Appendix E-1 - HealthPartners Claims Premium Data 2017

Ramsey County [12900]

Paid through 01/31/2018Service Dates of 01/01/2017 through 12/31/2017

Medical Expenditure Summary

Service Category Claims PMPMAggregate

PMPMVariance in

PMPMPMPMTrend

Professional $21,407,337 $231.80 $179.30 29.28% -0.76%

Hospital IP $8,143,876 $88.18 $89.52 -1.49% -12.35%

Hospital OP $10,669,594 $115.53 $105.17 9.85% -0.33%

Pharmacy $9,959,524 $107.84 $82.12 31.33% 5.68%

DME, Transportation, Other $1,387,149 $15.02 $11.54 30.21% 20.55%

Preventive/Accidental Dental $0 $0.00 $1.34 -100.00% 0.00%

Total $51,567,481 $558.38 $468.99 19.06% -1.10%

All Packages/All Sites YTD Qtrly

Claims include IBNR

Note: The Aggregate PMPM for Preventive Dental services reflects the cost for coverage of children only.

Current Year

Run Date: 02/12/2018Report Period: 2/1/2018 12:00: © Copyright 2018 HealthPartners

100_Ex_Expenditure_SummaryReport Id: 43735

Page 1 of 109





PMPMVariance in

PMPM

Professional $21,284,758 $233.57 $172.17 35.66%

Hospital IP $9,167,229 $100.60 $91.03 10.51%

Hospital OP $10,562,345 $115.91 $103.74 11.72%

Pharmacy $9,298,655 $102.04 $79.08 29.03%

DME, Transportation, Other $1,135,349 $12.46 $10.98 13.46%

Preventive/Accidental Dental $0 $0.00 $1.39 -100.00%

Total $51,448,336 $564.57 $458.40 23.16%


Claims include IBNR


Prior Year



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Medical Per Member Per Month Comparisons


CG Current Year PG Prior YearC Current Aggregate PA Prior Aggregate


100_Ex_Expenditure_SumReport Id: 43735

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Medical Professional Utilization by Major Practice Category

Major Practice Category ClaimsUnits perMember

Paid perUnit PMPM

Units perMember

Paid PerUnit PMPM

Variancein PMPM

PMPMTrend

Orthopedic and Arthritic Conditions $3,505,489.04 10.163 $44.82 $37.96 10.204 $34.45 $29.29 29.58% 10.64%Psychiatry $2,010,713.81 3.184 $82.05 $21.77 2.860 $65.49 $15.61 39.48% 12.86%Gastroenterology $1,385,614.16 3.939 $45.70 $15.00 3.903 $37.75 $12.28 22.20% 8.15%Endocrinology $1,357,506.90 6.394 $27.59 $14.70 3.758 $26.80 $8.39 75.17% -12.86%Preventive and Administrative Care $1,264,066.74 2.819 $58.27 $13.69 2.746 $58.21 $13.32 2.74% 6.87%Otolaryngology $1,243,410.90 3.205 $50.41 $13.46 2.881 $41.72 $10.02 34.42% 15.44%Cardiology $1,148,415.74 2.494 $59.84 $12.44 2.151 $52.71 $9.45 31.61% -6.18%Cancer $1,104,139.95 3.564 $40.26 $11.96 4.625 $37.91 $14.61 -18.17% -50.70%Dermatology $1,000,118.29 1.921 $67.64 $10.83 1.850 $51.58 $7.95 36.15% 7.76%Gynecology $959,502.55 4.950 $25.19 $10.39 3.505 $26.18 $7.65 35.89% 4.42%Ophthalmology $826,545.61 1.483 $72.43 $8.95 1.467 $57.30 $7.01 27.76% 1.13%Neurology $807,969.22 2.568 $40.88 $8.75 2.475 $34.79 $7.18 21.91% 9.79%Obstetrics $752,073.11 1.741 $56.14 $8.14 2.196 $45.46 $8.32 -2.09% -0.37%Pulmonology $498,314.61 0.759 $85.36 $5.40 0.920 $51.99 $3.99 35.33% 11.11%Other $468,907.30 2.200 $27.70 $5.08 2.337 $19.50 $3.80 33.70% 27.64%Urology $369,618.88 1.225 $39.20 $4.00 1.287 $31.10 $3.34 19.98% -1.48%Isolated Signs/Symptoms $314,852.94 0.986 $41.48 $3.41 0.876 $38.39 $2.80 21.62% -13.89%Chemical dependency $243,128.82 0.240 $131.42 $2.63 0.243 $59.70 $1.21 118.17% 96.27%Hepatology $185,943.22 0.732 $32.99 $2.01 0.685 $29.03 $1.66 21.43% -28.47%Hematology $185,596.04 2.688 $8.97 $2.01 1.041 $10.09 $0.87 129.72% 34.90%Infectious diseases $109,137.04 0.320 $44.26 $1.18 1.303 $17.90 $1.94 -39.20% 7.27%Nephrology $107,840.79 0.169 $82.89 $1.17 0.257 $39.26 $0.84 39.11% -16.43%Neonatology $81,055.13 0.077 $136.00 $0.88 0.155 $106.92 $1.39 -36.65% -32.31%Late effects/Complications $65,256.49 0.126 $67.48 $0.71 0.229 $30.26 $0.58 22.22% -1.39%Total $19,995,217 57.948 $44.84 $216.51 53.956 $38.58 $173.48 24.80% -0.83%


Note: Claims do not include IBNR

AggregateCurrent Year Actual

Report Period: 2/1/2018 12:00:00 AMRun Date: 02/12/2018

© Copyright 2018 HealthPartners110_Ex_Professional_by_MPCReport Id: 43735

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Paid perUnit PMPM

Units perMember

Paid PerUnit PMPM

Variancein PMPM

Orthopedic and Arthritic Conditions $3,126,588.50 10.299 $39.98 $34.31 10.293 $33.12 $28.41 20.77%Cancer $2,211,148.57 5.616 $51.85 $24.26 5.372 $31.70 $14.19 70.95%Psychiatry $1,757,458.40 2.806 $82.49 $19.29 2.797 $62.19 $14.50 33.04%Endocrinology $1,537,632.01 6.128 $33.04 $16.87 4.684 $22.42 $8.75 92.83%Gastroenterology $1,264,019.48 4.224 $39.41 $13.87 3.745 $36.16 $11.29 22.91%Cardiology $1,208,606.34 2.365 $67.29 $13.26 2.183 $52.14 $9.48 39.83%Preventive and Administrative Care $1,167,368.65 2.618 $58.71 $12.81 2.824 $56.01 $13.18 -2.84%Otolaryngology $1,062,173.53 2.599 $53.82 $11.66 2.926 $38.80 $9.46 23.19%Dermatology $916,046.05 1.859 $64.90 $10.05 1.780 $52.57 $7.80 28.94%Gynecology $906,611.14 4.889 $24.42 $9.95 3.924 $22.75 $7.44 33.74%Ophthalmology $806,139.71 1.432 $74.11 $8.85 1.433 $56.04 $6.69 32.18%Obstetrics $744,383.00 1.834 $53.44 $8.17 1.957 $47.72 $7.78 4.97%Neurology $726,000.44 2.582 $37.02 $7.97 2.312 $36.11 $6.96 14.54%Pulmonology $443,089.51 0.853 $68.42 $4.86 1.067 $44.18 $3.93 23.83%Urology $369,697.58 1.485 $32.78 $4.06 1.383 $29.15 $3.36 20.77%Other $362,276.91 1.622 $29.41 $3.98 1.183 $21.60 $2.13 86.67%Isolated Signs/Symptoms $360,505.62 1.105 $42.97 $3.96 0.960 $38.43 $3.07 28.66%Hepatology $255,813.66 1.050 $32.09 $2.81 0.723 $27.82 $1.68 67.47%Hematology $136,113.46 2.447 $7.32 $1.49 0.772 $15.04 $0.97 54.43%Nephrology $127,388.18 0.386 $43.42 $1.40 0.387 $30.55 $0.99 41.78%Chemical dependency $121,677.65 0.252 $63.71 $1.34 0.288 $38.04 $0.91 46.39%Neonatology $118,585.24 0.092 $170.63 $1.30 0.145 $112.41 $1.36 -4.17%Infectious diseases $100,041.31 0.208 $63.28 $1.10 0.773 $28.10 $1.81 -39.39%Late effects/Complications $65,357.98 0.207 $41.50 $0.72 0.201 $29.22 $0.49 46.82%Total $19,894,723 58.957 $44.44 $218.32 54.112 $36.95 $166.62 31.03%



AggregatePrior Year Actual



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Medical Professional PMPM by Major Practice Category


C Current Year P Prior YearC Current Aggregate P Prior Aggregate

Report Period: 2/1/2018 12:00:00 ARun Date: 02/12/2018


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Medical Professional Utilization by Service Category

Service Category ClaimsUnits perMember

Paid perUnit PMPM

Units perMember

Paid perUnit PMPM

Variance inPMPM

PMPMTREND

Office Visit $4,306,561 3.406 $164.28 $46.63 3.069 $125.32 $32.05 45.49% -0.09%

Surgery $4,303,363 18.109 $30.88 $46.60 17.565 $26.35 $38.58 20.80% 8.95%

Radiology / Lab / Pathology $3,280,676 9.890 $43.10 $35.52 8.653 $39.68 $28.61 24.17% -11.02%

Injections / Immunizations / IV Therapy $2,226,484 16.493 $17.54 $24.11 14.573 $17.26 $20.97 14.99% -18.38%

Hospital / Institutional Visits $1,158,353 0.540 $278.58 $12.54 0.486 $239.57 $9.71 29.17% 6.36%

Mental Health $1,125,598 2.273 $64.35 $12.19 1.996 $55.22 $9.19 32.69% 16.65%

Other Visits / Procedures $1,124,115 1.861 $78.49 $12.17 1.963 $55.25 $9.04 34.68% 4.20%

Physical Exam $869,371 0.538 $209.89 $9.41 0.550 $205.78 $9.43 -0.15% 6.93%

Physical Therapy / Chiropractic $517,107 2.893 $23.23 $5.60 3.034 $21.90 $5.54 1.12% 5.66%

Maternity Care and Delivery $402,851 0.050 $1,049.09 $4.36 0.055 $975.62 $4.46 -2.13% 6.08%

Routine Eye Care $332,774 0.339 $127.60 $3.60 0.333 $106.40 $2.96 21.90% 2.56%

Allergy / Dermatology $187,620 0.939 $25.95 $2.03 0.669 $18.33 $1.02 98.77% 34.44%

Chemotherapy $55,064 0.035 $205.46 $0.60 0.053 $151.90 $0.67 -10.82% -41.75%

Consults $38,472 0.043 $115.88 $0.42 0.039 $143.06 $0.47 -10.74% -17.65%

Supplies $31,786 0.425 $9.71 $0.34 0.752 $5.29 $0.33 3.92% -12.82%

E-Visits $20,394 0.062 $42.85 $0.22 0.080 $47.10 $0.31 -29.64% 4.76%

Chemical Health $14,628 0.051 $37.22 $0.16 0.085 $23.03 $0.16 -3.16% 23.08%

Total $19,995,217 57.948 $44.84 $216.51 53.956 $38.58 $173.48 24.80% -0.83%





120_Ex_Professional_by_CategoryReport Id: 43735

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Paid perUnit PMPM

Units perMember

Paid perUnit PMPM

Variance inPMPM

Office Visit $4,252,744 3.458 $161.97 $46.67 3.086 $120.72 $31.05 50.32%

Surgery $3,897,323 18.709 $27.43 $42.77 17.781 $24.87 $36.84 16.08%

Radiology / Lab / Pathology $3,637,518 11.008 $43.52 $39.92 8.766 $38.20 $27.91 43.04%

Injections / Immunizations / IV Therapy $2,692,177 16.351 $21.68 $29.54 14.801 $16.14 $19.91 48.41%

Hospital / Institutional Visits $1,074,584 0.511 $277.10 $11.79 0.511 $222.61 $9.48 24.36%

Other Visits / Procedures $1,064,533 1.902 $73.71 $11.68 1.877 $55.70 $8.71 34.10%

Mental Health $952,127 1.847 $67.90 $10.45 1.725 $56.43 $8.11 28.79%

Physical Exam $801,627 0.509 $207.19 $8.80 0.531 $205.17 $9.08 -3.07%

Physical Therapy / Chiropractic $483,054 2.653 $23.97 $5.30 2.949 $21.51 $5.29 0.29%

Maternity Care and Delivery $374,089 0.067 $732.07 $4.11 0.054 $961.86 $4.36 -5.87%

Routine Eye Care $320,026 0.343 $122.90 $3.51 0.334 $103.75 $2.89 21.55%

Allergy / Dermatology $137,320 0.848 $21.31 $1.51 0.716 $17.22 $1.03 46.54%

Chemotherapy $93,673 0.046 $267.64 $1.03 0.048 $177.49 $0.71 45.29%

Consults $46,683 0.048 $127.55 $0.51 0.036 $144.85 $0.43 18.47%

Supplies $35,626 0.563 $8.33 $0.39 0.731 $5.49 $0.33 16.89%

E-Visits $19,416 0.064 $40.12 $0.21 0.078 $51.58 $0.33 -36.26%

Chemical Health $12,206 0.030 $53.77 $0.13 0.087 $22.62 $0.16 -18.72%

Total $19,894,723 58.957 $44.44 $218.32 54.112 $36.95 $166.62 31.03%






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Medical Professional PMPM by Service Category




120_Ex_Professional_by_Report Id: 43735

Page 9 of 109



Medical Inpatient Utilization by Major Practice Category

Major Practice Category ClaimsAdmits

per 1000Paid per

AdmitDays

per 1000 PMPMAdmits per

1000Paid Per

AdmitDays

per 1000 PMPMVariancein PMPM

PMPMTrend

Cardiology $1,590,160 6.1 $33,833 28.2 $17.22 4.4 $30,307 20.2 $11.22 53.44% 4.87%Orthopedic and Arthritic Conditions $1,397,069 7.1 $25,401 27.2 $15.13 7.7 $23,233 33.0 $14.83 2.02% -22.25%Obstetrics $798,590 13.4 $7,753 31.1 $8.65 13.6 $7,697 34.0 $8.72 -0.84% -5.88%Gastroenterology $467,811 4.2 $14,619 14.2 $5.07 4.0 $15,514 14.9 $5.19 -2.35% -26.52%Cancer $413,951 2.2 $24,350 12.3 $4.48 3.3 $26,299 16.2 $7.25 -38.14% 1.82%Psychiatry $408,136 4.2 $12,754 28.8 $4.42 4.0 $14,725 44.3 $4.87 -9.33% 108.49%Infectious diseases $359,191 1.9 $23,946 10.7 $3.89 2.0 $23,021 11.0 $3.80 2.46% 30.98%Neurology $349,732 2.9 $15,897 28.6 $3.79 2.8 $23,626 23.5 $5.58 -32.16% -30.59%Chemical dependency $347,895 4.2 $10,872 57.6 $3.77 2.4 $11,319 36.3 $2.24 67.85% 114.20%Endocrinology $294,229 2.2 $17,308 5.6 $3.19 1.7 $18,945 6.5 $2.75 15.77% 39.30%Pulmonology $253,887 2.6 $12,694 19.0 $2.75 2.9 $19,303 15.7 $4.67 -41.07% -33.25%Neonatology $199,812 9.2 $2,814 20.0 $2.16 10.9 $7,882 35.0 $7.16 -69.78% -55.83%Gynecology $184,075 1.7 $14,160 3.6 $1.99 0.6 $14,353 1.4 $0.77 157.88% 32.67%Urology $107,300 1.0 $13,412 3.6 $1.16 0.9 $11,220 3.0 $0.84 37.82% -25.16%Dermatology $98,674 1.2 $10,964 5.1 $1.07 1.0 $9,876 5.0 $0.80 33.60% -44.27%Hepatology $94,954 1.6 $7,913 4.8 $1.03 1.5 $19,332 5.9 $2.35 -56.22% -83.62%Late effects/Complications $71,686 0.9 $10,241 1.9 $0.78 0.7 $18,202 2.5 $1.09 -28.56% 14.71%Otolaryngology $43,079 0.6 $8,616 1.6 $0.47 0.6 $13,043 1.4 $0.70 -33.06% 0.00%Hematology $32,628 0.5 $8,157 0.9 $0.35 0.4 $12,913 1.1 $0.42 -14.88% 0.00%Other $18,845 0.1 $18,845 0.8 $0.20 0.1 $27,066 0.3 $0.12 64.19% 1,900.00%Nephrology $12,947 0.1 $12,947 0.3 $0.14 0.6 $21,997 3.2 $1.05 -86.61% -83.33%Ophthalmology $10,097 0.1 $10,097 0.4 $0.11 0.1 $17,939 0.3 $0.11 -2.66% 0.00%Preventive and Administrative Care $1,272 0.0 $0 0.0 $0.01 0.1 $19,510 0.8 $0.13 -89.43% -50.00%Isolated Signs/Symptoms $0 0.0 $0 0.0 $0.00 0.0 $25,379 0.1 $0.04 -100.00% 0.00%Total $7,556,020 68.1 $14,420 306.1 $81.82 66.2 $15,704 315.4 $86.70 -5.63% -12.34%





