Iowa Bankers Benefit Plan
description
Transcript of Iowa Bankers Benefit Plan
April 2011 Update
Iowa Bankers Benefit Plan1
Iowa Bankers Benefit Plan Update 2011
IBBP Demographic Update
Financials and Year End Numbers
Analysis of the Plan
2
Iowa Bankers Benefit Plan Health and Dental Employee Numbers3
2008 2009 2010 20110
2,000
4,000
6,000
8,000
10,000
12,00011,146 11,121 11,123 11,012
9,4699,005
8,3357,831
Number of Employees Health including Retirees Number of Employees Dental
4
IBBP Employee Demographics
Single Employee & Spouse
Employee plus Child(ren)
Family0
1,000
2,000
3,000
4,000
5,000
6,000
5
$250 deductible $500 deductible $1,000 deductible
$1,500 deductible
$2,000 deductible
$2,000 HDHP 0
5001,0001,5002,0002,5003,0003,5004,0004,500
469
1012
2866
3630
2330
739
Number of Employees at Renewal by Plan
Choice
2009 2010 2011 2012
6
$250 deductible $500 deductible $1,000 deductible
$1,500 deductible
$2,000 deductible
$2,000 HDHP 0
20
40
60
80
100
120
140
35
65
128 126
84
43
Number of Employers at Renewal by Plan
Choice
7
IBBP Demographic Detail
Health membership has declined 4% - 26,004 (2007) to 24,947(2011) in the past 4 years.
The workforce is primarily female (67%). Overall the gender is female (55%). The greatest concentration of members is between
the ages of 5 – 34(42%) and accounted for 24% of health claims paid.
Members over 45 account for 41% of membership and 60% of health claims paid.
Iowa Bankers Benefit Plan Update 2011
IBBP Update
Financials and Year End Numbers
Analysis of the Plan
8
9
IBBP Health Cost Summary
Prior Year Current Year
Percent Change
COVERED CHARGES
$131,624,577
$136,971,858
4.1%
Inpatient $36,773,991
$35,981,525
(2.2%)
Outpatient $54,197,442
$58,608,631
8.1%
Office $35,824,651
$37,166,289
3.7%
Other $4,828,493 $5,215,413 8.0%CLAIMS PAID $67,285,63
7$68,635,008
2%
PharmacyCovered Charges
$27,937,391
$28,419,188
1.7%
Pharmacy Paid
$13,653,625
$13,589,957
(0.5)
2010 Administrative Expense Ratio10
2010 Total Premiums: $99,382,931
Wellmark Administrative Fees: $5,054,467
IBIS Administrative Expense: $4,469,936
Other Expense: Audit Expense $25,000 Legal Expense $47,452 Misc. Expense $489
Total Administrative Expense : $9,597,344
9.6% Administrative Expense Ratio
2010 Claims Wellmark Admin Fees
IBIS Admin. Expense Other Expense
Iowa IBBP
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Health Claims86.5%
Adm.Exp13.8%
Operating Margin
.7%
Health Claims
90.35%
Wellmark Adm Fees
5.1%
IBIS Adm.
