 2011 Lockton, Inc. All rights reserved.
$10,603$11,513
$8,357
$0$2,000$4,000$6,000$8,000
$10,000$12,000$14,000
2009 PMPY 2010 PMPY Norm
Osteoarthritis Members - Annual Cost
3.8%3.3%
369050100150200250300350400
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
Prevalence Norm
Osteoarthritis Prevalence
51
74
91
120
208
0 50 100 150 200 250
Depression
Hyperlipidemia
Hypertension
Neck Pain
Back Pain
Top 5 Comorbidities by Number of Members
MusculoskeletalOsteoarthritis
60
Members with Osteoarthritis
62% 37% 0%Members by Relationship Employees Spouses Dependents
6% 28% 50% 16%Member by Risk Category Low Risk Moderate Risk High Risk HCC
84% 16%Members by Compliance Compliant Non-Compliant
16% 27% 25% 32%Number of Comorbidities Osteoarthritis Only 1 comorbidity2 comorbidities 3+ comorbidities
Excludes High Cost Claimants
Norm from Lockton InfoLock Book of Business.
© 2011 Lockton, Inc. All rights reserved.
MusculoskeletalOsteoarthritis Quality and Risk Measures
61
Risk Measures
Quality Care Measures
Norm from Lockton InfoLock Book of Business.
Criteria # Description Actual % Norm % VarianceOsteoarthritis 369 Patients with continuous use of opiates across the last 12 months 9.2% 11.4% -2.2%Osteoarthritis 369 Osteoarthritis Related ER Visit in Analysis Period 41.5% 44.3% -2.8%Osteoarthritis 369 Osteoarthritis with >1 Hospitalizations in Analysis Period 6.8% 12.1% -5.3%Osteoarthritis 369 Osteoarthritis Related Hospitalization in Analysis Period 16.0% 12.3% 3.7%
Criteria # Description Actual % Norm % VarianceOsteoarthritis-related ER visit 1 Patients without office visit in the analysis period 0.0% 2.3% -2.3%Osteoarthritis-related admission 63 Patients without office visit in the analysis period 0.0% 0.1% -0.1%
© 2011 Lockton, Inc. All rights reserved.
Pregnancy & Neonates Summary & Observations
62
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.
4.7%
3.7%
0.0% 50.0% 100.0%
Norm
Actual
Pregnancy as a % of Total Paid
All Others Pregnancy
Pregnancy
63Norm from Lockton InfoLock Book of Business.
1686
143
120
20
Pregnancy-Related Claimants of Total Childbearing Aged Females
Child Bearing Age - No Pregnancy Claims
Pregnancy Claimants - Employee
Pregnancy Claimants - Spouse
Pregnancy Claimants - Dependent
Risk Measures
Quality Care MeasuresDescription # Actual % Norm % VarianceWomen with hospitalization for pregnancy-related diagnosis other than delivery 263 4.9% 6.4% -1.5%Women with pregnancy-related ER visit in the analysis period 263 16.0% 16.6% -0.6%
Description # Actual % Norm % VariancePregnant women delivered with fewer than six prenatal visits 263 90.5% 25.5% 65.0%
$53,676 $82,610
$1,267,302
$1,222,682
$-$200,000 $400,000 $600,000 $800,000
$1,000,000 $1,200,000 $1,400,000
2009 2010 2009 2010
ER Cost Inpatient Cost
Pregnancy-Related Cost
37 40
117 117
0
20
40
60
80
100
120
140
2009 2010 2009 2010
ER Claimants Inpatient Claimants
Pregnancy-Related Claimants
© 2011 Lockton, Inc. All rights reserved.
6 5
110119
0
20
40
60
80
100
120
140
2009 2010 2009 2010
ER Claimants Inpatient Claimants
Neonates-Related Claimants
4.1%
1.8%
0.0% 50.0% 100.0%
Norm
Actual
Neonates as a % of Total Paid
All Others Neonates
Neonates
64
$2,983 $2,081
$284,907
$601,323
$-$100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000
2009 2010 2009 2010
ER Cost Inpatient Cost
Neonates-Related Cost
© 2011 Lockton, Inc. All rights reserved.
Recommendations
65
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.
Recommendations
66
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
Appendix
© 2011 Lockton, Inc. All rights reserved.
Chronic Condition Reference
68
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 PainBack 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. COPDThe 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.
CADThis 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.
Chronic Condition Reference (continued)
69
DiabetesType 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.
HyperlipidemiaAn 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.
OsteoarthritisAbout 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.
Glossary
70
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 AmountTotal paid amount, this includes both the employee and employer paid amount.
Co-morbiditiesA medical condition that exists simultaneously with and usually independently of another medical condition.
Compliant MembersMembers with a Care Gap Index of 5 or less.
Current MembersIndividuals who are eligible with the plan as of the end of the reporting period.
Employee PaidEmployee paid consists of co-pays, coinsurances, and deductibles paid by an enrollee, the spouses, and their dependents.
Employer PaidEmployer paid includes total paid by the plan for enrollee, the spouses, and their dependents.
Emergency Room VisitDistinct 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 CycleTime 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.
Glossary (continued)
71
High Risk ClaimantsClaimants 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 ScriptScript with a plan paid amount of $1,000 or more.
Homegrown CodesNon-standard codes found in the dataset being reported.
Incurred BasisClaim expenses reported based on the service date.
InpatientAll claims paid for hospital inpatient services base on HCFA Place of Service code 21, 51, and 61.
Low Risk ClaimantsClaimants 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 MonthsTotal number of members eligible for the time period.
Moderate Risk ClaimantsClaimants with plan payment of less than $50,000 during the most recent 12 months and a Risk Index between 5-14.
Non-Compliant MembersMembers with a Care Gap Index of 6 or more.
NormNorms 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.
Glossary (continued)
72
Office VisitDistinct service dates for members with claims that have HCFA Place of Service code of 11.
OutpatientServices which take place outside of an inpatient place of service are defined as outpatient.
Paid BasisClaim expenses reported based on the date the claim was paid.
PEPM Per Employee per Month.
PMPM Per Member per Month.
Plan PaymentPlan payment includes total paid by the plan for enrollee, the spouses, and their dependents. Also referred to as Employer Paid.
Quality and Risk MeasuresThe 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 ClassGrouping of drugs into categories defined by First Data Banks.
Total MembersNumber of unique members in the time period.
Units per 1,000The average number of units (days, members, emergency room visits, etc.) per 1,000 members per year.
© 2011 Lockton, Inc. All rights reserved.
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