© Copyright 2018 HealthPartners130_Ex_Inpatient_by_MPCReport Id: 43735

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per 1000Paid per

AdmitDays


1000Paid Per

AdmitDays


Orthopedic and Arthritic Conditions $1,773,186 9.7 $23,962 36.5 $19.46 7.9 $21,023 34.9 $13.87 40.33%Cardiology $1,496,020 4.5 $44,001 22.3 $16.42 4.8 $27,763 23.1 $11.05 48.57%Obstetrics $837,155 12.9 $8,542 38.5 $9.19 13.6 $7,472 34.3 $8.45 8.68%Gastroenterology $628,406 5.3 $15,710 19.6 $6.90 3.5 $14,629 13.4 $4.25 62.27%Hepatology $573,557 3.0 $24,937 13.7 $6.29 1.0 $18,183 3.8 $1.48 326.39%Neurology $497,313 3.3 $19,893 18.7 $5.46 3.5 $31,238 28.9 $9.18 -40.58%Neonatology $445,632 9.7 $6,022 27.8 $4.89 11.1 $5,397 30.4 $5.00 -2.28%Cancer $400,566 2.1 $25,035 6.6 $4.40 3.3 $27,983 17.3 $7.75 -43.27%Pulmonology $375,340 2.6 $18,767 16.2 $4.12 2.8 $19,061 12.9 $4.47 -7.96%Infectious diseases $270,533 1.2 $30,059 5.9 $2.97 1.3 $15,407 6.4 $1.70 74.25%Endocrinology $208,299 2.0 $13,887 4.6 $2.29 2.7 $26,078 13.4 $5.84 -60.83%Psychiatry $193,180 2.4 $10,732 13.7 $2.12 4.1 $13,332 37.3 $4.56 -53.54%Dermatology $174,614 0.5 $43,654 1.8 $1.92 0.6 $10,505 3.0 $0.49 292.14%Chemical dependency $160,748 2.5 $8,460 27.3 $1.76 2.3 $12,465 32.0 $2.34 -24.65%Urology $141,136 1.1 $17,642 2.6 $1.55 0.8 $14,058 2.6 $0.90 71.96%Gynecology $136,934 1.3 $13,693 2.8 $1.50 0.7 $14,383 1.7 $0.88 70.06%Nephrology $76,540 0.8 $12,757 2.9 $0.84 0.8 $32,235 5.7 $2.11 -60.15%Late effects/Complications $62,148 0.7 $12,430 2.8 $0.68 0.6 $16,129 2.0 $0.84 -19.03%Otolaryngology $42,794 0.4 $14,265 1.2 $0.47 0.7 $18,407 2.7 $1.01 -53.49%Ophthalmology $9,718 0.1 $9,718 0.1 $0.11 0.1 $11,449 0.2 $0.07 51.62%Preventive and Administrative Care $1,590 0.0 $0 0.0 $0.02 0.5 $25,214 2.8 $1.02 -98.29%Other $914 0.0 $0 0.0 $0.01 0.1 $34,732 0.9 $0.21 -95.30%Hematology $0 0.0 $0 0.0 $0.00 0.5 $16,356 1.9 $0.63 -100.00%Isolated Signs/Symptoms $0 0.0 $0 0.0 $0.00 0.0 $13,307 0.1 $0.04 -100.00%Total $8,506,323 66.1 $16,945 265.5 $93.34 67.2 $15,752 311.8 $88.15 5.89%






Page 11 of 109



Medical Top 10 Inpatient PMPM by Major Practice Category


C Current Year P Prior YearC Current Aggregate P Current Aggregate



Page 12 of 109



Medical Inpatient Utilization by Service Category

Service Category ClaimsAdmits

per 1000Paid Per

AdmitDays per

1000 PMPMAdmits per

1000Paid per

AdmitDays per

1000 PMPMVariancein PMPM

PMPMTrend

Surgical $3,522,949 15.1 $30,370 48.7 $38.15 15.0 $32,424 54.9 $40.41 -5.61% -27.37%

Medical $1,768,857 19.2 $11,952 59.6 $19.15 17.8 $12,885 60.7 $19.08 0.37% 8.99%

Maternity $798,596 13.4 $7,753 31.1 $8.65 13.6 $7,667 33.9 $8.67 -0.30% -5.88%

Mental Health $366,483 3.8 $12,637 24.8 $3.97 3.4 $13,131 23.8 $3.74 6.15% 198.50%

Chemical Health $346,883 4.0 $11,190 59.0 $3.76 2.7 $13,873 54.7 $3.12 20.56% 102.15%

Other Treatments $302,050 1.2 $33,561 4.3 $3.27 0.6 $42,847 2.3 $2.24 46.29% -29.53%

Non-Acute $262,861 2.3 $14,603 58.7 $2.85 2.3 $11,442 50.1 $2.22 28.15% 114.29%

Newborn $187,341 9.1 $2,676 19.9 $2.03 10.9 $7,960 35.0 $7.21 -71.88% -58.49%

Total $7,556,020 68.1 $14,420 306.1 $81.82 66.2 $15,704 315.4 $86.70 -5.63% -12.34%


Aggregate


Current Year Actual


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Page 13 of 109





per 1000Paid Per

AdmitDays per

1000 PMPMAdmits per

1000Paid per

AdmitDays per


Surgical $4,787,321 19.5 $32,347 74.1 $52.53 16.0 $31,569 61.0 $42.07 24.87%

Medical $1,600,847 16.3 $12,910 58.7 $17.57 17.5 $13,841 63.8 $20.20 -13.04%

Maternity $837,155 12.9 $8,542 38.5 $9.19 13.5 $7,434 34.5 $8.38 9.67%

Newborn $445,243 9.7 $6,017 27.8 $4.89 11.3 $6,787 34.0 $6.39 -23.52%

Other Treatments $423,252 0.9 $60,465 5.0 $4.64 0.6 $52,508 2.9 $2.65 75.29%

Chemical Health $169,640 2.5 $8,928 27.9 $1.86 2.4 $14,608 42.5 $2.93 -36.45%

Mental Health $121,582 2.0 $8,105 7.2 $1.33 3.1 $11,866 20.9 $3.04 -56.05%

Non-Acute $121,283 2.2 $7,134 26.2 $1.33 2.7 $10,907 52.1 $2.50 -46.73%

Total $8,506,323 66.1 $16,945 265.5 $93.34 67.2 $15,752 311.8 $88.15 5.89%


Aggregate


Prior Year Actual



Page 14 of 109



Medical Inpatient PMPM by Service Category




140_Ex_Inpatient_By_CateReport Id: 43735

Page 15 of 109



Medical Outpatient Utilization by Major Practice Category

Major Practice Category ClaimsUnits per

1000Paid per

Unit PMPMUnits per

1000Paid Per

Unit PMPMVariancein PMPM

PMPMTrend

Cancer $1,590,957 6,172 $33.49 $17.23 5,286 $35.83 $15.78 9.14% -4.22%Orthopedic and Arthritic Conditions $1,410,380 2,247 $81.56 $15.27 3,057 $70.42 $17.94 -14.87% -16.51%Cardiology $1,182,830 2,862 $53.70 $12.81 2,416 $50.35 $10.14 26.33% -2.21%Gastroenterology $904,618 2,391 $49.16 $9.80 2,466 $54.07 $11.11 -11.85% 5.04%Gynecology $700,332 1,379 $66.01 $7.58 1,022 $64.09 $5.46 38.89% -2.57%Otolaryngology $559,177 1,047 $69.39 $6.05 846 $79.83 $5.63 7.63% 46.14%Psychiatry $407,974 667 $79.43 $4.42 606 $91.46 $4.62 -4.35% -1.34%Nephrology $398,193 7,391 $7.00 $4.31 1,954 $14.41 $2.35 83.77% -20.77%Endocrinology $382,805 1,905 $26.11 $4.15 1,109 $30.81 $2.85 45.55% 5.87%Chemical dependency $359,377 728 $64.14 $3.89 412 $57.21 $1.96 98.25% 76.82%Neurology $349,250 1,228 $36.97 $3.78 1,713 $35.67 $5.09 -25.74% -9.79%Urology $324,628 864 $48.83 $3.52 750 $54.33 $3.39 3.54% 17.73%Ophthalmology $236,559 471 $65.20 $2.56 416 $68.18 $2.36 8.39% 4.07%Hepatology $224,131 643 $45.28 $2.43 525 $44.01 $1.93 25.95% 17.96%Preventive and Administrative Care $210,958 293 $93.63 $2.28 335 $89.57 $2.50 -8.61% -6.17%Dermatology $192,116 350 $71.29 $2.08 443 $53.31 $1.97 5.78% 31.65%Pulmonology $144,613 654 $28.73 $1.57 577 $34.12 $1.64 -4.57% -14.21%Obstetrics $102,488 232 $57.38 $1.11 310 $65.98 $1.70 -34.87% -15.91%Isolated Signs/Symptoms $101,159 235 $56.04 $1.10 171 $65.05 $0.93 18.20% 26.44%Late effects/Complications $53,202 107 $64.49 $0.58 103 $42.13 $0.36 59.65% 11.54%Neonatology $51,783 59 $114.56 $0.56 137 $36.84 $0.42 33.77% 250.00%Hematology $48,360 984 $6.39 $0.52 927 $7.98 $0.62 -15.09% -24.64%Other $25,404 781 $4.23 $0.28 816 $8.99 $0.61 -55.03% -20.00%Infectious diseases $20,843 106 $25.54 $0.23 176 $31.17 $0.46 -50.56% -4.17%Total $9,982,138 33,796 $38.38 $108.09 26,572 $45.98 $101.81 6.16% -0.23%





© Copyright 2018 HealthPartners150_EX_Outpatient_by_MPCReport Id: 43735

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1000Paid per

Unit PMPMUnits per

1000Paid Per


Orthopedic and Arthritic Conditions $1,666,372 3,149 $69.69 $18.29 3,154 $63.00 $16.56 10.44%Cancer $1,639,278 4,708 $45.85 $17.99 5,501 $32.77 $15.02 19.76%Cardiology $1,193,424 3,022 $52.00 $13.10 3,101 $48.99 $12.66 3.45%Gastroenterology $849,996 2,296 $48.74 $9.33 2,170 $49.87 $9.02 3.42%Gynecology $708,736 1,758 $53.09 $7.78 829 $57.08 $3.94 97.28%Nephrology $496,025 4,644 $14.06 $5.44 1,614 $17.72 $2.38 128.41%Psychiatry $408,318 686 $78.34 $4.48 761 $77.20 $4.90 -8.53%Neurology $381,450 1,274 $39.43 $4.19 1,370 $42.42 $4.84 -13.57%Otolaryngology $377,537 626 $79.40 $4.14 934 $64.74 $5.04 -17.80%Endocrinology $356,886 1,691 $27.80 $3.92 1,604 $37.35 $4.99 -21.57%Urology $272,490 716 $50.10 $2.99 691 $47.74 $2.75 8.74%Ophthalmology $223,920 364 $81.01 $2.46 371 $64.40 $1.99 23.38%Preventive and Administrative Care $221,219 292 $99.92 $2.43 408 $69.10 $2.35 3.45%Chemical dependency $200,295 535 $49.30 $2.20 571 $55.75 $2.65 -17.16%Hepatology $188,020 607 $40.78 $2.06 337 $42.26 $1.19 73.66%Pulmonology $166,382 629 $34.82 $1.83 833 $41.35 $2.87 -36.41%Dermatology $143,631 341 $55.54 $1.58 473 $51.06 $2.01 -21.65%Obstetrics $120,163 257 $61.46 $1.32 237 $71.68 $1.42 -7.01%Isolated Signs/Symptoms $79,692 159 $66.08 $0.87 230 $66.82 $1.28 -31.61%Hematology $63,075 1,697 $4.89 $0.69 787 $18.60 $1.22 -43.30%Late effects/Complications $47,467 100 $62.54 $0.52 97 $42.71 $0.35 50.42%Other $31,497 762 $5.44 $0.35 2 $87.48 $0.02 1,960.47%Infectious diseases $22,286 89 $33.07 $0.24 133 $50.25 $0.56 -56.20%Neonatology $15,030 13 $147.36 $0.16 161 $34.28 $0.46 -64.06%Total $9,873,188 30,416 $42.74 $108.34 26,371 $45.72 $100.47 7.84%






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Medical Outpatient PMPM by Major Practice Category





Page 18 of 109



Medical Outpatient Utilization by Service Category

Service Category ClaimsUnits per

1000Paid per

Unit PMPMUnits per

1000Paid per

Unit PMPMVariance in

PMPMPMPMTrend

Surgery $4,061,530 9,330 $56.56 $43.98 8,525 $61.12 $43.42 1.29% 6.46%

Other Treatments $1,807,156 12,856 $18.27 $19.57 8,548 $25.66 $18.28 7.07% -13.02%

Emergency Room $1,552,066 4,457 $45.25 $16.81 3,883 $42.81 $13.85 21.31% 10.01%

Radiology $1,172,080 4,436 $34.34 $12.69 3,313 $43.17 $11.92 6.48% -7.37%

Cardiovascular $523,571 93 $732.27 $5.67 92 $544.88 $4.19 35.41% 5.19%

Physical Therapy / Chiropractic $240,441 435 $71.75 $2.60 551 $73.16 $3.36 -22.47% -2.26%

Chemical Health $204,291 381 $69.68 $2.21 202 $72.05 $1.21 82.28% 45.39%

Lab $187,230 696 $34.98 $2.03 733 $43.44 $2.65 -23.63% -10.18%

Mental Health $177,094 63 $363.64 $1.92 83 $310.13 $2.14 -10.49% -2.54%

Observation/Non-Invasive Procedures $38,580 114 $44.14 $0.42 88 $56.13 $0.41 1.43% -68.66%

Pharmacy, Hospital or Clinic $18,099 936 $2.51 $0.20 554 $8.25 $0.38 -48.54% -52.38%

Total $9,982,138 33,796 $38.38 $108.09 26,572 $45.98 $101.81 6.16% -0.23%


Aggregate


Current Year Actual


160_Ex_Outpatient_by_CategoryReport Id: 43735

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1000Paid per

Unit PMPMUnits per

1000Paid per


PMPM

Surgery $3,764,480 8,942 $55.44 $41.31 8,287 $61.13 $42.21 -2.14%

Other Treatments $2,050,536 10,851 $24.88 $22.50 8,499 $26.60 $18.84 19.43%

Emergency Room $1,392,672 4,061 $45.16 $15.28 3,904 $43.37 $14.11 8.31%

Radiology $1,248,459 3,932 $41.81 $13.70 3,099 $43.97 $11.35 20.66%

Cardiovascular $491,058 99 $650.41 $5.39 90 $517.12 $3.88 38.76%

Physical Therapy / Chiropractic $242,006 513 $62.18 $2.66 614 $67.69 $3.47 -23.37%

Lab $206,004 696 $38.97 $2.26 728 $42.41 $2.57 -12.10%

Mental Health $179,430 73 $325.64 $1.97 78 $303.49 $1.97 -0.01%

Chemical Health $138,124 243 $74.90 $1.52 196 $75.43 $1.23 23.09%

Observation/Non-Invasive Procedures $122,170 231 $69.53 $1.34 113 $53.81 $0.51 164.00%

Pharmacy, Hospital or Clinic $38,249 775 $6.50 $0.42 763 $4.99 $0.32 32.23%

Total $9,873,188 30,416 $42.74 $108.34 26,371 $45.72 $100.47 7.84%


Aggregate


Prior Year Actual



Page 20 of 109



Medical Outpatient PMPM by Service Category




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Pharmacy Trend Report

Group Actual Current YearMeasure Prior Year Current Year %Change Prior Year Current Year VarianceTotal Pharmacy PMPM (PL+ML) $106.94 $112.34 5.05% $86.63 $89.45 25.59%Rx Paid PMPM (Plan Paid) $95.27 $100.74 5.74% $76.54 $79.46 26.78%Total Pharmacy (PL+ML) $9,745,424 $10,374,949 6.46% Total Prescriptions 30 day Rx 118,962 120,847 1.58% Total Members w/Rx benefit 7,594 7,696 1.34% Average Ingredient Cost/Rx $78.36 $81.79 4.38% $72.09 $74.31 10.05%Average Generic Ingredient Cost/Rx $25.91 $24.16 -6.76% $22.60 $21.33 13.29%Average Brand Ingredient Cost/Rx $548.22 $650.02 18.57% $490.76 $586.77 10.78%Average Brand Ingredient Cost/Rx(Without Specialty Drugs) $320.78 $354.29 10.45% $287.31 $313.36 13.06%

Average Brand Ingredient Cost/Rx(Specialty Drugs only) $4,626.26 $5,347.56 15.59% $4,697.29 $5,128.96 4.26%

Average Rx/Member/Year 15.67 15.70 0.24% 13.89 13.88 13.15%Average Days Supply/Rx 26.48 26.43 -0.19% 26.25 26.26 0.63%Copay as Percent of Total Pharmacy 10.91% 10.33% -5.36% 11.64% 11.17% -7.54%Average Generic Copay/Rx $6.35 $6.47 1.76% $5.89 $5.89 9.87%Average Brand Copay/Rx $32.11 $32.54 1.35% $32.63 $35.29 -7.78%% Generic Use 89.96% 90.79% 0.93% 89.43% 90.63% 0.18%% Non-Formulary 2.34% 2.09% -10.58% 3.24% 2.78% -24.83%



Aggregate

Report Period: 2/1/2018 12:00:00 Run Date: 02/12/2018

© Copyright 2018 HealthPartners178_Ex_Pharmacy_TrendReport Id: 43735

Page 22 of 109



Pharmacy Utilization by Therapeutic Class

Current Year Actual Aggregate

Therapeutic ClassPercentGeneric Paid PMPM

Paid perRx

Rx perMember

PercentGeneric

PaidPMPM

Paid perRx

Rx perMember

Variancein PMPM

PMPMTrend

Multiple Sclerosis 25.11% $1,339,493 $14.50 $5,798.67 0.03 10.45% $6.78 $5,768.76 0.01 113.92% -0.21%Chronic Inflammatory Disease 53.35% $1,277,194 $13.83 $1,946.94 0.09 53.52% $13.85 $2,128.11 0.08 -0.17% 15.06%Diabetes 62.72% $1,082,516 $11.72 $153.37 0.92 59.23% $9.62 $161.77 0.71 21.82% 10.25%Oncology 94.16% $656,370 $7.11 $851.32 0.10 93.66% $5.83 $706.98 0.10 21.93% 39.96%HIV 2.92% $654,097 $7.08 $1,591.48 0.05 3.61% $2.46 $1,661.58 0.02 187.57% 26.88%Stimulants 90.01% $520,190 $5.63 $161.85 0.42 86.02% $4.70 $159.65 0.35 19.79% -12.03%Asthma 32.77% $472,970 $5.12 $108.63 0.57 33.90% $4.52 $108.02 0.50 13.30% 10.82%OTHER 94.10% $404,250 $4.38 $53.02 0.99 92.99% $3.43 $49.53 0.83 27.78% 2.82%Dermatology 95.76% $289,375 $3.13 $95.13 0.40 94.17% $3.28 $118.07 0.33 -4.35% -12.81%Cystic Fibrosis 0.00% $184,735 $2.00 $5,598.02 0.00 6.67% $2.47 $4,921.40 0.01 -19.08% 173.97%Pulmonary Hypertension 0.00% $167,955 $1.82 $6,459.81 0.00 0.00% $0.43 $6,642.33 0.00 326.60% 18.18%Anticonvulsants 93.54% $158,632 $1.72 $41.16 0.50 91.98% $1.69 $54.21 0.37 1.72% -12.24%Hepatitis 79.31% $152,296 $1.65 $5,251.58 0.00 68.87% $0.96 $8,077.80 0.00 72.55% 34.15%Antidepressants 98.49% $151,611 $1.64 $10.52 1.87 98.66% $1.60 $10.78 1.78 2.34% 3.14%Ophthalmics 72.11% $146,363 $1.58 $85.39 0.22 74.49% $1.32 $67.18 0.24 19.76% 23.44%Contraceptives 94.50% $145,272 $1.57 $29.69 0.64 94.13% $1.86 $28.10 0.80 -15.57% 1.29%Inflammatory Bowel 26.06% $144,416 $1.56 $875.25 0.02 40.20% $1.26 $753.60 0.02 23.94% 3.31%Antipsychotics 91.54% $109,472 $1.19 $111.59 0.13 92.02% $0.94 $112.26 0.10 25.75% -7.03%Narcotic Analgesics 94.86% $105,462 $1.14 $32.10 0.43 95.37% $0.71 $26.21 0.33 60.89% -7.32%HRT 71.99% $104,970 $1.14 $60.75 0.22 69.86% $0.97 $62.63 0.19 16.93% 2.70%Anticoagulants 71.35% $92,592 $1.00 $123.95 0.10 70.66% $1.15 $115.67 0.12 -12.52% -3.85%Hypertension/Cardiac 99.81% $86,098 $0.93 $3.91 2.86 99.63% $0.92 $4.52 2.44 1.49% 1.09%Antibiotics 99.56% $83,861 $0.91 $14.60 0.75 99.72% $0.80 $12.88 0.74 14.14% -12.50%