Expense4.5%
Other Expense.05%
Comparison of Administrative Expense
$0 $5,000,000
$10,000,000 $15,000,000 $20,000,000 $25,000,000 $30,000,000
Dec-07
Dec-08
Dec-09
Dec-10
Aug-11
August 2011 $27,794,822
December 2010 $20,629,7312010 Actuarial Certification Amount $9,698,548
December 2009 $18,210,897 2009 Actuarial Certification Amount
$8,739,928
December 2008 $17,133,978 2008 Actuarial Certification Amount
$8,050,445
December 2007 $16,996,278 2007 Actuarial Certification Amount
$6,835,781
December 2006 $12,426,176 2006 Actuarial Certification Amount
$7,419,510
Iowa Bankers Benefit Plan Trust Reserve12
Iowa Bankers Benefit Plan Update 2011
•IBBP Update
Financials and Year End Numbers
Analysis of the Plan
13
Total IBBP Claims by Month14
January February March April May June July August September October November December
2008 $5,538,729 $6,312,230 $5,472,395 $6,018,769 $6,633,649 $5,696,861 $5,684,415 $6,805,533 $5,464,621 $7,603,092 $5,836,552 $6,119,0142009 $6,767,899 $6,309,826 $5,590,944 $6,583,907 $7,461,058 $6,191,504 $7,857,762 $5,697,910 $5,905,447 $8,023,630 $6,259,775 $6,774,9312010 $7,223,080 $5,583,319 $6,634,185 $7,295,334 $6,092,703 $5,948,072 $7,290,348 $6,410,847 $6,961,272 $7,868,679 $6,665,801 $8,769,6902011 $6,158,473 $6,215,570 $6,322,191 $7,716,965 $6,580,135 $6,408,026 $7,217,173 $6,475,406
$0$2,000,000$4,000,000$6,000,000$8,000,000
$10,000,000
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Inpatient Services Summary
Financial and Utilization Metrics
2009 2010 2011
Percent Change Wellmark Book
Admissions/1,000 56 52 52 0.0% 62
Average Length of Stay 3.7 3.9 3.5 (10.3%) 3.9
Covered Charge/Admission $26,345 $28,441 $27,979 (1.6%) $30,474
Claims Paid/Admission $13,641 $14,390 $13,759 (4.4%) $13,585
Claims Paid Per Member $759 $753 $709 (5.8%) n/a
Top Diagnostic Categories by Claims Paid
2010 2011 Difference % Change
Obstetrical $3,206,638 $3,785,357 $805,825 25.1%
Bones/Muscle/Ligaments $2,992,549 $3,138,993 $334,771 11.2%
Heart/Vessel $2,324,220 $2,106,973 ($90,838) (3.9%)
Digestive $1,567,514 $1,497,310 $19,628 1.3%
Injuries/Poisonings $1,480,777 $1,431,582 $36,694 2.5%
Top Diagnoses Categories by covered charges were: Bone/muscle/ligament conditions
accounted for 19% of covered charges. Covered charges per member were 2% less than the Wellmark average, but 11% more than the prior year level. Admissions also increased 14%. The primary diagnoses were osteoarthrosis, intervertebral disc disorders and curvature of the spine.
Obstetrical conditions also accounted for 19% of covered charges, which on a per member basis were 8% above the Wellmark book of business. The primary diagnoses were single live-born, normal delivery and abnormality of pelvic organs and soft tissue.
Heart/vessel followed with 13% of covered charges. Covered charges per member were 37% less than the Wellmark average. Top diagnoses included acute myocardial infarction, chronic ischemic heart disease and cardiac dysrhythmias.
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Outpatient Services Summary
Financial and Utilization Metrics
2009 2010 2011
Percent Change
Wellmark Book
Claims/1,000 Members 1,229 1,255 1,244 (0.9%) 1,267 Covered Charge/Member $1,937 $2,193 $2,349 7.1% $2,613 Claims Paid/Visit $676 $761 $818 7.5% n/a Claims Paid/Member $831 $955 $1,017 6.5% n/a
Top Diagnostic Categories by Claims Paid
Prior Current Difference % Change
Bones/Muscles/Ligaments $3,220,686 $3,321,551 $300,144 9.3%
Benign/Cancerous Tumors $2,224,838 $2,763,116 $704,054 31.7%
Digestive $2,548,233 $2,329,857 ($78,594) (3.1%)
Genital/Urinary $2,055,549 $1,975,630 $38,610 1.9%
Nerves/Eyes/Ears $1,729,054 $1,873,626 $256,981 14.9%
Top Diagnoses Categories by covered charges were: Muscular/skeletal accounted for 14%
of covered charges. Covered charge per member was 2% more than the Wellmark average. Top diagnoses included intervertebral disc disease and other disorders of the back and joints.
