Page 55 - Bird RFP Response_Burnham Benefits

Healthcare Trends - High Cost Medical
Population: Book of Business
Threshold: $50,000

Periodic Analysis Paid Claims by Type, Trended Monthly
$4.0m
Metric Reporting Comparison %∆

# Claimants 117 115 1.74% $3.50m
# Claims 10,256 8,929 14.86%
Total Paid (in thousands) $14,185 $13,076 8.48% $3.0m
Avg Claims/Member 1.36 1.18 15.20%
Avg Lines/Member 3.06 2.86 6.92% $2.50m
% of Claimants to Members 1.28% 1.30% -1.54%
Avg Turnaround Incurred to Paid 23.96 23.81 0.63% $2.0m
Claims/1000 Covered Lives 1,340 1,168 14.79%
$1.50m
Avg Claim Cost $1,383.06 $1,464.47 -5.56%
Avg Cost/Claimants $121,236.70 $113,706.88 6.62% $1.0m
Avg Lines/Claimants 197.22 188.21 4.79%
% In Paid In-Network (Facility) 92.78% 91.63% 1.26% $500k
% In Paid In-Network (Professional) 78.12% 85.72% -8.87%
% In Paid In-Network (Total) 90.25% 90.65% -0.44% $0k
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
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High Cost Claims ($50,000+) Non High Cost Claims

Trend Average Jan-2018 Feb-2018 Mar-2018 Apr-2018 May-2018 Jun-2018 Jul-2018 Aug-2018 Sep-2018 Oct-2018 Nov-2018 Dec-2018
Claimants 95 87 90 89 94 94 99 99 98 101 102 99 91
Number of Claims 855 786 1,052 884 765 912 869 775 946 835 859 835 738
Total Paid (in thousands) $1,182 $911 $1,537 $1,683 $972 $1,141 $1,027 $794 $1,269 $950 $1,693 $1,291 $917
PEPM $380.21 $299.05 $501.58 $546.54 $313.87 $366.58 $328.85 $252.42 $403.39 $302.19 $539.29 $415.62 $294.52
PMPM $154.50 $119.78 $201.76 $219.40 $126.25 $148.50 $133.39 $103.36 $164.75 $123.67 $221.00 $170.72 $121.42
Claims/Member 0.11 0.10 0.14 0.12 0.10 0.12 0.11 0.10 0.12 0.11 0.11 0.11 0.10
Claim Lines/Member 0.25 0.23 0.31 0.26 0.21 0.26 0.24 0.23 0.27 0.24 0.24 0.26 0.26
% Claimants/Members 1.24% 1.14% 1.18% 1.16% 1.22% 1.22% 1.29% 1.29% 1.27% 1.31% 1.33% 1.31% 1.20%
Avg. Days Incurred to Paid 23.96 24.48 24.34 23.52 22.67 27.86 23.74 22.59 22.15 21.61 24.59 23.33 26.61
Claims/1000 1,340 1,240 1,657 1,383 1,193 1,425 1,354 1,210 1,474 1,304 1,346 1,326 1,173
Inpatient Days/1000 127.30 255.55 86.65 140.81 173.05 143.71 107.55 62.46 102.82 163.96 87.73 160.34 42.90
ER visits/1000 19.73 31.55 28.36 10.95 21.83 15.62 20.26 24.98 17.14 26.55 20.37 7.94 11.12
Avg Claim Cost $1,383.06 $1,159.29 $1,460.87 $1,903.63 $1,270.27 $1,250.88 $1,181.82 $1,024.97 $1,341.52 $1,138.17 $1,970.71 $1,545.52 $1,242.71
Avg Cost/Claimant $12,410.06 $10,473.59 $17,075.99 $18,907.95 $10,337.82 $12,136.22 $10,373.78 $8,023.78 $12,949.78 $9,409.66 $16,596.48 $13,035.45 $10,078.26
Avg Lines/Claimant 20.19 20.24 26.59 22.34 17.06 21.48 18.44 17.94 21.41 18.46 17.94 19.95 21.33
% In Paid In-Network (Facility) 92.78% 98.72% 85.07% 79.73% 73.95% 97.11% 86.74% 94.12% 97.66% 94.04% 100.20% 102.21% 108.36%
% In Paid In-Network (Professional) 78.12% 85.88% 77.88% 85.21% 83.02% 75.34% 77.55% 84.72% 78.32% 58.49% 72.57% 86.27% 78.65%
% In Paid In-Network (Total) 90.25% 95.38% 83.73% 80.53% 75.38% 94.25% 85.15% 92.03% 93.97% 84.24% 96.26% 100.00% 105.11%

Reporting Period: Paid January 2018 to December 2018
Comparison Period: Paid January 2017 to December 2017
Benchmark: Commercial February 15, 2019

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