© Copyright 2018 HealthPartners179_Ex_Pharmacy_by_ClassReport Id: 43735

Page 23 of 109



Pharmacy Utilization by Therapeutic ClassCurrent Year Actual Aggregate


Paid perRx

Rx perMember

PercentGeneric

PaidPMPM

Paid perRx

Rx perMember

Variancein PMPM

PMPMTrend

Migraines 93.82% $75,958 $0.82 $97.76 0.10 94.16% $0.63 $79.21 0.09 31.31% 7.89%Smoking Cessation 53.81% $73,913 $0.80 $194.00 0.05 51.06% $0.42 $198.99 0.03 88.71% 29.03%Cholesterol 99.43% $63,116 $0.68 $7.14 1.15 99.06% $0.72 $8.33 1.04 -5.38% -53.42%Ulcer/GERD 97.85% $62,057 $0.67 $11.31 0.71 97.65% $0.41 $8.96 0.55 64.93% -46.40%Androgens 72.87% $59,767 $0.65 $317.91 0.02 58.42% $0.52 $311.16 0.02 25.56% -13.33%Immunosuppressants 98.14% $59,737 $0.65 $185.52 0.04 92.20% $0.41 $132.97 0.04 57.82% 58.54%Immune Globulins 0.00% $42,265 $0.46 $3,251.12 0.00 0.00% $0.02 $3,258.90 0.00 1,835.56% 9.52%Over Active Bladder 90.49% $34,232 $0.37 $72.37 0.06 83.63% $0.35 $87.47 0.05 6.94% -26.00%Growth Hormones 0.00% $31,660 $0.34 $1,758.88 0.00 0.00% $1.21 $3,082.56 0.00 -71.65% 21.43%Erectile Dysfunction 79.87% $31,411 $0.34 $66.55 0.06 81.44% $0.22 $51.62 0.05 51.89% -44.26%Osteoporosis 94.19% $30,547 $0.33 $98.54 0.04 96.37% $0.33 $93.30 0.04 0.68% -58.75%Antiplatelets 84.69% $29,758 $0.32 $73.48 0.05 85.78% $0.22 $54.80 0.05 48.34% 3.23%Antivirals 95.11% $27,508 $0.30 $30.56 0.12 96.69% $0.27 $29.81 0.11 9.09% -16.67%Allergy 97.52% $27,350 $0.30 $9.30 0.38 97.53% $0.26 $10.03 0.32 11.89% 7.14%Biliary Cirrhosis 100.00% $18,719 $0.20 $301.92 0.01 100.00% $0.07 $238.00 0.00 211.43% 33.33%Thyroid 92.14% $18,516 $0.20 $3.56 0.67 88.95% $0.31 $5.97 0.62 -34.74% 5.26%Parkinsons Disease 96.07% $14,814 $0.16 $38.78 0.05 97.16% $0.16 $38.14 0.05 -1.65% 77.78%Infertility 46.15% $14,648 $0.16 $225.35 0.01 40.33% $0.30 $389.81 0.01 -47.21% -20.00%NSAIDS/COX-2 99.18% $13,086 $0.14 $8.94 0.19 99.86% $0.11 $8.39 0.16 23.40% -48.15%Hypnotics 98.56% $11,869 $0.13 $13.14 0.12 98.31% $0.12 $14.73 0.10 4.62% 0.00%Corticosteroids 98.63% $10,527 $0.11 $8.01 0.17 99.42% $0.22 $14.67 0.18 -47.37% 0.00%Antifungals 98.69% $10,315 $0.11 $19.25 0.07 99.76% $0.10 $20.42 0.06 10.47% -42.11%Antianxiety 99.87% $7,674 $0.08 $3.28 0.30 99.78% $0.09 $4.65 0.23 -6.47% 14.29%Alzheimers Disease 100.00% $3,823 $0.04 $46.63 0.01 98.42% $0.04 $32.88 0.01 14.95% -20.00%




Page 24 of 109





Paid perRx

Rx perMember

PercentGeneric

PaidPMPM

Paid perRx

Rx perMember

Variancein PMPM

PMPMTrend

Blood Modiefiers 0.00% $0 $0.00 $0.00 0.00 0.00% $0.00 $0.00 0.00 0.00% -100.00%

Total 180.75% $9,303,463 $100.74 $76.99 1.31 180.06% $79.06 $68.37 13.88 27.42% 5.74%



SPECIALTY 15.40% $4,010,978 $43.43 $5,148.88 0.10 8.08% $33.42 $4,992.44 0.08 29.96% 16.75%



Page 25 of 109




Prior Year Actual Aggregate


Paid perRx

Rx perMember

PercentGeneric

PaidPMPM

Paid perRx

Rx perMember

Variancein PMPM

Multiple Sclerosis 23.17% $1,324,418 $14.53 $5,383.81 0.032 11.75% $6.34 $5,291.19 0.014 129.28%Chronic Inflammatory Disease 56.30% $1,095,596 $12.02 $1,703.88 0.085 70.84% $11.10 $1,206.14 0.110 8.30%Diabetes 64.36% $968,679 $10.63 $144.41 0.883 59.68% $8.90 $153.45 0.696 19.45%Stimulants 87.33% $583,303 $6.40 $189.51 0.405 83.72% $4.95 $173.78 0.342 29.29%HIV 4.46% $508,727 $5.58 $1,417.07 0.047 0.00% $0.00 $0.00 0.000 0.00%Oncology 96.07% $462,506 $5.08 $605.37 0.101 89.76% $5.29 $1,064.58 0.060 -4.10%Asthma 32.13% $420,623 $4.62 $99.44 0.557 32.41% $4.28 $104.52 0.492 7.74%OTHER 92.32% $387,809 $4.26 $53.29 0.958 92.09% $3.55 $52.51 0.812 19.74%Dermatology 94.03% $327,034 $3.59 $111.50 0.386 92.38% $3.36 $117.83 0.342 6.83%Anticonvulsants 92.15% $178,201 $1.96 $48.57 0.483 91.51% $1.65 $54.06 0.367 18.44%Antidepressants 98.08% $144,744 $1.59 $10.37 1.838 98.19% $1.83 $12.81 1.712 -13.10%Contraceptives 94.61% $141,653 $1.55 $27.94 0.668 93.40% $1.92 $28.06 0.820 -18.93%Pulmonary Hypertension 0.00% $140,715 $1.54 $5,863.11 0.003 95.96% $0.46 $284.94 0.019 236.94%Inflammatory Bowel 4.71% $137,895 $1.51 $811.15 0.022 9.82% $1.19 $699.92 0.020 26.88%Cholesterol 94.72% $132,999 $1.46 $15.02 1.166 94.48% $1.51 $17.08 1.059 -3.22%Ophthalmics 69.48% $116,994 $1.28 $72.71 0.212 71.27% $1.24 $65.15 0.228 3.83%Antipsychotics 91.98% $116,694 $1.28 $111.35 0.138 90.02% $1.19 $145.01 0.099 7.43%Ulcer/GERD 97.47% $113,975 $1.25 $21.67 0.693 96.82% $0.61 $13.31 0.549 105.42%Hepatitis 71.88% $112,486 $1.23 $3,515.20 0.004 56.65% $1.63 $11,651.46 0.002 -24.43%Narcotic Analgesics 95.64% $112,282 $1.23 $32.40 0.456 95.28% $0.85 $28.32 0.359 45.36%HRT 65.26% $101,162 $1.11 $59.16 0.225 59.02% $1.09 $62.56 0.209 1.80%Antibiotics 99.71% $94,865 $1.04 $16.42 0.761 99.64% $0.97 $15.28 0.758 7.82%Anticoagulants 76.02% $94,608 $1.04 $113.44 0.110 77.65% $0.94 $95.72 0.118 9.93%




Page 26 of 109



Pharmacy Utilization by Therapeutic ClassPrior Year Actual Aggregate


Paid perRx

Rx perMember

PercentGeneric

PaidPMPM

Paid perRx

Rx perMember

Variancein PMPM

Hypertension/Cardiac 99.70% $84,162 $0.92 $3.81 2.907 99.28% $1.00 $4.86 2.456 -7.23%Osteoporosis 91.24% $73,038 $0.80 $164.13 0.059 96.99% $0.24 $61.22 0.046 240.84%Migraines 89.88% $68,958 $0.76 $95.64 0.095 91.94% $0.64 $81.90 0.094 17.45%Androgens 55.25% $67,999 $0.75 $375.68 0.024 55.93% $0.49 $315.57 0.019 52.85%Cystic Fibrosis 0.00% $66,631 $0.73 $1,448.50 0.006 6.07% $1.49 $3,663.44 0.005 -50.86%Smoking Cessation 53.82% $56,391 $0.62 $165.86 0.045 48.35% $0.35 $181.61 0.023 76.53%Erectile Dysfunction 44.44% $55,351 $0.61 $146.43 0.050 0.00% $0.51 $163.02 0.038 18.11%Over Active Bladder 86.68% $45,295 $0.50 $92.82 0.064 80.04% $0.43 $104.98 0.049 16.19%Immune Globulins 0.00% $38,367 $0.42 $3,197.29 0.002 0.00% $0.00 $0.00 0.000 0.00%Immunosuppressants 91.34% $37,028 $0.41 $133.68 0.036 86.84% $0.52 $166.51 0.038 -21.97%Antivirals 90.82% $33,215 $0.36 $39.59 0.110 80.28% $2.50 $242.62 0.123 -85.40%Antiplatelets 82.06% $27,937 $0.31 $66.83 0.055 87.10% $0.18 $44.84 0.049 66.44%Blood Modiefiers 0.00% $26,581 $0.29 $4,430.17 0.001 0.00% $0.26 $3,328.81 0.001 10.33%Growth Hormones 0.00% $25,815 $0.28 $1,843.92 0.002 0.00% $0.99 $3,006.40 0.004 -71.42%Allergy 97.97% $25,447 $0.28 $9.06 0.370 96.70% $0.30 $11.32 0.317 -6.70%NSAIDS/COX-2 98.77% $24,281 $0.27 $15.67 0.204 99.66% $0.19 $13.52 0.167 41.62%Infertility 40.63% $18,386 $0.20 $287.28 0.008 38.96% $0.37 $422.80 0.010 -44.92%Antifungals 98.51% $17,646 $0.19 $32.80 0.071 99.66% $0.10 $21.55 0.058 87.28%Thyroid 90.88% $17,237 $0.19 $3.47 0.654 87.87% $0.32 $6.09 0.622 -40.08%Biliary Cirrhosis 100.00% $13,224 $0.15 $330.61 0.005 100.00% $0.08 $283.89 0.003 90.91%Hypnotics 98.67% $12,152 $0.13 $11.53 0.139 97.80% $0.16 $17.62 0.110 -17.81%Corticosteroids 99.11% $10,329 $0.11 $7.69 0.177 99.36% $0.26 $18.58 0.171 -57.18%Parkinsons Disease 99.02% $8,108 $0.09 $19.83 0.054 97.08% $0.16 $35.22 0.055 -44.50%Antianxiety 99.82% $5,964 $0.07 $2.75 0.286 99.73% $0.08 $4.45 0.226 -22.05%




Page 27 of 109





Paid perRx

Rx perMember

PercentGeneric

PaidPMPM

Paid perRx

Rx perMember

Variancein PMPM

Alzheimers Disease 100.00% $4,425 $0.05 $83.50 0.007 95.79% $0.04 $33.46 0.013 31.89%

Total 180.75% $8,681,936 $95.27 $72.98 15.665 180.06% $76.51 $66.12 13.886 24.52%



SPECIALTY 14.61% $3,389,709 $37.20 $4,586.89 0.097 7.83% $28.02 $4,576.01 0.073 32.75%



Page 28 of 109



Top 10 Pharmacy PMPM by Therapeutic Class


C P Prior YearCurrent Year C Current Aggregate P Prior Aggregate



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Pharmacy Channel Management


Utilization and Trend Aggregate

Percent Total Rx Prior Year Current Year % Change Prior Year Current YearCurrent Year

Variance

% Retail 41.30% 40.62% -1.64% 42.62% 41.70% -2.58%

% Extended Retail, 3-month Rx 56.45% 57.25% 1.42% 55.73% 56.85% 0.70%

% Mail Order 1.63% 1.49% -8.86% 1.12% 0.88% 69.82%

% Specialty 0.62% 0.64% 3.77% 0.53% 0.58% 11.37%

Utilization and Trend


© Copyright 2018 HealthPartners Report Id: 43735179_Ex_Pharmacy_by_Class

Page 30 of 109





Chain Name % Total Rx Total Rx % Paid Paid % Total Rx % PaidVariance in

% PaidCVS PHARMACARE SPECIALTY PHARM 0.53% 627 34.08% $2,958,925 0.40% 29.05% 17.32%

WALGREENS 33.78% 40,187 21.91% $1,902,409 30.60% 21.11% 3.78%

HEALTHPARTNERS MAILORDER 12.56% 14,941 8.48% $736,383 8.88% 6.88% 23.25%

HEALTHPARTNERS 9.25% 11,003 7.02% $609,400 5.42% 4.57% 53.58%

TARGET 12.85% 15,285 5.90% $512,293 13.65% 7.90% -25.28%

Total 68.97% 82,043 77.40% $6,719,410 58.95% 69.51% 11.34%





% PaidPaid

TrendCVS PHARMACARE SPECIALTY PHARM 0.50% 609 33.05% $3,075,143 0.42% 31.28% 5.67% -3.02%

WALGREENS 34.32% 41,480 20.09% $1,869,078 31.67% 20.04% 0.27% -8.31%

HEALTHPARTNERS MAILORDER 12.62% 15,254 8.15% $758,697 8.07% 5.86% 39.20% -3.89%

HEALTHPARTNERS 8.97% 10,835 6.45% $599,658 4.99% 4.35% 48.13% -8.12%

TARGET 12.16% 14,695 5.51% $512,895 13.15% 7.01% -21.34% -6.61%

Total 68.58% 82,873 73.26% $6,815,472 58.30% 68.53% 9.13% -29.95%

Top 5 Pharmacy Chains



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Pharmacy Top 20 Drugs by Cost

Drug Therapeutic Brand / Rx Claims Paid / RxName Class Generic Prior Current %Change Prior Current %Change Prior Current %ChangeHumira* Chronic Inflammatory DisBrand 140 138 -1.43% $602,565 $649,631 7.81% $4,304.03 $4,707.47 9.37%Enbrel* Chronic Inflammatory DisBrand 80 94 17.50% $308,477 $382,245 23.91% $3,855.97 $4,066.44 5.46%Humalog Diabetes Brand 669 671 0.30% $323,298 $345,537 6.88% $483.26 $514.96 6.56%Rebif* Multiple Sclerosis Brand 50 48 -4.00% $305,781 $325,754 6.53% $6,115.62 $6,786.54 10.97%Adderall Stimulants Generic 964 948 -1.66% $259,259 $243,779 -5.97% $268.94 $257.15 -4.38%Tecfidera* Multiple Sclerosis Brand 26 32 23.08% $160,290 $219,754 37.10% $6,165.02 $6,867.30 11.39%Glatopa* Multiple Sclerosis Generic 57 55 -3.51% $223,093 $214,747 -3.74% $3,913.91 $3,904.50 -0.24%Advair Asthma Brand 580 584 0.69% $193,638 $208,504 7.68% $333.86 $357.03 6.94%Gilenya* Multiple Sclerosis Brand 33 28 -15.15% $220,534 $207,445 -5.94% $6,682.85 $7,408.76 10.86%Victoza Diabetes Brand 249 308 23.69% $148,653 $191,467 28.80% $597.00 $621.65 4.13%Copaxone* Multiple Sclerosis Brand 40 29 -27.50% $230,625 $185,588 -19.53% $5,765.62 $6,399.58 11.00%Basaglar Diabetes Brand 5 or Under 779 0.00% $0 $169,189 0.00% $0.00 $217.19 0.00%Aubagio* Multiple Sclerosis Brand 17 24 41.18% $98,981 $145,754 47.25% $5,822.41 $6,073.06 4.30%Ibrance* Oncology Brand 11 15 36.36% $94,364 $142,958 51.50% $8,578.52 $9,530.55 11.10%Kalydeco* Cystic Fibrosis Brand 5 or Under 6 0.00% $0 $142,106 0.00% $0.00 $23,684.27 0.00%Methylphenidate Stimulants Generic 843 773 -8.30% $139,735 $135,503 -3.03% $165.76 $175.30 5.76%Truvada HIV Brand 83 88 6.02% $119,500 $134,543 12.59% $1,439.76 $1,528.89 6.19%Xyrem* OTHER Brand 12 12 0.00% $121,218 $128,982 6.40% $10,101.51 $10,748.50 6.40%Letairis* Pulmonary Hypertension Brand 12 13 8.33% $104,155 $120,411 15.61% $8,679.57 $9,262.38 6.71%Imatinib* Oncology Generic 22 23 4.55% $155,575 $115,275 -25.90% $7,071.60 $5,011.98 -29.13%

Total 3,888 4,668 20.06% $3,809,741 $4,409,171 15.73% $979.87 $944.55 -3.60%


Note: Claims do not include IBNR* Specialty Drug

Report Period: 2/1/2018 12:Run Date: 02/12/2018

© Copyright 2018 HealthPartners Report Id: 43735180_Ex_Pharmacy_Top_20

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Pharmacy Top 20 Drugs by Volume