Benign/cancerous tumors On a per member basis, covered charges were 15% more than last year, but 3% less than the Wellmark average. Top diagnoses included breast cancer, benign tumor of the digestive system and cancer of the trachea/bronchus/ lung.
Digestive Covered charges per member were 11% below the Wellmark average. The top diagnoses were gall bladder disease, diseases of the esophagus and abdominal hernia.
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Office Visit Services Summary
Financial and Utilization Metrics
2009 2010 2011
Percent Change
Wellmark Book
Office Visits/1,000 6,011 6,381 6,459 1.2% 6,782
Covered Charge/Member $1,330 $1,450 $1,490 2.8% $1,510
Claims Paid/Visit $139 $142 $141 (0.7%) n/a
Claims Paid/Member $833 $904 $913 1.0% n/a
Top Diagnostic Categories by Claims Paid
Prior Current Difference % Change
Routine/Diagnostic $3,223,470 $3,306,947 $281,880 8.7%
Bones/Muscles/Ligaments $2,929,884 $3,056,262 $309,742 10.6%
Benign/Cancerous Tumors $2,757,090 $2,691,823 $96,231 3.5%
Nerves/Eyes/Ears $1,645,592 $1,756,939 $216,756 13.2%
Nose/Throat/Lungs $1,521,189 $1,653,822 $231,855 15.2%
Top Diagnoses Categories by covered charges were: Bone/muscles/ligaments accounted
for 14% of covered charges. This was 17% below the Wellmark average in covered charges per member. Primary diagnoses included unspecified disorders of the joints and back and non-allopathic lesions – chiropractic (16% of claims paid) and physical therapy (19% of claims paid).
Routine/diagnostic The number of office visits was down 8%, while covered charge per member was steady, but 21% above the Wellmark average. Primary diagnoses included special investigations/examinations, well-child exams and general medical examinations.
Benign/cancerous tumors Per member charges were 6% below the Wellmark average. Primary diagnoses included cancers of the breast and prostate and tumors or growths of other unspecified sites.
IBBP Drug Claims by Month
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Janu
ary
Febru
ary
March Apr
ilMay
June Ju
ly
Augus
t
Septem
ber
Octobe
r
Novem
ber
Decem
ber
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000
$1,400,000
$1,600,000
$1,143,943
2008200920102011 th
ousa
nds
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Prescription Drugs
Generic utilization increased 13%, but remained slightly below the Wellmark book of business.
Prescription claims paid per member decreased nearly a percent, well above expected trend.
A number of specialty medications including Humira, Copaxone, Avonex and Enbrel noted at left contributed to the pharmacy costs, but were off-set by decreased utilization and increased generic utilization.
Nearly 25% of members obtained no prescriptions and another 41% had claims paid of $100 or less. Just over 11% of members filled prescriptions in excess of $1,000, accounting for 42% of prescriptions and 81% of prescription dollars paid.
Biologic response modifiers accounted for the most claims paid (9.4%). These include several specialty meds used to treat multiple sclerosis. Antidepressants and disease modifying anti-heumatics (used to treat rheumatoid arthritis and other autoimmune conditions) followed, each with 6.2% of claims paid.
Financial and Utilization Metrics
2009 2010 2011Percent Change
Wellmark Book
Generic Fill 63.7% 67.1% 75.5% 12.5% 76.1%
Covered Charge/Rx $94.22$106.6
5$109.6
1 2.8% $98.07
Claims Paid/Rx $46.26 $51.69 $51.87 0.3% n/a
Claims paid/Member $492.00$563.6
1$559.0
8 (0.8%) n/a
Member Liability/Rx $18.49 $20.11 $19.51 (3.0%) n/a
Member Liability % 28.6% 28.0% 27.3% (0.3%) n/a
Prescriptions/Member/Year 10.64 10.90 10.78 (1.1%) 12.20
Top Drugs by Claims Paid
Drug Name Primary Use Claims PaidHumira Rheumatoid Arthritis $520,870
Lipitor Cholesterol $394,851
Copaxone Multiple Sclerosis $391,158
Avonex Multiple Sclerosis $354,799Enbrel Rheumatoid Arthritis $324,908
20 Wellmark Blue Cross and Blue Shield
Generic Pipeline
2010 2011 2012 2013 2014$0
$5
$10
$15
$20
$25
$30
$35
$40
$45
$17.3 M $21.2 M
$41.1 M
$9.4 M
$19.2 M
Generic Pipeline - Pharmacy Benefit Cost Efficiencies$107.4 M in
Benefit Savings by 2014*
CozaarEffexor XR
ConcertaLevaquinXalatanZyprexa
ActosAvandiaDiovanLipitorLexaproPlavixSeroquelSingulair
AciphexCymbalta
CelebrexLunestaNexium
*Generic market entrance is estimated based on existing patent expiration dates. Patent litigation may alter these projections and actual savings may vary.