Drug Therapeutic Brand / Rx Claims Paid / RxName Class Generic Prior Current %Change Prior Current %Change Prior Current %ChangeAtorvastatin Cholesterol Generic 4,333 4,702 8.52% $1,926 $1,166 -39.44% $0.44 $0.25 -43.18%Levothyroxine Thyroid Generic 4,452 4,683 5.19% $12,815 $12,115 -5.46% $2.88 $2.59 -10.07%Lisinopril Hypertension/Cardiac Generic 4,251 4,190 -1.43% $501 $463 -7.64% $0.12 $0.11 -8.33%Omeprazole Ulcer/GERD Generic 3,165 3,260 3.00% $1,137 $723 -36.40% $0.36 $0.22 -38.89%Metformin Diabetes Generic 2,998 3,135 4.57% $1,966 $1,568 -20.23% $0.66 $0.50 -24.24%Amlodipine Hypertension/Cardiac Generic 2,575 2,692 4.54% $254 $387 52.42% $0.10 $0.14 40.00%Metoprolol Hypertension/Cardiac Generic 2,301 2,618 13.78% $9,417 $8,540 -9.30% $4.09 $3.26 -20.29%Sertraline Antidepressants Generic 2,344 2,567 9.51% $687 $632 -8.12% $0.29 $0.25 -13.79%Simvastatin Cholesterol Generic 2,576 2,168 -15.84% $239 $131 -45.12% $0.09 $0.06 -33.33%Hydrochlorothiazide Hypertension/Cardiac Generic 2,335 2,081 -10.88% $170 $133 -21.55% $0.07 $0.06 -14.29%Bupropion Antidepressants Generic 1,951 2,058 5.48% $20,562 $18,079 -12.08% $10.54 $8.78 -16.70%Fluticasone Allergy Generic 1,849 1,875 1.41% $1,785 $880 -50.67% $0.97 $0.47 -51.55%Losartan Hypertension/Cardiac Generic 1,538 1,868 21.46% $421 $465 10.38% $0.27 $0.25 -7.41%Fluoxetine Antidepressants Generic 1,760 1,817 3.24% $1,524 $763 -49.91% $0.87 $0.42 -51.72%Citalopram Antidepressants Generic 1,728 1,612 -6.71% $204 $249 21.77% $0.12 $0.15 25.00%Trazodone Antidepressants Generic 1,543 1,544 0.06% $1,111 $3,571 221.25% $0.72 $2.31 220.83%Gabapentin Anticonvulsants Generic 1,313 1,444 9.98% $4,915 $5,304 7.92% $3.74 $3.67 -1.87%Ventolin Asthma Brand 1,342 1,421 5.89% $33,425 $41,237 23.37% $24.91 $29.02 16.50%Lisinopril-Hctz Hypertension/Cardiac Generic 1,372 1,364 -0.58% $146 $175 19.91% $0.11 $0.13 18.18%Atenolol Hypertension/Cardiac Generic 1,810 1,326 -26.74% $205 $171 -16.62% $0.11 $0.13 18.18%

Total 47,536 48,425 1.87% $93,412 $96,755 3.58% $1.97 $2.00 1.68%





Page 33 of 109



Medical Tier Utilization

Utilization Category Tier 1 Tier 2 Tier 3 Out of Network Total

Professional 17,898,926.48 3,303,804.74 0 204,605.7 $21,407,337

Hospital IP 5,267,540.73 2,693,791.56 0 182,544.06 $8,143,876

Hospital OP 7,253,522.17 3,036,128.24 0 379,943.77 $10,669,594

Pharmacy 9,959,524.47 0 0 0 $9,959,524

DME, Transportation, Other 1,267,487.08 104,158.21 0 15,503.99 $1,387,149

Preventive/Accidental Dental 0 0 0 0 $0

Total 41,647,000.93 9,137,882.75 0 782,597.52 $51,567,481

Percent of Claims 80.76% 17.72% 0.00% 1.52% 100.00%

Members 7,506 2,479 0 215 10,200

Percent Members 73.59% 24.30% 0.00% 2.11% 100.00%


Notes: Members will be counted more than once if they incurred services in multiple networks.Members with only out-of-network claims = 2Claims include IBNRSome benefit plans do not utilize all tier levles. In these cases, there would be no claims dollars.

Current Year


190_Ex_Tier_Network_UtilizationReport Id: 43735

Page 34 of 109





Professional 17,171,776.47 3,923,909.71 0 189,071.57 $21,284,758

Hospital IP 3,975,670.28 5,101,403.86 0 90,154.95 $9,167,229

Hospital OP 6,419,771.21 3,894,143.78 0 248,430.13 $10,562,345

Pharmacy 9,298,655.22 0 0 0 $9,298,655

DME, Transportation, Other 995,947.46 128,875.77 0 10,525.8 $1,135,349


Total 37,861,820.64 13,048,333.12 0 538,182.46 $51,448,336


Members 7,437 2,634 0 223 10,294

Percent Members 72.25% 25.59% 0.00% 2.17% 100.00%


Notes: Members will be counted more than once if they incurred services in multiple networks.Members with only out-of-network claims = 2Claims include IBNRSome benefit plans do not utilize all tier levels. In these cases, there would be no claims dollars.

Prior Year



Page 35 of 109



Medical Monthly Summary - Contracts


Member and contract counts are as of the 15th of each month and include retroactive adjustments.

Period Members Total Single Family

Jan 2017 7,657 3,752 2,274 1,478

Feb 2017 7,617 3,745 2,276 1,469

Mar 2017 7,669 3,775 2,301 1,474

Apr 2017 7,697 3,782 2,298 1,484

May 2017 7,710 3,787 2,298 1,489

Jun 2017 7,711 3,790 2,297 1,493

Jul 2017 7,707 3,797 2,302 1,495

Aug 2017 7,716 3,802 2,310 1,492

Sep 2017 7,718 3,807 2,314 1,493

Oct 2017 7,701 3,804 2,314 1,490

Nov 2017 7,714 3,801 2,302 1,499

Dec 2017 7,735 3,813 2,317 1,496

Total 92,352 45,455 27,603 17,852

Average 7,696 3,788 2,300 1,488

Current Year

Run Date: 02/12/2018Report Period: 2/1/2018 12:00:00 AM © Copyright 2018 HealthPartners

200_Ex_Monthly_SummaryReport Id: 43735

Page 36 of 109







Jan 2016 7,572 3,740 2,273 1,467

Feb 2016 7,559 3,737 2,272 1,465

Mar 2016 7,595 3,749 2,276 1,473

Apr 2016 7,610 3,767 2,295 1,472

May 2016 7,595 3,762 2,297 1,465

Jun 2016 7,626 3,768 2,297 1,471

Jul 2016 7,576 3,750 2,289 1,461

Aug 2016 7,581 3,758 2,300 1,458

Sep 2016 7,589 3,760 2,300 1,460

Oct 2016 7,615 3,751 2,281 1,470

Nov 2016 7,611 3,753 2,288 1,465

Dec 2016 7,599 3,740 2,274 1,466

Total 91,128 45,035 27,442 17,593

Average 7,594 3,753 2,287 1,466

Prior Year



Page 37 of 109



Medical Monthly Summary - Revenue and Claims


Revenue is shown on an earned premium basis and includes retroactive adjustments. Revenue only includes medical premiums;special charges are not included.

Period Members Total PMPM Total PMPM Care Ratio

Jan 2017 7,657 $4,692,231 $612.80 $4,376,379 $571.55

Feb 2017 7,617 $4,676,857 $614.00 $3,781,285 $496.43

Mar 2017 7,669 $4,705,964 $613.63 $4,572,238 $596.20

Apr 2017 7,697 $4,723,555 $613.69 $4,109,473 $533.91

May 2017 7,710 $4,730,577 $613.56 $4,570,626 $592.82

Jun 2017 7,711 $4,740,383 $614.76 $4,078,647 $528.94

Jul 2017 7,707 $4,747,597 $616.01 $4,120,544 $534.65

Aug 2017 7,716 $4,753,041 $616.00 $4,582,387 $593.88

Sep 2017 7,718 $4,759,625 $616.69 $4,502,074 $583.32

Oct 2017 7,701 $4,754,146 $617.34 $5,203,131 $675.64

Nov 2017 7,714 $4,761,009 $617.19 $4,455,515 $577.59

Dec 2017 7,735 $4,774,368 $617.24 $5,436,830 $702.89

Total 92,352 $56,819,352 $53,789,129 94.67%

Average 7,696 $4,734,946 $615.24 $4,482,427 $582.44

Claims include IBNR and pooling charges

Revenue ClaimsCurrent Year



Page 38 of 109







Jan 2016 7,572 $4,488,443 $592.77 $3,541,703 $467.74

Feb 2016 7,559 $4,481,907 $592.92 $4,239,044 $560.79

Mar 2016 7,595 $4,496,974 $592.10 $4,380,492 $576.76

Apr 2016 7,610 $4,510,417 $592.70 $4,573,015 $600.92

May 2016 7,595 $4,500,083 $592.51 $5,201,060 $684.80

Jun 2016 7,626 $4,512,336 $591.70 $4,369,435 $572.97

Jul 2016 7,576 $4,486,043 $592.14 $4,531,363 $598.12

Aug 2016 7,581 $4,490,452 $592.33 $4,468,789 $589.47

Sep 2016 7,589 $4,494,219 $592.20 $4,223,935 $556.59

Oct 2016 7,615 $4,498,828 $590.78 $4,081,577 $535.99

Nov 2016 7,611 $4,492,572 $590.27 $4,264,854 $560.35

Dec 2016 7,599 $4,484,270 $590.11 $5,690,375 $748.83

Total 91,128 $53,936,542 $53,565,640 99.31%

Average 7,594 $4,494,712 $591.88 $4,463,803 $587.81


Revenue ClaimsPrior Year



Page 39 of 109



Medical Contract Distribution


C PCurrent Year Prior Year

Average Members per Ramsey County [12900] Prior Year Aggregate

All Family Type Contracts: 3.63 3.62 3.42

All Contracts: 2.03 2.02 2.05

C Current Aggregate P Prior Aggregate

Run Date: 02/12/2018Report Period: 2/1/2018 12:00:00 AM © Copyright 2018 HealthPartners Report Id: 43735

200_Ex_Monthly_Summary

Page 40 of 109



Medical Demographics Summary

Member Months Average % of Total Aggregate % of Total

Female 50,959 4,247 55.18% 53.24%

Male 41,393 3,449 44.82% 46.76%

Total 92,352 7,696 100.00% 100.00%


Current Year Gender Distribution

Current Year Relationship Distribution


Policyholder 44,949 3,746 48.67% 48.66%

Dependent 47,403 3,950 51.33% 51.34%

Total 92,352 7,696 100.00% 100.00%


210_Ex_Demographics_SummaryReport Id: 43735

Page 41 of 109





Female 50,380 4,198 55.28% 53.54%

Male 40,748 3,396 44.72% 46.46%

Total 91,128 7,594 100.00% 100.00%


Prior Year Gender Distribution

Prior Year Relationship Distribution


Policyholder 44,626 3,719 48.97% 48.81%

Dependent 46,502 3,875 51.03% 51.19%

Total 91,128 7,594 100.00% 100.00%



Page 42 of 109



Medical Demographics: Detail

Age RangeFemale

Policyholder DependentMale

Policyholder Dependent Total % of Total

Under 1 0 29 0 31 60 0.78%

1 - 4 0 138 0 183 321 4.15%

5 - 9 0 242 0 223 465 6.01%

10 - 14 0 270 1 272 543 7.02%

15 - 19 2 324 1 296 623 8.05%

20 - 24 23 306 18 277 624 8.07%

25 - 29 114 78 82 60 334 4.32%

30 - 34 197 66 147 35 445 5.75%

35 - 39 252 85 159 88 584 7.55%

40 - 44 237 92 151 93 573 7.41%

45 - 49 256 87 192 81 616 7.96%

50 - 54 321 97 224 90 732 9.46%

55 - 59 363 98 230 95 786 10.16%

60 - 64 421 76 238 112 847 10.95%

65 Over 77 12 62 31 182 2.35%

Total 2,263 2,000 1,505 1,967 7,735 100.00%


Counts shown are for the last month in the reporting period.

Current Year


220_Ex_Demographics_DetailReport Id: 43735

Page 43 of 109




Age RangeFemale



Under 1 0 23 0 43 66 0.87%

1 - 4 0 132 0 171 303 3.99%

5 - 9 0 265 0 227 492 6.47%

10 - 14 0 252 1 266 519 6.83%

15 - 19 2 309 0 308 619 8.15%

20 - 24 9 295 12 268 584 7.69%

25 - 29 100 78 65 51 294 3.87%

30 - 34 195 58 146 36 435 5.72%

35 - 39 261 85 138 85 569 7.49%

40 - 44 226 94 153 88 561 7.38%

45 - 49 268 89 186 77 620 8.16%

50 - 54 319 96 234 89 738 9.71%

55 - 59 369 94 230 103 796 10.48%

60 - 64 423 64 246 107 840 11.05%

65 Over 73 11 46 33 163 2.15%

Total 2,245 1,945 1,457 1,952 7,599 100.00%



Prior Year



Page 44 of 109



Medical Age Distribution


CG Current Year CA Current Aggregate PG Prior Year PA Prior Aggregate


220_Ex_Demographics_DeReport Id: 43735

Page 45 of 109



Medical Cost Savings Detail


COB Savings

COB SavingsWorkers Compensation $25,558 $0 $580 $0 $27 $0 $26,165No-Fault $1,365 $0 $733 $0 $1,458 $0 $3,556Third Party Liability $0 $0 $0 $0 $0 $0 $0Occupational Health $0 $0 $0 $0 $0 $0 $0Other Insurance: Under 65 $484,484 $489,179 $3,201,076 $0 $45,789 $0 $4,220,527Other Insurance: Over 65 $187,348 $8,840 $400,070 $0 $12,952 $0 $609,210Total: $698,756 $498,019 $3,602,458 $0 $60,225 $0 $4,859,459

Benefit Design Savings

Benefit Design SavingsDeductibles $220,863 $4,470 $15,760 $0 $8,633 $0 $249,726Copayments/Coinsurance $1,364,159 $87,648 $379,186 $1,071,487 $190,505 $0 $3,092,986Other Member Liability $0 $326 $2,904 $0 $100 $0 $3,330Total: $1,585,022 $92,445 $397,850 $1,071,487 $199,238 $0 $3,346,042

Other Savings

Other SavingsUCR Limits $180,398 $0 $0 $0 $0 $0 $180,398Ineligible Services $49,774 $162 $4,855 $0 $37,732 $0 $92,524Total: $230,173 $162 $4,855 $0 $37,732 $0 $272,922

Provider Discount Savings

Provider Discount SavingsNegotiated Discounts $12,469,348 $6,919,820 $14,420,923 $10,771,700 $695,507 $0 $45,277,298Total: $12,469,348 $6,919,820 $14,420,923 $10,771,700 $695,507 $0 $45,277,298

Professional Hospital IP Hospital OP Pharmacy Other Dental TotalBilled Charge $34,630,142 $14,939,173 $28,264,281 $21,030,207 $2,279,979 $0 $101,143,782

Grand Total Savings $14,983,299 $7,510,445 $18,426,087 $11,843,187 $992,702 $0 $53,755,720

Claims$19,995,217 $7,556,020 $9,982,138 $9,303,463 $1,294,570 $0 $48,131,408

(billed charge - grand total savings + tax)

Provider Tax $348,374 $127,293 $143,944 $116,442 $7,293 $0 $743,346

Savings Percentage 43.27% 50.27% 65.19% 56.32% 43.54% 0.00% 53.15%(based on billed charge)


Current Year


310_Ex_Cost_Savings_DetailReport Id: 43735

Page 46 of 109





COB Savings

COB SavingsWorkers Compensation $8,293 $0 $0 $0 $1,364 $0 $9,657No-Fault $922 $0 $6,829 $0 $4,058 $0 $11,809Third Party Liability $0 $0 $0 $0 $0 $0 $0Occupational Health $0 $0 $0 $0 $0 $0 $0Other Insurance: Under 65 $430,705 $542,048 $1,067,327 $0 $25,581 $0 $2,065,662Other Insurance: Over 65 $186,050 $968 $648,993 $0 $10,546 $0 $846,558Total: $625,970 $543,017 $1,723,149 $0 $41,549 $0 $2,933,685



Other Savings

Other SavingsUCR Limits $34,562 $0 $0 $0 $0 $0 $34,562Ineligible Services $42,501 $145 -$18,816 $0 $35,340 $0 $59,170Total: $77,063 $145 -$18,816 $0 $35,340 $0 $93,733





Claims$19,894,723 $8,506,323 $9,873,188 $8,681,936 $1,056,178 $0 $48,012,348


Provider Tax $339,754 $138,235 $142,605 $108,991 $7,122 $0 $736,706



Prior Year



Page 47 of 109



Top 25 Medical Providers - All Service Categories

Provider Claims ClaimantsHEALTHPARTNERS MEDICAL GROUP $5,024,668 3,613

REGIONS HOSPITAL-RAD/ACUTE/SLEEP $3,443,124 854

CVS/SPECIALTY #02921 $3,075,143 68

UNITED HOSPITAL $1,224,243 233

HEALTHEAST ST JOHNS & MIDWAY $1,058,010 285

UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW WEST $963,797 221

MAYO CLINIC ROCHESTER $813,953 97

HEALTHPARTNERS MAIL ORDER PHARMACY $758,697 502

MAYO CLINIC HOSPITAL-ROCHESTER $675,186 40

CHILDRENS HEALTH CARE-MPLS $629,099 102

PARK NICOLLET CLINIC $614,390 384

HEALTHEAST WOODWINDS HOSPITAL $584,459 169

CVS PHARMACY # $569,310 1,281

FAIRVIEW SOUTHDALE HOSPITAL $525,198 71

CHILDRENS HEALTH CARE-ST PAUL $502,878 165

ABBOTT NORTHWESTERN HOSPITAL $492,528 140

HEALTHPARTNERS SAME DAY SURG CENTER $469,661 267

HEALTHEAST ST JOSEPHS $469,078 80

SUMMIT ORTHOPEDICS,LTD $421,249 280

PARK NICOLLET METHODIST HOSPITAL-ACUTE $416,143 79

MERCY HOSPITAL $395,194 87

FAIRVIEW SPECIALTY SERVICES PHARMACY $351,769 12

FAIRVIEW PHARMACY SERVICES LLC-HH $345,856 5 or under


Current Year by Dollars Paid

Report Period: 2/1/2018 12:00:0Run Date: 02/12/2018

© Copyright 2018 HealthPartners320_Ex_Top_ProvidersReport Id: 43735

Page 48 of 109



Top 25 Medical Providers - All Service CategoriesProvider Claims ClaimantsMINNESOTA GASTROENTEROLOGY PA $343,259 246

SUMMIT ORTHOPEDICS,LTD-BUNDLED $323,875 14





Page 49 of 109






CVS/SPECIALTY #02921 $2,958,925 68

UNIVERSITY OF MINNESOTA MEDICAL CENTER, FAIRVIEW WEST $1,659,911 175


MAYO CLINIC ROCHESTER $1,275,346 93





MINNESOTA ONCOLOGY HEMATOLOGY, PA $633,004 55





CVS PHARMACY # $552,701 1,321







LAKEVIEW HOSPITAL $310,539 90


Prior Year by Dollars Paid



Page 50 of 109



Top 25 Medical Providers - All Service CategoriesProvider Claims ClaimantsTWIN CITIES ORTHOPEDICS,PA $309,085 196

MINNESOTA GASTROENTEROLOGY PA $305,177 221





Page 51 of 109




Provider Claimants ClaimsHEALTHPARTNERS MEDICAL GROUP 3,613 $5,024,668

ST PAUL RADIOLOGY PA 1,304 $285,566

CVS PHARMACY # 1,281 $569,310

REGIONS HOSPITAL-RAD/ACUTE/SLEEP 854 $3,443,124

HEALTHPARTNERS WORKSITE HEALTH 592 $20,001

WALGREENS 590 $283,129

CVS PHARMACY 561 $192,121

FULCRUM HEALTH,INC 544 $83,171

HEALTHPARTNERS MAIL ORDER PHARMACY 502 $758,697

NOT APPLICABLE 458 $15,425

PARK NICOLLET CLINIC 384 $614,390

CUB PHARMACY 331 $220,876

MINUTECLINIC DIAGNOSTIC OF MN PA 316 $18,972

EMERGENCY PHYSICIANS,PA 295 $201,873

HOSPITAL PATHOLOGY ASSOCIATES 292 $50,321

REGIONS HOSPITAL-PRO FEE 291 $170,160

HEALTHPARTNERS MENTAL HEALTH 287 $257,960

HEALTHEAST ST JOHNS & MIDWAY 285 $1,058,010

SUMMIT ORTHOPEDICS,LTD 280 $421,249

DERMATOLOGY CONSULTANTS,PA 279 $122,349

HEALTHPARTNERS SAME DAY SURG CENTER 267 $469,661

HEALTHPARTNERS ST. PAUL PHARMACY 266 $87,642

VIRTUWELL 256 $15,215


Current Year by Claimant Count



Page 52 of 109



Top 25 Medical Providers - All Service CategoriesProvider Claimants ClaimsST PAUL EYE CLINIC,PA 254 $82,272

MINNESOTA GASTROENTEROLOGY PA 246 $343,259





Page 53 of 109






CVS PHARMACY # 1,321 $552,701















ST PAUL EYE CLINIC,PA 272 $80,188





HEALTHPARTNERS MEDICAL GROUP-NW ALLIANCE 247 $186,703


Prior Year by Claimant Count



Page 54 of 109



Top 25 Medical Providers - All Service CategoriesProvider Claimants ClaimsUNITED HOSPITAL 242 $1,657,168

HEALTHPARTNERS WOODBURY PHARMACY 235 $68,663





Page 55 of 109



Medical Effect of Catastrophic Claims on PMPM

Amount Aggregate Variance PMPM Trend

Total Claims $51,567,481

Total Claims: Per Member Per Month $558.38 $468.99 19.06% -1.10%

Catastrophic Claims Excess Amount $14,709,696 (for members with $25,000 +, the amount over $25,000

Catastrophic Excess Amount: % of Total Claims 28.53% 31.18%

(catastrophic claims as a percentage of total claims)

Net Claims $36,857,785

(total claims less catastrophic excess)

Net Claims: Per Member Per Month $399.10 $322.77 23.65% 1.09%

Note: Catastrophic Dollars do not include IBNR Claims include IBNR


Current Year

Run Date: 02/12/2018Report Period: 2/1/2018 12:00:00 A © Copyright 2018 HealthPartners

400_Ex_Effect_Catastrophic_ClaimsReport Id: 43735

Page 56 of 109




Amount Aggregate Variance


Total Claims: Per Member Per Month $564.57 $458.40 23.16%






Net Claims: Per Member Per Month $394.80 $317.84 24.21%



Prior Year



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Medical PMPM Before and After Removing Claims in Excess of Catastrophic Threshold


C CCurrent Year Current Aggregate P Prior Year Prior AggregateP


© Copyright 2018 HealthPartners Report Id: 43735400_Ex_Effect_Catastrophic_Claims

Page 58 of 109



Medical Distribution of Claimants and Dollars

Dollar RangeNumber ofClaimants Claims

Cumulative %of Claimants

Cumulative %of Claims



1 - 250 942 $104,332 12.40% 0.22% 20.30% 0.35%

250 - 500 789 $292,384 22.79% 0.82% 33.12% 1.26%

500 - 1000 1,187 $869,454 38.43% 2.63% 50.09% 3.60%

1000 - 2500 1,731 $2,827,736 61.22% 8.51% 69.59% 9.61%

2500 - 5000 1,156 $4,095,470 76.44% 17.01% 81.51% 17.67%

5000 - 10000 743 $5,256,418 86.23% 27.94% 89.20% 27.99%

10000 - 15000 342 $4,198,903 90.73% 36.66% 92.63% 36.05%

15000 - 25000 302 $5,727,016 94.71% 48.56% 95.81% 47.77%

25000 - 35000 138 $4,065,046 96.52% 57.00% 97.23% 55.75%

35000 - 50000 89 $3,746,822 97.70% 64.79% 98.27% 63.98%

50000 - 75000 81 $4,776,493 98.76% 74.71% 99.08% 73.28%

75000 - 100000 51 $4,432,835 99.43% 83.92% 99.45% 79.34%

100000 - 125000 18 $1,978,287 99.67% 88.03% 99.63% 83.19%

125000+ 25 $5,760,214 100.00% 100.00% 100.00% 100.00%

7,594 $48,131,408





410_Ex_Distribution_of_ClaimantsReport Id: 43735

Page 59 of 109









1 - 250 960 $107,990 12.75% 0.22% 19.65% 0.35%

250 - 500 753 $279,246 22.74% 0.81% 32.49% 1.27%

500 - 1000 1,161 $844,188 38.16% 2.56% 49.41% 3.65%

1000 - 2500 1,741 $2,861,298 61.27% 8.52% 69.39% 9.89%

2500 - 5000 1,153 $4,081,683 76.58% 17.03% 81.48% 18.15%

5000 - 10000 785 $5,505,076 87.00% 28.49% 89.31% 28.80%

10000 - 15000 317 $3,910,106 91.21% 36.64% 92.82% 37.12%

15000 - 25000 280 $5,402,052 94.93% 47.89% 96.00% 48.95%

25000 - 35000 137 $4,032,976 96.75% 56.29% 97.39% 56.91%

35000 - 50000 96 $3,944,164 98.02% 64.50% 98.36% 64.72%

50000 - 75000 66 $3,840,573 98.90% 72.50% 99.13% 73.66%

75000 - 100000 34 $2,900,994 99.35% 78.54% 99.47% 79.42%

100000 - 125000 17 $1,956,578 99.58% 82.62% 99.65% 83.19%

125000+ 32 $8,345,427 100.00% 100.00% 100.00% 100.00%

7,532 $48,012,348






Page 60 of 109



Medical Distribution of Member Liability

Member LiabilityDollar Range

Number ofClaimants

MemberLiability Claims


Cumulative % ofMember LIability


1 - 250 3,904 $381,441 $4,097,581 51.41% 11.41% 8.51%

250 - 500 1,467 $528,145 $5,871,712 70.73% 27.21% 20.71%

500 - 1000 1,204 $846,541 $9,652,923 86.58% 52.54% 40.77%

1000 - 2500 966 $1,405,860 $25,853,715 99.30% 94.59% 94.48%

2500 - 5000 53 $180,724 $2,655,477 100.00% 100.00% 100.00%

5000 - 10000 0 $0 $0 100.00% 100.00% 100.00%

10000+ 0 $0 $0 100.00% 100.00% 100.00%

Total 7,594 $3,342,712 $48,131,408


Current Year Actual



415_Ex_Distribution_of_Member_LiReport Id: 43735

Page 61 of 109





Number ofClaimants



Cumulative % ofMember Liability


1 - 250 3,935 $381,175 $4,196,481 52.24% 11.96% 8.74%

250 - 500 1,507 $536,219 $6,257,419 72.25% 28.78% 21.77%

500 - 1000 1,144 $802,424 $9,426,570 87.44% 53.96% 41.41%

1000 - 2500 900 $1,312,105 $25,942,394 99.39% 95.12% 95.44%

2500 - 5000 46 $155,510 $2,189,485 100.00% 100.00% 100.00%

5000 - 10000 0 $0 $0 100.00% 100.00% 100.00%

10000+ 0 $0 $0 100.00% 100.00% 100.00%

Total 7,532 $3,187,434 $48,012,348


Prior Year Actual




Page 62 of 109



Medical Catastrophic Cases

Principal Diagnosis ClaimsMalignant Neoplasm Of Frontal Lobe $383,788Infection And Inflammatory Reaction Due To Other Cardiac And Vascular Devices,Implants And Grafts, Initial Encounter $383,017

Fabry (-anderson) Disease $340,422

Embolism And Thrombosis Of Arteries Of The Lower Extremities $335,632

Encounter For Antineoplastic Radiation Therapy $309,668

Tetralogy Of Fallot $306,978

Malignant Neoplasm Of Ascending Colon $291,187

Secondary Malignant Neoplasm Of Bone $288,240

Multiple Myeloma Not Having Achieved Remission $284,935

Spondylolisthesis, Lumbar Region $264,296

Nonrheumatic Tricuspid (valve) Insufficiency $235,992

End Stage Renal Disease $224,781

Malignant Neoplasm Of Lower-inner Quadrant Of Left Female Breast $206,408

Infection Following A Procedure, Initial Encounter $192,155

Cystic Fibrosis, Unspecified $185,240

Hypertensive Heart Disease With Heart Failure $183,092



Current Year


© Copyright 2018 HealthPartners420_Ex_Catastrophic_CasesReport Id: 43735

Page 63 of 109




Principal Diagnosis ClaimsSpinal Stenosis, Cervical Region $172,627

Malignant Melanoma Of Right Lower Limb, Including Hip $158,854

Ulcerative Colitis, Unspecified, Without Complications $155,234

Other Specified Disorders Of Breast $147,425

Encounter For Aftercare Following Heart Transplant $137,385

Encounter For Aftercare Following Liver Transplant $131,017

Malignant Neoplasm Of Unspecified Site Of Left Female Breast $130,314

Sepsis, Unspecified Organism $128,841

Obstructive Sleep Apnea (adult) (pediatric) $121,482

Malignant Neoplasm Of Central Portion Of Right Female Breast $119,962

Ventricular Premature Depolarization $119,854

Sensitive Diagnosis $119,194

Other Chronic Pain $115,534

Pathological Fracture, Other Site, Initial Encounter For Fracture $112,919

Malignant Neoplasm Of Temporal Lobe $112,827Peptic Ulcer, Site Unspecified, Unspecified As Acute Or Chronic, Without Hemorrhage OrPerforation $112,406

Abnormal Uterine And Vaginal Bleeding, Unspecified $111,951


Current Year



Page 64 of 109




Principal Diagnosis ClaimsCrohn's Disease Of Both Small And Large Intestine With Fistula $111,229

Carpal Tunnel Syndrome, Right Upper Limb $109,337

Other Spondylosis With Radiculopathy, Lumbar Region $103,957St Elevation (stemi) Myocardial Infarction Involving Left Anterior Descending CoronaryArtery $103,270


Undifferentiated Schizophrenia $100,803

Multiple Sclerosis $100,787

Atherosclerotic Heart Disease Of Native Coronary Artery With Unstable Angina Pectoris $100,711

Myelodysplastic Syndrome, Unspecified $100,612

Malignant Carcinoid Tumor Of The Bronchus And Lung $99,945

Other Internal Derangements Of Left Knee $99,671

Other Postprocedural Cardiac Functional Disturbances Following Other Surgery $99,661


Congenital Stenosis Of Aortic Valve $99,209

Malignant Neoplasm Of Upper Lobe, Right Bronchus Or Lung $99,185

Flatback Syndrome, Lumbar Region $99,130

St Elevation (stemi) Myocardial Infarction Involving Left Circumflex Coronary Artery $98,539


Current Year



Page 65 of 109




Principal Diagnosis ClaimsMalignant Neoplasm Of Overlapping Sites Of Bladder $98,428

Urgency Of Urination $97,685


Benign Neoplasm Of Ascending Colon $93,348

Nocturia $93,269


Atrioventricular Block, Complete $92,309

Postmenopausal Bleeding $90,423

Benign Neoplasm Of Pituitary Gland $90,215

Juvenile Arthritis, Unspecified, Unspecified Site $89,759


Secondary Malignant Neoplasm Of Retroperitoneum And Peritoneum $88,949

Hypermetropia, Bilateral $88,069

Malignant Neoplasm Of Unspecified Part Of Unspecified Bronchus Or Lung $87,792

Craniosynostosis $87,555

Low Back Pain $87,409




Current Year



Page 66 of 109




Principal Diagnosis ClaimsUnilateral Primary Osteoarthritis, Right Hip $86,648

Malignant Neoplasm Of Lower-outer Quadrant Of Left Female Breast $86,507

Intrahepatic Bile Duct Carcinoma $86,441

Spinal Stenosis, Lumbar Region With Neurogenic Claudication $85,704


Spinal Stenosis, Lumbar Region With Neurogenic Claudication $84,611



Other Complications Of Other Bariatric Procedure $81,988

Guillain-barre Syndrome $81,965

Spinal Stenosis, Lumbar Region Without Neurogenic Claudication $80,838

Spinal Stenosis, Lumbar Region $79,022

Sepsis, Unspecified Organism $78,092Infection And Inflammatory Reaction Due To Internal Right Hip Prosthesis, InitialEncounter $77,342

Nontraumatic Intracerebral Hemorrhage, Intraventricular $77,337

Trigeminal Neuralgia $77,186

Type 1 Diabetes Mellitus Without Complications $76,861


Current Year



Page 67 of 109




Principal Diagnosis ClaimsFracture Of Nasal Bones, Initial Encounter For Closed Fracture $76,758


Other Specified Disorders Of Nose And Nasal Sinuses $76,234


Morbid (severe) Obesity Due To Excess Calories $76,077

Cerebral Infarction, Unspecified $76,058

Precocious Puberty $75,723

Other Tear Of Medial Meniscus, Current Injury, Right Knee, Initial Encounter $75,434


Rheumatoid Lung Disease With Rheumatoid Arthritis Of Multiple Sites $73,063


Chronic Obstructive Pulmonary Disease With (acute) Exacerbation $70,587

Other Mechanical Complication Of Internal Right Hip Prosthesis, Initial Encounter $70,552

Unilateral Primary Osteoarthritis, Right Knee $70,526

Unspecified Atrial Flutter $70,462

Unilateral Primary Osteoarthritis, Right Hip $68,869


Cholangitis $67,506


Current Year



Page 68 of 109




Principal Diagnosis ClaimsMorbid (severe) Obesity Due To Excess Calories $67,368

Saddle Embolus Of Pulmonary Artery With Acute Cor Pulmonale $67,181

Endometriosis Of Uterus $66,909



Other Mechanical Complication Of Internal Left Hip Prosthesis, Initial Encounter $66,019


Epilepsy, Unspecified, Not Intractable, Without Status Epilepticus $65,738

Inflammatory Polyarthropathy $65,497Cerebral Infarction Due To Unspecified Occlusion Or Stenosis Of Left Middle CerebralArtery $65,471

Gastro-esophageal Reflux Disease With Esophagitis $64,165

Anaphylactic Shock, Unspecified, Initial Encounter $64,148

Tubulo-interstitial Nephritis, Not Specified As Acute Or Chronic $63,332

Malignant Neoplasm Of Thyroid Gland $63,215

Unilateral Primary Osteoarthritis, Left Knee $62,722


Dissection Of Carotid Artery $62,427


Current Year



Page 69 of 109





Crohn's Disease Of Small Intestine Without Complications $60,479

Contracture, Unspecified Ankle $60,468

Other Encephalopathy $60,151

Other Sprain Of Left Shoulder Joint, Initial Encounter $59,758



Type 1 Diabetes Mellitus With Hyperglycemia $58,712


Paroxysmal Atrial Fibrillation $58,472



Malignant Neoplasm Of Upper Lobe, Left Bronchus Or Lung $58,048

Other Psoriasis $57,700

Malignant Neoplasm Of Overlapping Sites Of Right Female Breast $57,502


Influenza Due To Other Identified Influenza Virus With Other Respiratory Manifestations $57,282



Current Year



Page 70 of 109




Principal Diagnosis ClaimsMalignant Neoplasm Of Upper Lobe, Right Bronchus Or Lung $57,139

Other Chest Pain $56,520

Cervical Disc Disorder At C5-c6 Level With Radiculopathy $55,949

Mammary Duct Ectasia Of Right Breast $55,807

Non-st Elevation (nstemi) Myocardial Infarction $55,674

Right Lower Quadrant Pain $55,486

Other Specified Joint Disorders, Left Hip $55,102



Rheumatoid Arthritis, Unspecified $54,808


Calculus Of Ureter $53,849

Sensitive Diagnosis $53,808Rheumatoid Arthritis With Rheumatoid Factor Of Multiple Sites Without Organ Or SystemsInvolvement $53,710

Other Long Term (current) Drug Therapy $53,689

Other Hyperfunction Of Pituitary Gland $53,627

Mild Cognitive Impairment, So Stated $53,582


Current Year



Page 71 of 109




Principal Diagnosis ClaimsOther Specified Diseases Of Spinal Cord $53,369

Toxic Encephalopathy $53,247


Obstruction Of Bile Duct $52,579

St Elevation (stemi) Myocardial Infarction Of Unspecified Site $52,526


Crohn's Disease Of Large Intestine With Unspecified Complications $51,642


Persistent Atrial Fibrillation $51,467

Dysphagia, Unspecified $50,883


Hypospadias, Perineal $50,789

Intrahepatic Bile Duct Carcinoma $50,754

Encounter For Other Specified Surgical Aftercare $50,516


Other Specified Cardiac Arrhythmias $50,443




Current Year



Page 72 of 109




Principal Diagnosis ClaimsPersistent Atrial Fibrillation $50,291

Chronic Sinusitis, Unspecified $49,889

Pain In Right Foot $49,674

Peripheral Vascular Disease, Unspecified $49,664


Myopia, Bilateral $49,291

Scar Conditions And Fibrosis Of Skin $49,042


Umbilical Hernia Without Obstruction Or Gangrene $48,908

Malignant Neoplasm Of Pancreas, Unspecified $48,804

Conversion Disorder With Seizures Or Convulsions $48,304




Brachial Plexus Disorders $47,622

Calculus Of Gallbladder Without Cholecystitis Without Obstruction $47,402

Food Protein-induced Enterocolitis Syndrome $47,259

Ventricular Premature Depolarization $47,035


Current Year



Page 73 of 109




Principal Diagnosis ClaimsFistula Of Vagina To Large Intestine $46,521

Systemic Lupus Erythematosus, Unspecified $46,450


Spinal Stenosis, Lumbar Region Without Neurogenic Claudication $46,308Encounter For Adjustment And Management Of Automatic Implantable CardiacDefibrillator $46,129