IBBP Total Health and Pharmacy Claims Paid Per Member
The Average Increase over the Past Five Years was 5.1%
Year 2007 2008 2009 2010 2011
Paid perMember
$2574 $2,806 $3,049 $3,276 $3,296
Percent ofChange
(.04%) 9% 8.7% 7.4% .6%
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Most Costly Diagnosis Categories
The following graph represents the “top” diagnoses categories using claims paid for services obtained through all places of service, excluding pharmacy, comparing the current benefit period data to the prior benefit period dat
Bones
/Mus
cles/L
igamen
ts
Benign
/Can
cero
us T
umor
s
Routin
e/Diag
nosti
c
Obstet
rical
Heart/
Vesse
l
Digesti
ve
Nerve
s/Eye
s/Ear
s
Injur
ies/P
oison
ings
Genita
l/Urin
ary
Nose/T
hroa
t/Lun
gs0%2%4%6%8%
10%12%14%16%
14%
10%
7%6%
7% 7%6% 6% 6%
4%
14%
10%
7% 7% 7% 7% 6% 6% 5% 5%
Top 10 Diagnosis Categories by Claims Paid
% of Prior % of Current
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Health Status Distribution
The above graph notes the current distribution of Iowa Bankers’ members along the health risk continuum. Compared to the prior period, the health risk of members remained relatively steady. However looking at members continuously enrolled in the plan throughout the two year period, there was a slightly greater move of members to a higher (less healthy) risk category. Of continuously enrolled members:
Over 77% (18,633 members) remained unchanged within the same risk category Nearly 11% (2,552 members) moved to healthier risk category Just over 12% of members (2,959) moved to a higher risk category
59% 15% 25% 2%
Low - Healthy / Non-User Elevated - Chronic Conditions
0.2% Extreme - Severe Illness Complex DiseaseModerate - Minor Chronic
High - Disease Progression
12 Month Ending 12/31/2010
58% 15% 25% 2%
Low - Healthy / Non-User Elevated - Chronic Conditions
0.2% Extreme - Severe Illness Complex DiseaseModerate - Minor Chronic
High - Disease Progression
12 Month Ending 12/31/2009
63% 12% 23% 2%
Low - Healthy / Non-User Elevated - Chronic Conditions
0.3% Extreme - Severe Illness Complex DiseaseModerate - Minor Chronic
High - Disease Progression
Wellmark Book of Business
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IBBP Over All
Including all members, enrollment has increased 1%. Health claims paid per member increased less than
1% due to a 6% decrease in inpatient claims. Outpatient claims paid were 7% higher than last year.
Pharmacy claims paid per member decreased 1%,compared to 22% increase in 2010.
165 members account for 23% of total claims paid. Over all, health and pharmacy claims paid
increased .06%, compared to 7.4% last year
IBBP Dental Highlights
47.9% of paid claims are for check-ups Average claim cost is $142.67 94.8% of members receive service in-network Provider savings averages 12.5% of billed charge 84.4% of covered members visited a dentist at least
once in the past 12 months 2% of our members met or exceeded the annual
benefit maximum(all plan options combined)
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