Non-hodgkin Lymphoma, Unspecified, Unspecified Site $46,037


Submucous Leiomyoma Of Uterus $45,815


Prolapse Of Vaginal Vault After Hysterectomy $45,426




Unilateral Primary Osteoarthritis, Left Knee $44,693Atherosclerotic Heart Disease Of Native Coronary Artery With Unspecified AnginaPectoris $44,195



Current Year



Page 74 of 109




Principal Diagnosis ClaimsUnilateral Osteoarthritis Resulting From Hip Dysplasia, Left Hip $43,367


Occlusion And Stenosis Of Left Carotid Artery $42,754

Estrogen Receptor Positive Status [er+] $42,536

Diverticulitis Of Large Intestine Without Perforation Or Abscess Without Bleeding $42,478Rheumatoid Arthritis With Rheumatoid Factor Of Multiple Sites Without Organ Or SystemsInvolvement $42,248

Spinal Stenosis, Cervical Region $42,238

Diverticulitis Of Large Intestine Without Perforation Or Abscess Without Bleeding $42,155




Bilateral Primary Osteoarthritis Of Hip $41,619


Other Specified Disorders Of Kidney And Ureter $41,441

Other Specified Retinal Disorders $40,974

Malignant Neoplasm Of Prostate $40,570



Current Year



Page 75 of 109




Principal Diagnosis ClaimsOther And Unspecified Ventral Hernia With Obstruction, Without Gangrene $40,518

Chronic Cholecystitis $40,429

Pre-existing Type 1 Diabetes Mellitus, In Childbirth $40,141

Retinal Detachment With Multiple Breaks, Left Eye $40,141

Other Hypoglycemia $40,087


Hallux Valgus (acquired), Left Foot $39,795


Malignant Neoplasm Of Bladder, Unspecified $39,688

Encounter For Screening For Malignant Neoplasm Of Colon $39,634




Influenza Due To Other Identified Influenza Virus With Other Respiratory Manifestations $39,067

Other Instability, Left Ankle $39,020

Bilateral Primary Osteoarthritis Of Knee $38,740

Primary Osteoarthritis, Right Elbow $38,659

Precordial Pain $38,538


Current Year



Page 76 of 109




Principal Diagnosis ClaimsSensitive Diagnosis $38,508

Other Effects Of High Altitude, Initial Encounter $37,961

Atrial Premature Depolarization $37,849



Acute Cystitis Without Hematuria $37,546

Allergic Rhinitis Due To Pollen $37,397



Gastrointestinal Hemorrhage, Unspecified $36,502

Hypocalcemia $36,294

Mechanical Loosening Of Internal Left Knee Prosthetic Joint, Initial Encounter $36,110

Supraventricular Tachycardia $36,104


Encounter For Aftercare Following Kidney Transplant $35,888

Osteonecrosis Due To Previous Trauma, Right Femur $35,458




Current Year



Page 77 of 109




Principal Diagnosis ClaimsStenosis Of Pulmonary Artery $35,342



Malignant Neoplasm Of Sigmoid Colon $34,975

Disproportion Of Reconstructed Breast $34,772



Acute On Chronic Systolic (congestive) Heart Failure $34,571Displaced Fracture (avulsion) Of Medial Epicondyle Of Right Humerus, Initial EncounterFor Closed Fracture $34,512

Strain Of Muscle(s) And Tendon(s) Of The Rotator Cuff Of Right Shoulder, InitialEncounter $34,483

Noninfective Gastroenteritis And Colitis, Unspecified $34,418


Maxillary Hypoplasia $34,333

Urticaria, Unspecified $34,219

Dental Caries, Unspecified $34,187



Current Year



Page 78 of 109




Principal Diagnosis ClaimsAcute Appendicitis With Generalized Peritonitis $34,035

Uterovaginal Prolapse, Unspecified $33,854





Excessive And Frequent Menstruation With Regular Cycle $33,417

Ulcer Of Intestine $33,409

Malignant Neoplasm Of Unspecified Ovary $33,338

Acute Appendicitis With Generalized Peritonitis $33,138


Atrioventricular Block, Complete $32,721


Ulcerative (chronic) Pancolitis Without Complications $32,637

Recurrent Dislocation Of Patella, Right Knee $32,453


Atherosclerotic Heart Disease Of Native Coronary Artery Without Angina Pectoris $32,272



Current Year



Page 79 of 109




Principal Diagnosis ClaimsUnilateral Primary Osteoarthritis, Left Knee $32,122




Sprain Of Anterior Cruciate Ligament Of Left Knee, Initial Encounter $31,823

Arthropathic Psoriasis, Unspecified $31,820



Solitary Pulmonary Nodule $31,488

Acute And Subacute Hepatic Failure Without Coma $31,365



Incomplete Rotator Cuff Tear Or Rupture Of Right Shoulder, Not Specified As Traumatic $31,181

Chronic Pansinusitis $31,063

Unspecified Acute Appendicitis $31,032


Ankylosing Spondylitis Of Multiple Sites In Spine $30,831

Unilateral Primary Osteoarthritis, Left Hip $30,675


Current Year



Page 80 of 109




Principal Diagnosis ClaimsCholangitis $30,601

Hydronephrosis With Renal And Ureteral Calculous Obstruction $30,492

Diaphragmatic Hernia Without Obstruction Or Gangrene $30,418


Dysplasia Of Vagina, Unspecified $30,150



Instability Of Internal Right Knee Prosthesis, Initial Encounter $29,830



Incisional Hernia With Obstruction, Without Gangrene $29,578


Tremor, Unspecified $29,258





Stress Incontinence (female) (male) $29,001


Current Year



Page 81 of 109




Principal Diagnosis ClaimsOther Chest Pain $28,944



Peritoneal Adhesions (postprocedural) (postinfection) $28,907

Unspecified Acute Appendicitis $28,850

Other Specified Noninflammatory Disorders Of Uterus $28,850Hypertensive Heart And Chronic Kidney Disease With Heart Failure And Stage 1 ThroughStage 4 Chronic Kidney Disease, Or Unspecified Chronic Kidney Disease $28,753




Other Chronic Pain $28,604Exudative Age-related Macular Degeneration, Left Eye, With Active ChoroidalNeovascularization $28,544

Hallux Valgus (acquired), Right Foot $28,475


Torsion Of Right Ovary And Ovarian Pedicle $28,431

Snoring $28,216


Current Year



Page 82 of 109




Principal Diagnosis ClaimsSudden Idiopathic Hearing Loss, Right Ear $28,142


Type 2 Diabetes Mellitus With Hyperglycemia $28,091Type 2 Diabetes Mellitus With Proliferative Diabetic Retinopathy With Macular Edema,Left Eye $28,083






Other Bursitis Of Knee, Left Knee $27,648

Unspecified Abdominal Pain $27,605

Complete Rotator Cuff Tear Or Rupture Of Right Shoulder, Not Specified As Traumatic $27,528


Calculus Of Kidney With Calculus Of Ureter $27,386



Encounter For Preprocedural Cardiovascular Examination $27,210


Current Year



Page 83 of 109







Cutaneous Abscess Of Left Axilla $27,039

Personal History Of Malignant Neoplasm Of Other Female Genital Organs $27,033

Muscle Weakness (generalized) $26,977

Pain In Thoracic Spine $26,689



Cough $26,577

Intestinal Adhesions [bands] With Obstruction (postinfection) $26,549


Unilateral Post-traumatic Osteoarthritis, Left Knee $26,374

Unspecified Lack Of Coordination $26,280

Unspecified Open Wound, Right Thigh, Initial Encounter $26,275





Current Year



Page 84 of 109




Principal Diagnosis ClaimsUmbilical Hernia Without Obstruction Or Gangrene $25,950

Dehydration $25,860Other Specified Complication Of Internal Orthopedic Prosthetic Devices, Implants AndGrafts, Initial Encounter $25,783



Gestational Diabetes Mellitus In Childbirth, Controlled By Oral Hypoglycemic Drugs $25,755


Occlusion And Stenosis Of Right Carotid Artery $25,683



Type 1 Diabetes Mellitus With Ketoacidosis Without Coma $25,453

Morbid (severe) Obesity Due To Excess Calories $25,421Strain Of Other Muscles, Fascia And Tendons At Shoulder And Upper Arm Level, RightArm, Initial Encounter $25,407

Hypertrophy Of Breast $25,366




Current Year



Page 85 of 109




Principal Diagnosis ClaimsIntraductal Carcinoma In Situ Of Right Breast $25,289

Intramural Leiomyoma Of Uterus $25,283Other Intraoperative And Postprocedural Complications And Disorders Of TheMusculoskeletal System $25,113

Headache $25,060

Total $24,759,696

Total Above $25,000 $14,709,696



Current Year



Page 86 of 109




Principal Diagnosis ClaimsDilated Cardiomyopathy $859,471



Laceration Of Liver, Unspecified Degree, Initial Encounter $448,730


Malignant Melanoma Of Skin, Unspecified $335,966

Acute Respiratory Failure With Hypoxia $326,481

Sepsis Due To Methicillin Susceptible Staphylococcus Aureus $324,203


Secondary Malignant Neoplasm Of Other Parts Of Nervous System $287,241

Encounter For Antineoplastic Immunotherapy $286,700



Malignant Neoplasm Of Prostate $203,540Pathological Fracture In Neoplastic Disease, Other Specified Site, Initial Encounter ForFracture $200,597

Postsurgical Lordosis $197,035


Prior Year



Page 87 of 109




Principal Diagnosis ClaimsSt Elevation (stemi) Myocardial Infarction Involving Left Anterior Descending CoronaryArtery $194,777

Benign Neoplasm Of Peripheral Nerves And Autonomic Nervous System Of Abdomen $190,962

Malignant Neoplasm Of Brain, Unspecified $185,472Encounter For Adjustment And Management Of Automatic Implantable CardiacDefibrillator $181,971

Stenosis Of Other Cardiac Prosthetic Devices, Implants And Grafts, Initial Encounter $179,583


Malignant Neoplasm Of Upper-outer Quadrant Of Right Female Breast $167,742

Unspecified Juvenile Rheumatoid Arthritis Of Unspecified Site $163,761



Primary Osteoarthritis, Left Shoulder $151,697


Malignant Neoplasm Of Unspecified Part Of Right Bronchus Or Lung $136,666

Idiopathic Acute Pancreatitis $129,773




Prior Year



Page 88 of 109




Principal Diagnosis ClaimsNonrheumatic Aortic (valve) Stenosis With Insufficiency $124,852



Other Secondary Pulmonary Hypertension $121,232







Malignant Neoplasm Of Upper-outer Quadrant Of Left Female Breast $115,155


Chronic Myeloid Leukemia, Bcr/abl-positive, Not Having Achieved Remission $109,347

Neuromuscular Dysfunction Of Bladder, Unspecified $109,140


Benign Neoplasm Of Cerebral Meninges $103,981

Malignant Neoplasm Of Overlapping Sites Of Left Female Breast $102,356


Prior Year



Page 89 of 109




Principal Diagnosis ClaimsMultiple Sclerosis $99,482

Urethral Stricture, Unspecified $96,376

Malignant Neoplasm Of Endometrium $95,034



Malignant Neoplasm Of Unspecified Site Of Unspecified Female Breast $92,906


Longitudinal Reduction Defect Of Left Femur $89,566


Rheumatoid Arthritis Without Rheumatoid Factor, Multiple Sites $88,483






Other Spondylosis With Radiculopathy, Lumbar Region $87,235

Anemia, Unspecified $87,108


Prior Year



Page 90 of 109




Principal Diagnosis ClaimsType 1 Diabetes Mellitus Without Complications $86,448


Pain In Left Knee $83,020



Atherosclerosis Of Native Arteries Of Left Leg With Ulceration Of Other Part Of Foot $80,999







Encounter For Screening Mammogram For Malignant Neoplasm Of Breast $77,247


Other Instability, Right Foot $76,510

Abscess Of Lung With Pneumonia $76,397

Endometriosis Of Pelvic Peritoneum $75,632


Prior Year



Page 91 of 109




Principal Diagnosis ClaimsSpinal Stenosis, Lumbar Region $74,437



Pseudarthrosis After Fusion Or Arthrodesis $71,575

Fistula Of Stomach And Duodenum $70,548





Retention Of Urine, Unspecified $66,484




Intramural Leiomyoma Of Uterus $64,796



Congenital Malformations Of Intestinal Fixation $61,532


Prior Year



Page 92 of 109




Principal Diagnosis ClaimsSubserosal Leiomyoma Of Uterus $60,620

Sepsis, Unspecified Organism $59,854Pain Due To Internal Orthopedic Prosthetic Devices, Implants And Grafts, InitialEncounter $59,660

Abdominal Aortic Aneurysm, Without Rupture $59,623Pain Due To Internal Orthopedic Prosthetic Devices, Implants And Grafts, InitialEncounter $59,281


Other Spondylosis With Radiculopathy, Cervical Region $58,417

Malignant Neoplasm Of Appendix $57,994





Cleft Palate, Unspecified $57,275





Prior Year



Page 93 of 109




Principal Diagnosis ClaimsUnilateral Post-traumatic Osteoarthritis, Right Knee $56,370

Unspecified Hydronephrosis $55,877

Unspecified Iridocyclitis $55,726

Diarrhea, Unspecified $55,642

Osteomyelitis, Unspecified $55,575

Other Pneumothorax $55,544

Malignant Neoplasm Of Frontal Lobe $55,242

Inflammatory Polyarthropathy $54,984


Vesicointestinal Fistula $54,384









Prior Year



Page 94 of 109




Principal Diagnosis ClaimsMultiple Sclerosis $52,852

Juvenile Rheumatoid Polyarthritis (seronegative) $52,740

Radiculopathy, Cervical Region $52,556

Chronic Ethmoidal Sinusitis $52,542


Osteoarthritis Of Knee, Unspecified $52,490


Plantar Fascial Fibromatosis $52,016Atherosclerotic Heart Disease Of Native Coronary Artery With Other Forms Of AnginaPectoris $51,551

Malignant Neoplasm Of Cervix Uteri, Unspecified $51,320


Psoriasis Vulgaris $50,925

Gastrostomy Status $50,754



Calculus Of Gallbladder With Acute Cholecystitis With Obstruction $50,212



Prior Year



Page 95 of 109




Principal Diagnosis ClaimsAcute On Chronic Systolic (congestive) Heart Failure $48,854


Acute Serous Otitis Media, Bilateral $48,277


Other Specified Rheumatoid Arthritis, Multiple Sites $47,462

Migraine Without Aura, Intractable, Without Status Migrainosus $47,330

Streptococcus B Carrier State Complicating Childbirth $47,122



Rheumatoid Arthritis With Rheumatoid Factor, Unspecified $46,928







Other Cervical Disc Degeneration, Mid-cervical Region $45,652


Prior Year



Page 96 of 109




Principal Diagnosis ClaimsUnilateral Primary Osteoarthritis, Left Knee $45,591







Calculus Of Kidney $43,861

Primary Pulmonary Hypertension $43,748

Other Cyst Of Bone, Other Site $43,626





Edema, Unspecified $43,294

Crohn's Disease Of Small Intestine With Other Complication $43,253



Prior Year



Page 97 of 109




Principal Diagnosis ClaimsEncounter For Antineoplastic Immunotherapy $42,387

Intestinal Adhesions [bands] With Obstruction (postinfection) $42,345

Pericardial Effusion (noninflammatory) $41,976



Benign Neoplasm Of Right Ovary $41,538

Lesion Of Plantar Nerve, Right Lower Limb $41,495

Gastro-esophageal Laceration-hemorrhage Syndrome $41,403

Sepsis Due To Hemophilus Influenzae $40,922


Other Specified Diabetes Mellitus With Ketoacidosis Without Coma $40,596Strain Of Other Specified Muscles, Fascia And Tendons At Thigh Level, Right Thigh,Initial Encounter $40,567

Benign Neoplasm Of Parathyroid Gland $40,468



Other Cervical Disc Displacement, Mid-cervical Region $40,101

Family History Of Ischemic Heart Disease And Other Diseases Of The Circulatory System $39,998


Prior Year



Page 98 of 109







Induration Penis Plastica $39,232


Unspecified Fracture Of Lower End Of Right Tibia, Initial Encounter For Closed Fracture $39,059


Unspecified Sequelae Of Unspecified Cerebrovascular Disease $38,954





Benign Neoplasm, Unspecified Site $38,503


Esophageal Varices Without Bleeding $38,247

Unspecified Cataract $38,164



Prior Year



Page 99 of 109




Principal Diagnosis ClaimsMalignant Neoplasm Of Endometrium $38,073











Dissection Of Other Specified Artery $36,824



Other Acute Postprocedural Pain $36,550

Other Specified Types Of Non-hodgkin Lymphoma, Extranodal And Solid Organ Sites $36,434



Prior Year



Page 100 of 109




Principal Diagnosis ClaimsExcessive And Frequent Menstruation With Irregular Cycle $35,899

Delayed Milestone In Childhood $35,893

Streptococcal Sepsis, Unspecified $35,780


Leiomyoma Of Uterus, Unspecified $35,633




Other Secondary Cataract, Left Eye $35,301

Other Ascites $35,206

Other Specified Disorders Of Eyelid $34,988


Excessive And Frequent Menstruation With Irregular Cycle $34,822






Prior Year



Page 101 of 109




Principal Diagnosis ClaimsPoisoning By Propionic Acid Derivatives, Intentional Self-harm, Initial Encounter $34,448

Other Noninflammatory Disorders Of Ovary, Fallopian Tube And Broad Ligament $34,434

Dizziness And Giddiness $34,010

Dry Eye Syndrome Of Bilateral Lacrimal Glands $33,991







Encounter For Therapeutic Drug Level Monitoring $33,408

Unspecified Atrial Fibrillation $33,183


Sprain Of Anterior Cruciate Ligament Of Right Knee, Initial Encounter $33,040





Prior Year



Page 102 of 109




Principal Diagnosis ClaimsAnemia, Unspecified $32,869Displaced Intraarticular Fracture Of Right Calcaneus, Initial Encounter For ClosedFracture $32,769



Intervertebral Disc Disorders With Radiculopathy, Lumbar Region $32,391

Disruptive Mood Dysregulation Disorder $32,292

Displacement Of Intraocular Lens, Initial Encounter $32,203




Infections Of Kidney In Pregnancy, Third Trimester $32,014

Benign Neoplasm Of Left Ovary $31,995

Sensorineural Hearing Loss, Bilateral $31,850


Other Specified Diseases Of Intestine $31,581




Prior Year



Page 103 of 109




Principal Diagnosis ClaimsVascular Disorder Of Intestine, Unspecified $31,372





Maternal Care For Breech Presentation, Fetus 1 $31,133




Unspecified Lump In Breast $30,219



Unspecified Osteoarthritis, Unspecified Site $30,128

Atypical Atrial Flutter $30,121

Incisional Hernia Without Obstruction Or Gangrene $30,120

Incomplete Rotator Cuff Tear Or Rupture Of Left Shoulder, Not Specified As Traumatic $30,077



Prior Year



Page 104 of 109




Principal Diagnosis ClaimsHyperlipidemia, Unspecified $29,895Other Generalized Epilepsy And Epileptic Syndromes, Not Intractable, Without StatusEpilepticus $29,894

Obstructed Labor Due To Breech Presentation, Fetus 1 $29,801

Dermatochalasis Of Right Upper Eyelid $29,750



Thrombotic Microangiopathy $29,564

Chronic Or Unspecified Gastrojejunal Ulcer With Hemorrhage $29,490

Bilateral Inguinal Hernia, Without Obstruction Or Gangrene, Not Specified As Recurrent $29,477

Unspecified Abnormalities Of Gait And Mobility $29,309


Encounter For Other Preprocedural Examination $29,127


Primary Osteoarthritis, Left Shoulder $28,968Other Intraarticular Fracture Of Lower End Of Right Radius, Initial Encounter For ClosedFracture $28,963



Prior Year



Page 105 of 109





Deviated Nasal Septum $28,815



Other Abnormal Involuntary Movements $28,558

Unilateral Inguinal Hernia, Without Obstruction Or Gangrene, Not Specified As Recurrent $28,523Displaced Fracture Of Lateral Malleolus Of Left Fibula, Initial Encounter For ClosedFracture $28,349

Respiratory Distress Of Newborn, Unspecified $28,332


Hypothyroidism, Unspecified $28,033

Cerebral Infarction Due To Unspecified Occlusion Or Stenosis Of Left Cerebellar Artery $27,968





Benign Lipomatous Neoplasm Of Intra-abdominal Organs $27,600

Headache $27,503


Prior Year



Page 106 of 109




Principal Diagnosis ClaimsUnilateral Primary Osteoarthritis, Right Knee $27,442

Neoplasm Of Uncertain Behavior Of Left Ovary $27,268


Ganglion, Right Wrist $27,196







Other Iron Deficiency Anemias $26,826




Right Upper Quadrant Pain $26,724

Cervical Shortening, Second Trimester $26,700

Other Specified Diseases Of Gallbladder $26,599


Prior Year



Page 107 of 109




Principal Diagnosis ClaimsMalignant Neoplasm Of Left Ovary $26,557

Spondylosis Without Myelopathy Or Radiculopathy, Lumbar Region $26,451


Calculus Of Gallbladder And Bile Duct With Cholecystitis, Unspecified, With Obstruction $26,331

Other Postprocedural Complications And Disorders Of Nervous System $26,297









Parkinson's Disease $25,600

Chronic Or Unspecified Duodenal Ulcer With Perforation $25,584

Displaced Fracture Of Shaft Of Left Clavicle, Initial Encounter For Closed Fracture $25,543



Prior Year



Page 108 of 109




Principal Diagnosis ClaimsPrecocious Puberty $25,514



Lumbago With Sciatica, Right Side $25,401



Alcoholic Hepatitis With Ascites $25,210

Hydronephrosis With Renal And Ureteral Calculous Obstruction $25,182Atherosclerotic Heart Disease Of Native Coronary Artery With Unspecified AnginaPectoris $25,094



Unspecified Dislocation Of Right Acromioclavicular Joint, Initial Encounter $25,010

Total $25,020,710

Total Above $25,000 $15,470,710



Prior Year



Page 109 of 109





PMPMVariance in

PMPMPMPMTrend

Professional $21,284,758 $233.56 $172.17 35.65% 12.19%

Hospital IP $9,167,229 $100.59 $91.03 10.51% 16.34%

Hospital OP $10,562,345 $115.90 $103.74 11.72% 1.35%

Pharmacy $9,298,655 $102.04 $79.08 29.02% 3.06%



Total $51,448,336 $564.55 $458.40 23.16% 8.83%


Claims include IBNR


Current Year



Page 1 of 106





PMPMVariance in

PMPM

Professional $18,963,874 $208.18 $163.09 27.65%

Hospital IP $7,876,114 $86.46 $84.93 1.80%

Hospital OP $10,417,203 $114.36 $99.67 14.74%

Pharmacy $9,019,153 $99.01 $76.16 30.00%

DME, Transportation, Other $977,133 $10.73 $10.18 5.39%


Total $47,253,477 $518.74 $435.33 19.16%


Claims include IBNR


Prior Year



Page 2 of 106








Page 3 of 106





Paid perUnit PMPM

Units perMember

Paid PerUnit PMPM

Variancein PMPM

PMPMTrend

Orthopedic and Arthritic Conditions $3,136,694.74 10.369 $39.83 $34.42 10.293 $33.12 $28.41 21.15% 1.06%Cancer $2,201,522.91 5.630 $51.49 $24.16 5.372 $31.70 $14.19 70.20% 50.25%Psychiatry $1,823,217.67 3.172 $75.68 $20.01 2.797 $62.19 $14.50 38.01% 4.87%Cardiology $1,634,608.38 2.758 $78.04 $17.94 2.183 $52.14 $9.48 89.11% 13.83%Gastroenterology $1,235,437.78 4.251 $38.27 $13.56 3.745 $36.16 $11.29 20.13% 26.73%Endocrinology $1,228,447.90 6.170 $26.22 $13.48 4.684 $22.42 $8.75 54.05% 6.31%Preventive and Administrative Care $1,219,519.81 2.666 $60.24 $13.38 2.824 $56.01 $13.18 1.50% 10.58%Otolaryngology $1,023,744.86 2.530 $53.29 $11.23 2.926 $38.80 $9.46 18.72% -1.40%Gynecology $933,326.41 4.914 $25.01 $10.24 3.924 $22.75 $7.44 37.67% 21.18%Dermatology $902,698.03 1.886 $63.01 $9.91 1.780 $52.57 $7.80 27.06% 6.79%Ophthalmology $796,070.07 1.465 $71.56 $8.74 1.433 $56.04 $6.69 30.52% 19.56%Neurology $759,152.97 2.417 $41.36 $8.33 2.312 $36.11 $6.96 19.77% -1.42%Obstetrics $718,725.83 1.825 $51.85 $7.89 1.957 $47.72 $7.78 1.35% 8.83%Pulmonology $454,462.93 0.985 $60.73 $4.99 1.067 $44.18 $3.93 27.01% 3.53%Urology $386,761.52 1.537 $33.13 $4.24 1.383 $29.15 $3.36 26.34% 22.90%Isolated Signs/Symptoms $314,271.67 0.949 $43.62 $3.45 0.960 $38.43 $3.07 12.15% 3.60%Hepatology $251,701.36 1.045 $31.70 $2.76 0.723 $27.82 $1.68 64.77% 14.05%Other $212,137.14 0.739 $37.77 $2.33 1.183 $21.60 $2.13 9.30% -17.96%Nephrology $137,577.22 0.826 $21.92 $1.51 0.387 $30.55 $0.99 53.11% 9.42%Hematology $124,696.71 2.104 $7.80 $1.37 0.772 $15.04 $0.97 41.47% -8.05%Chemical dependency $122,733.78 0.256 $63.20 $1.35 0.288 $38.04 $0.91 47.65% -8.78%Neonatology $114,268.93 0.088 $171.06 $1.25 0.145 $112.41 $1.36 -7.66% 7.76%Infectious diseases $97,371.44 0.172 $74.39 $1.07 0.773 $28.10 $1.81 -41.01% -7.76%Late effects/Complications $65,572.86 0.200 $43.25 $0.72 0.201 $29.22 $0.49 47.30% 50.00%Total $19,894,723 58.954 $44.44 $218.31 54.112 $36.95 $166.62 31.02% 11.04%






Page 4 of 106





Paid perUnit PMPM

Units perMember

Paid PerUnit PMPM

Variancein PMPM

Orthopedic and Arthritic Conditions $3,102,315.39 10.750 $38.02 $34.06 10.321 $31.27 $26.90 26.62%Psychiatry $1,738,283.00 2.793 $81.98 $19.08 2.739 $57.78 $13.19 44.68%Cancer $1,465,128.52 4.603 $41.93 $16.08 5.225 $34.75 $15.13 6.29%Cardiology $1,435,884.91 2.378 $79.55 $15.76 2.206 $49.34 $9.07 73.79%Endocrinology $1,154,916.97 5.963 $25.52 $12.68 4.833 $21.50 $8.66 46.40%Preventive and Administrative Care $1,102,379.28 2.513 $57.80 $12.10 4.518 $37.61 $14.16 -14.53%Otolaryngology $1,037,773.49 3.131 $43.67 $11.39 2.956 $37.88 $9.33 22.09%Gastroenterology $974,546.10 2.565 $50.06 $10.70 2.923 $41.96 $10.22 4.66%Dermatology $845,467.34 1.760 $63.29 $9.28 1.686 $48.02 $6.75 37.56%Gynecology $770,013.48 4.272 $23.74 $8.45 2.187 $26.75 $4.88 73.36%Neurology $769,457.60 2.327 $43.57 $8.45 2.364 $32.15 $6.33 33.35%Ophthalmology $665,512.27 1.239 $70.77 $7.31 1.467 $52.22 $6.38 14.46%Obstetrics $660,490.92 1.744 $49.89 $7.25 1.892 $47.89 $7.55 -3.96%Pulmonology $439,432.67 1.032 $56.11 $4.82 1.076 $41.99 $3.76 28.13%Urology $314,668.55 1.380 $30.04 $3.45 1.296 $28.95 $3.13 10.46%Isolated Signs/Symptoms $302,917.23 0.981 $40.69 $3.33 0.982 $39.57 $3.24 2.68%Other $258,721.50 1.339 $25.46 $2.84 1.145 $20.75 $1.98 43.48%Hepatology $220,085.80 1.028 $28.21 $2.42 0.702 $26.44 $1.55 56.14%Hematology $135,905.43 1.487 $12.04 $1.49 0.636 $18.00 $0.95 56.30%Chemical dependency $135,253.44 0.445 $40.06 $1.48 0.323 $39.11 $1.05 41.02%Nephrology $125,267.40 1.679 $9.83 $1.38 0.366 $27.93 $0.85 61.56%Neonatology $105,843.79 0.071 $196.37 $1.16 0.138 $97.90 $1.12 3.39%Infectious diseases $105,300.16 0.443 $31.30 $1.16 0.857 $19.87 $1.42 -18.50%Late effects/Complications $43,443.71 0.158 $36.11 $0.48 0.198 $26.60 $0.44 8.43%Total $17,909,009 56.077 $42.07 $196.60 53.037 $35.76 $158.05 24.39%






Page 5 of 106








Page 6 of 106





Paid perUnit PMPM

Units perMember

Paid perUnit PMPM

Variance inPMPM

PMPMTREND

Office Visit $4,252,744 3.457 $161.97 $46.67 3.086 $120.72 $31.05 50.31% 8.94%

Surgery $3,897,323 18.709 $27.43 $42.77 17.781 $24.87 $36.84 16.07% 10.40%

Radiology / Lab / Pathology $3,637,518 11.007 $43.52 $39.91 8.766 $38.20 $27.91 43.04% 22.35%

Injections / Immunizations / IV Therapy $2,692,177 16.350 $21.68 $29.54 14.801 $16.14 $19.91 48.40% 11.68%



Mental Health $952,127 1.847 $67.90 $10.45 1.725 $56.43 $8.11 28.78% 0.97%

Physical Exam $801,627 0.509 $207.19 $8.80 0.531 $205.17 $9.08 -3.07% 2.56%


Maternity Care and Delivery $374,089 0.067 $732.07 $4.10 0.054 $961.86 $4.36 -5.88% 9.63%

Routine Eye Care $320,026 0.343 $122.90 $3.51 0.334 $103.75 $2.89 21.55% 3.54%


Chemotherapy $93,673 0.046 $267.64 $1.03 0.048 $177.49 $0.71 45.29% 11.96%

Consults $46,683 0.048 $127.55 $0.51 0.036 $144.85 $0.43 18.47% -8.93%

Supplies $35,626 0.563 $8.33 $0.39 0.731 $5.49 $0.33 16.89% -2.50%

E-Visits $19,416 0.064 $40.12 $0.21 0.078 $51.58 $0.33 -36.26% 10.53%

Chemical Health $12,206 0.030 $53.77 $0.13 0.087 $22.62 $0.16 -18.73% -40.91%

Total $19,894,723 58.954 $44.44 $218.31 54.112 $36.95 $166.62 31.02% 11.04%






Page 7 of 106





Paid perUnit PMPM

Units perMember

Paid perUnit PMPM

Variance inPMPM

Office Visit $3,902,310 3.437 $149.57 $42.84 3.072 $115.87 $29.66 44.41%

Surgery $3,528,643 16.751 $27.75 $38.74 17.486 $23.72 $34.57 12.06%



Hospital / Institutional Visits $977,685 0.508 $253.68 $10.73 0.500 $205.06 $8.55 25.54%

Other Visits / Procedures $949,705 1.906 $65.64 $10.43 1.831 $53.28 $8.13 28.23%

Mental Health $943,232 1.635 $76.01 $10.35 1.732 $49.86 $7.20 43.90%

Physical Exam $781,186 0.482 $213.32 $8.58 0.506 $205.48 $8.66 -1.01%



Routine Eye Care $308,786 0.335 $121.52 $3.39 0.335 $102.50 $2.86 18.40%


Chemotherapy $83,423 0.045 $243.22 $0.92 0.048 $180.99 $0.72 27.72%

Consults $51,120 0.049 $138.54 $0.56 0.032 $154.92 $0.42 34.77%

Supplies $36,499 0.631 $7.62 $0.40 0.824 $4.78 $0.33 21.97%

Chemical Health $20,225 0.079 $33.93 $0.22 0.089 $22.75 $0.17 31.80%

E-Visits $17,256 0.055 $41.18 $0.19 0.059 $62.48 $0.31 -38.18%

Total $17,909,009 56.077 $42.07 $196.60 53.037 $35.76 $158.05 24.39%






Page 8 of 106








Page 9 of 106





per 1000Paid per

AdmitDays


1000Paid Per

AdmitDays


PMPMTrend

Orthopedic and Arthritic Conditions $1,673,183 9.1 $24,249 33.2 $18.36 7.9 $21,023 34.9 $13.87 32.41% 79.47%Cardiology $1,277,000 4.5 $37,559 17.8 $14.01 4.8 $27,763 23.1 $11.05 26.81% 62.34%Neurology $874,402 3.7 $31,229 24.6 $9.59 3.5 $31,238 28.9 $9.18 4.47% -34.32%Obstetrics $819,661 12.5 $8,628 36.9 $8.99 13.6 $7,472 34.3 $8.45 6.41% 43.84%Endocrinology $741,634 3.3 $29,665 16.2 $8.14 2.7 $26,078 13.4 $5.84 39.44% 70.65%Gastroenterology $587,002 4.7 $16,306 16.5 $6.44 3.5 $14,629 13.4 $4.25 51.58% 77.90%Neonatology $437,502 9.7 $5,912 28.2 $4.80 11.1 $5,397 30.4 $5.00 -4.07% 23.71%Cancer $434,009 2.1 $27,126 6.6 $4.76 3.3 $27,983 17.3 $7.75 -38.54% 1.71%Pulmonology $347,398 2.8 $16,543 15.9 $3.81 2.8 $19,061 12.9 $4.47 -14.81% 147.40%Psychiatry $242,824 2.5 $12,780 14.2 $2.66 4.1 $13,332 37.3 $4.56 -41.61% -41.54%Hepatology $206,603 2.6 $10,330 8.4 $2.27 1.0 $18,183 3.8 $1.48 53.58% -53.58%Chemical dependency $186,151 2.9 $8,461 29.0 $2.04 2.3 $12,465 32.0 $2.34 -12.75% -42.54%Urology $179,370 1.1 $22,421 3.7 $1.97 0.8 $14,058 2.6 $0.90 118.54% 198.48%Infectious diseases $132,368 0.8 $22,061 3.0 $1.45 1.3 $15,407 6.4 $1.70 -14.75% 245.24%Gynecology $124,409 1.2 $13,823 2.2 $1.37 0.7 $14,383 1.7 $0.88 54.50% 61.18%Nephrology $86,181 1.2 $9,576 4.1 $0.95 0.8 $32,235 5.7 $2.11 -55.13% -73.76%Late effects/Complications $60,685 0.5 $15,171 2.5 $0.67 0.6 $16,129 2.0 $0.84 -20.94% -8.22%Otolaryngology $34,364 0.3 $17,182 0.8 $0.38 0.7 $18,407 2.7 $1.01 -62.65% -56.82%Dermatology $28,085 0.3 $14,042 0.8 $0.31 0.6 $10,505 3.0 $0.49 -36.93% 82.35%Other $14,707 0.1 $14,707 0.4 $0.16 0.1 $34,732 0.9 $0.21 -24.37% 0.00%Ophthalmology $9,718 0.1 $9,718 0.1 $0.11 0.1 $11,449 0.2 $0.07 51.62% -90.35%Hematology $9,069 0.1 $9,069 0.4 $0.10 0.5 $16,356 1.9 $0.63 -84.24% -95.82%Isolated Signs/Symptoms $0 0.0 $0 0.0 $0.00 0.0 $13,307 0.1 $0.04 -100.00% -100.00%Preventive and Administrative Care $0 0.0 $0 0.0 $0.00 0.5 $25,214 2.8 $1.02 -100.00% -100.00%Total $8,506,323 66.1 $16,945 265.5 $93.34 67.2 $15,752 311.8 $88.15 5.89% 13.59%






Page 10 of 106





per 1000Paid per

AdmitDays


1000Paid Per

AdmitDays


Neurology $1,330,120 4.9 $35,949 44.3 $14.60 3.8 $24,855 28.5 $7.86 85.89%Orthopedic and Arthritic Conditions $931,938 7.0 $17,584 27.8 $10.23 8.2 $20,228 37.5 $13.75 -25.62%Cardiology $785,963 5.8 $17,863 19.9 $8.63 5.1 $23,618 24.4 $9.98 -13.58%Obstetrics $569,673 11.3 $6,624 25.8 $6.25 13.1 $6,843 32.7 $7.47 -16.26%Hepatology $445,188 1.3 $44,519 6.6 $4.89 0.9 $20,610 3.9 $1.53 219.00%Endocrinology $434,545 4.3 $13,168 9.5 $4.77 3.0 $21,002 15.4 $5.26 -9.28%Cancer $425,955 3.2 $17,748 15.1 $4.68 3.8 $26,301 17.8 $8.26 -43.42%Psychiatry $414,071 5.9 $9,202 63.9 $4.55 4.7 $11,685 47.8 $4.53 0.24%Neonatology $353,246 7.9 $5,887 21.1 $3.88 10.4 $5,605 29.3 $4.86 -20.28%Nephrology $329,929 2.0 $21,995 7.2 $3.62 0.6 $22,788 3.8 $1.23 195.36%Gastroenterology $329,822 3.2 $13,743 9.4 $3.62 3.5 $14,316 12.4 $4.18 -13.34%Chemical dependency $323,594 4.6 $9,246 39.0 $3.55 2.3 $10,653 29.3 $2.05 72.87%Hematology $217,615 0.8 $36,269 5.5 $2.39 0.4 $28,463 2.8 $1.01 135.96%Pulmonology $140,027 1.7 $10,771 3.7 $1.54 2.6 $14,089 11.5 $3.10 -50.46%Ophthalmology $103,393 0.0 $0 3.2 $1.14 0.1 $64,042 1.0 $0.32 253.31%Otolaryngology $79,726 0.5 $19,932 1.6 $0.88 0.6 $14,215 2.0 $0.71 22.74%Gynecology $77,668 1.1 $9,708 2.1 $0.85 1.1 $12,876 2.5 $1.17 -27.40%Late effects/Complications $66,298 0.8 $11,050 1.3 $0.73 0.6 $13,464 2.0 $0.63 15.08%Urology $60,275 0.8 $10,046 1.4 $0.66 1.1 $11,764 3.6 $1.07 -38.02%Infectious diseases $38,669 0.5 $9,667 1.6 $0.42 1.3 $16,533 6.4 $1.79 -76.34%Dermatology $15,508 0.1 $15,508 0.5 $0.17 0.4 $13,756 1.8 $0.43 -60.09%Isolated Signs/Symptoms $6,285 0.1 $6,285 0.4 $0.07 0.0 $8,558 0.1 $0.02 253.58%Preventive and Administrative Care $5,427 0.3 $2,713 0.8 $0.06 0.6 $21,696 4.5 $1.04 -94.27%Other $0 0.0 $0 0.0 $0.00 0.0 $34,280 0.3 $0.13 -100.00%Total $7,484,934 68.1 $14,478 311.7 $82.17 68.1 $14,516 321.1 $82.40 -0.28%






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Page 12 of 106





per 1000Paid Per

AdmitDays per

1000 PMPMAdmits per

1000Paid per

AdmitDays per


PMPMTrend

Surgical $4,787,321 19.5 $32,347 74.1 $52.53 16.0 $31,569 61.0 $42.07 24.86% 37.19%

Medical $1,600,847 16.3 $12,910 58.7 $17.57 17.5 $13,841 63.8 $20.20 -13.04% -3.51%

Maternity $837,155 12.9 $8,542 38.4 $9.19 13.5 $7,434 34.5 $8.38 9.66% 27.99%

Newborn $445,243 9.7 $6,017 27.8 $4.89 11.3 $6,787 34.0 $6.39 -23.52% -29.34%

Other Treatments $423,252 0.9 $60,465 5.0 $4.64 0.6 $52,508 2.9 $2.65 75.28% 1,756.00%

Chemical Health $169,640 2.5 $8,928 27.9 $1.86 2.4 $14,608 42.5 $2.93 -36.46% -48.90%

Mental Health $121,582 2.0 $8,105 7.2 $1.33 3.1 $11,866 20.9 $3.04 -56.05% -49.81%

Non-Acute $121,283 2.2 $7,134 26.2 $1.33 2.7 $10,907 52.1 $2.50 -46.73% -73.51%

Total $8,506,323 66.1 $16,945 265.5 $93.34 67.2 $15,752 311.8 $88.15 5.89% 13.59%


Aggregate


Current Year Actual



Page 13 of 106





per 1000Paid Per

AdmitDays per

1000 PMPMAdmits per

1000Paid per

AdmitDays per


Surgical $3,487,649 15.9 $28,824 53.5 $38.29 16.7 $27,697 61.4 $38.44 -0.39%

Medical $1,658,952 18.8 $11,601 60.6 $18.21 18.3 $13,091 67.0 $20.02 -9.02%

Maternity $653,913 12.5 $6,883 30.8 $7.18 13.3 $6,885 33.5 $7.64 -6.03%

Newborn $630,491 8.0 $10,336 28.2 $6.92 10.6 $7,136 33.3 $6.30 9.80%

Non-Acute $457,306 4.1 $14,752 43.5 $5.02 2.7 $10,410 52.4 $2.38 110.65%

Chemical Health $331,702 3.4 $12,758 77.7 $3.64 2.4 $13,723 49.7 $2.74 32.84%

Mental Health $241,834 5.0 $6,364 17.1 $2.65 3.7 $9,651 21.6 $2.94 -9.83%

Other Treatments $23,088 0.3 $11,544 0.3 $0.25 0.4 $58,261 2.2 $1.94 -86.93%

Total $7,484,934 68.1 $14,478 311.7 $82.17 68.1 $14,516 321.1 $82.40 -0.28%


Aggregate


Prior Year Actual



Page 14 of 106








Page 15 of 106





1000Paid per

Unit PMPMUnits per

1000Paid Per


PMPMTrend

Cancer $1,690,627 5,025 $44.30 $18.55 5,501 $32.77 $15.02 23.51% -1.90%Orthopedic and Arthritic Conditions $1,624,817 3,378 $63.34 $17.83 3,154 $63.00 $16.56 7.69% -11.73%Cardiology $1,284,583 3,187 $53.07 $14.10 3,101 $48.99 $12.66 11.35% 3.68%Gastroenterology $642,815 1,749 $48.40 $7.05 2,170 $49.87 $9.02 -21.79% 15.01%Endocrinology $567,954 2,572 $29.08 $6.23 1,604 $37.35 $4.99 24.81% 6.50%Psychiatry $492,073 960 $67.49 $5.40 761 $77.20 $4.90 10.22% -3.23%Gynecology $485,021 1,161 $55.03 $5.32 829 $57.08 $3.94 35.00% 77.33%Nephrology $484,807 5,066 $12.60 $5.32 1,614 $17.72 $2.38 123.23% 40.37%Chemical dependency $396,133 894 $58.33 $4.35 571 $55.75 $2.65 63.82% -32.03%Otolaryngology $361,213 692 $68.71 $3.96 934 $64.74 $5.04 -21.36% -12.00%Neurology $334,921 896 $49.22 $3.68 1,370 $42.42 $4.84 -24.11% -19.65%Pulmonology $266,957 999 $35.20 $2.93 833 $41.35 $2.87 2.03% -2.98%Preventive and Administrative Care $238,441 451 $69.56 $2.62 408 $69.10 $2.35 11.50% 95.52%Urology $218,937 639 $45.09 $2.40 691 $47.74 $2.75 -12.63% 25.65%Ophthalmology $200,469 419 $62.94 $2.20 371 $64.40 $1.99 10.46% 24.29%Dermatology $141,863 443 $42.16 $1.56 473 $51.06 $2.01 -22.62% -7.14%Obstetrics $90,706 165 $72.28 $1.00 237 $71.68 $1.42 -29.81% 28.21%Hepatology $89,725 554 $21.32 $0.98 337 $42.26 $1.19 -17.13% -26.87%Isolated Signs/Symptoms $85,608 163 $69.26 $0.94 230 $66.82 $1.28 -26.53% -22.95%Hematology $85,259 779 $14.42 $0.94 787 $18.60 $1.22 -23.37% -1.05%Infectious diseases $36,891 111 $43.71 $0.40 133 $50.25 $0.56 -27.50% -18.37%Late effects/Complications $31,526 66 $62.93 $0.35 97 $42.71 $0.35 -0.10% -22.22%Neonatology $20,006 43 $60.81 $0.22 161 $34.28 $0.46 -52.16% -37.14%Other $1,833 1 $261.88 $0.02 2 $87.48 $0.02 19.92% -77.78%Total $9,873,188 30,415 $42.74 $108.34 26,371 $45.72 $100.47 7.84% 0.39%






Page 16 of 106





1000Paid per

Unit PMPMUnits per

1000Paid Per


Orthopedic and Arthritic Conditions $1,839,802 3,156 $76.78 $20.20 3,006 $63.02 $15.79 27.94%Cancer $1,722,414 5,863 $38.70 $18.91 5,566 $31.96 $14.83 27.53%Cardiology $1,239,270 2,844 $57.41 $13.60 2,803 $51.32 $11.99 13.50%Chemical dependency $583,304 720 $106.70 $6.40 546 $60.50 $2.75 132.69%Gastroenterology $558,521 1,468 $50.11 $6.13 2,362 $45.06 $8.87 -30.85%Endocrinology $533,317 3,553 $19.78 $5.85 1,351 $36.13 $4.07 43.89%Psychiatry $508,117 635 $105.42 $5.58 706 $78.76 $4.63 20.37%Neurology $417,013 754 $72.83 $4.58 1,522 $41.01 $5.20 -12.00%Otolaryngology $409,652 910 $59.28 $4.50 939 $63.49 $4.97 -9.47%Nephrology $344,953 3,062 $14.84 $3.79 2,018 $11.56 $1.94 94.87%Pulmonology $275,320 729 $49.72 $3.02 640 $45.88 $2.45 23.44%Gynecology $272,901 802 $44.85 $3.00 850 $48.55 $3.44 -12.90%Urology $173,856 601 $38.09 $1.91 695 $43.92 $2.55 -25.01%Ophthalmology $161,370 290 $73.25 $1.77 480 $53.19 $2.13 -16.74%Dermatology $153,112 343 $58.75 $1.68 547 $39.82 $1.82 -7.44%Hepatology $122,494 490 $32.96 $1.34 549 $32.84 $1.50 -10.53%Preventive and Administrative Care $122,476 232 $69.63 $1.34 609 $58.07 $2.95 -54.39%Isolated Signs/Symptoms $110,845 156 $93.54 $1.22 144 $91.55 $1.10 10.55%Hematology $86,313 813 $13.99 $0.95 1,006 $13.72 $1.15 -17.60%Obstetrics $70,931 172 $54.31 $0.78 386 $43.37 $1.39 -44.12%Infectious diseases $44,247 105 $55.73 $0.49 188 $31.02 $0.49 -0.31%Late effects/Complications $40,593 63 $84.39 $0.45 65 $56.53 $0.30 46.15%Neonatology $31,545 32 $128.75 $0.35 151 $25.06 $0.31 10.04%Other $8,447 6 $191.97 $0.09 11 $32.62 $0.03 209.38%Total $9,830,810 27,800 $46.59 $107.92 27,141 $42.73 $96.64 11.67%






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Page 18 of 106





1000Paid per

Unit PMPMUnits per

1000Paid per


PMPMPMPMTrend

Surgery $3,764,480 8,941 $55.44 $41.31 8,287 $61.13 $42.21 -2.15% -1.97%

Other Treatments $2,050,536 10,851 $24.88 $22.50 8,499 $26.60 $18.84 19.42% 0.90%

Emergency Room $1,392,672 4,061 $45.16 $15.28 3,904 $43.37 $14.11 8.31% 7.00%

Radiology $1,248,459 3,932 $41.81 $13.70 3,099 $43.97 $11.35 20.65% 1.93%

Cardiovascular $491,058 99 $650.41 $5.39 90 $517.12 $3.88 38.75% 25.93%


Lab $206,004 696 $38.97 $2.26 728 $42.41 $2.57 -12.11% 4.15%

Mental Health $179,430 73 $325.64 $1.97 78 $303.49 $1.97 -0.02% -44.51%

Chemical Health $138,124 243 $74.90 $1.52 196 $75.43 $1.23 23.08% -25.49%

Observation/Non-Invasive Procedures $122,170 231 $69.53 $1.34 113 $53.81 $0.51 163.99% 67.50%

Pharmacy, Hospital or Clinic $38,249 775 $6.50 $0.42 763 $4.99 $0.32 32.23% 162.50%

Total $9,873,188 30,415 $42.74 $108.34 26,371 $45.72 $100.47 7.84% 0.39%


Aggregate


Current Year Actual



Page 19 of 106





1000Paid per

Unit PMPMUnits per

1000Paid per


PMPM

Surgery $3,838,787 8,191 $61.74 $42.14 8,699 $56.24 $40.77 3.38%


Emergency Room $1,301,171 3,811 $44.98 $14.28 4,051 $39.90 $13.47 6.05%

Radiology $1,224,598 3,249 $49.66 $13.44 2,978 $46.84 $11.62 15.66%

Cardiovascular $389,530 115 $447.22 $4.28 95 $489.64 $3.89 9.92%

Mental Health $323,804 107 $398.28 $3.55 87 $278.96 $2.01 76.56%


Lab $197,695 716 $36.38 $2.17 700 $37.50 $2.19 -0.84%

Chemical Health $185,791 203 $120.80 $2.04 184 $82.10 $1.26 61.89%


Pharmacy, Hospital or Clinic $14,584 909 $2.11 $0.16 833 $4.40 $0.31 -47.60%

Total $9,830,810 27,800 $46.59 $107.92 27,141 $42.73 $96.64 11.67%


Aggregate


Prior Year Actual



Page 20 of 106








Page 21 of 106




Group Actual Current YearMeasure Prior Year Current Year %Change Prior Year Current Year VarianceTotal Pharmacy PMPM (PL+ML) $105.44 $106.94 1.42% $84.25 $86.63 23.45%Rx Paid PMPM (Plan Paid) $93.35 $95.27 2.06% $73.80 $76.54 24.47%Total Pharmacy (PL+ML) $9,604,456 $9,745,424 1.47% Total Prescriptions 30 day Rx 120,267 118,962 -1.09% Total Members w/Rx benefit 7,591 7,594 0.04% Average Ingredient Cost/Rx $76.41 $78.36 2.54% $69.54 $72.09 8.69%Average Generic Ingredient Cost/Rx $25.70 $25.91 0.81% $23.46 $22.60 14.64%Average Brand Ingredient Cost/Rx $491.33 $548.22 11.58% $429.41 $490.76 11.71%Average Brand Ingredient Cost/Rx(Without Specialty Drugs) $297.45 $320.78 7.84% $262.78 $287.31 11.65%

Average Brand Ingredient Cost/Rx(Specialty Drugs only) $4,645.96 $4,626.26 -0.42% $4,362.16 $4,697.29 -1.51%

Average Rx/Member/Year 15.84 15.66 -1.13% 13.99 13.89 12.80%Average Days Supply/Rx 26.52 26.48 -0.14% 26.23 26.25 0.86%Copay as Percent of Total Pharmacy 11.46% 10.91% -4.81% 12.41% 11.64% -6.28%Average Generic Copay/Rx $6.53 $6.35 -2.71% $6.12 $5.89 7.89%Average Brand Copay/Rx $30.63 $32.11 4.83% $31.16 $32.63 -1.62%% Generic Use 89.11% 89.96% 0.95% 88.65% 89.43% 0.59%% Non-Formulary 2.56% 2.34% -8.71% 3.56% 3.24% -27.78%



Aggregate



Page 22 of 106






Paid perRx

Rx perMember

PercentGeneric

PaidPMPM

Paid perRx

Rx perMember

Variancein PMPM

PMPMTrend

MS Agents 23.17% $1,324,418 $14.53 $5,383.81 0.03 11.75% $6.34 $5,291.19 0.01 129.27% 18.13%Chronic Inflammatory Disease 70.31% $1,079,502 $11.85 $1,169.56 0.12 70.84% $11.10 $1,206.14 0.11 6.70% 51.34%Diabetes 64.36% $968,679 $10.63 $144.41 0.88 59.68% $8.90 $153.45 0.70 19.44% 7.48%Stimulants 87.33% $583,303 $6.40 $189.51 0.41 83.72% $4.95 $173.78 0.34 29.28% 5.79%Antivirals 64.94% $541,942 $5.95 $452.37 0.16 80.28% $2.50 $242.62 0.12 138.23% 21.18%Oncology 93.71% $453,205 $4.97 $950.12 0.06 89.76% $5.29 $1,064.58 0.06 -6.03% 19.18%OTHER 92.84% $448,833 $4.93 $62.02 0.95 92.09% $3.55 $52.51 0.81 38.58% 3.35%Asthma 32.13% $420,623 $4.62 $99.44 0.56 32.41% $4.28 $104.52 0.49 7.74% -3.95%Dermatology 94.00% $327,035 $3.59 $111.46 0.39 92.38% $3.36 $117.83 0.34 6.83% -3.75%Anticonvulsants 92.15% $178,201 $1.96 $48.57 0.48 91.51% $1.65 $54.06 0.37 18.43% -10.09%Antidepressants 98.08% $144,744 $1.59 $10.37 1.84 98.19% $1.83 $12.81 1.71 -13.11% -30.87%Contraceptives 94.61% $141,653 $1.55 $27.94 0.67 93.40% $1.92 $28.06 0.82 -18.93% -7.19%Pulmonary Hypertension 87.50% $141,426 $1.55 $736.59 0.03 95.96% $0.46 $284.94 0.02 238.63% 118.31%Inflammatory Bowel 4.71% $137,895 $1.51 $811.15 0.02 9.82% $1.19 $699.92 0.02 26.87% 19.84%Cholesterol 94.72% $132,999 $1.46 $15.02 1.17 94.48% $1.51 $17.08 1.06 -3.22% -26.63%Ophthalmics 69.48% $116,994 $1.28 $72.71 0.21 71.27% $1.24 $65.15 0.23 3.83% -9.22%Antipsychotics 91.98% $116,694 $1.28 $111.35 0.14 90.02% $1.19 $145.01 0.10 7.43% -52.06%Ulcer/GERD 97.47% $113,975 $1.25 $21.67 0.69 96.82% $0.61 $13.31 0.55 105.41% 30.21%Hepatitis 71.88% $112,486 $1.23 $3,515.20 0.00 56.65% $1.63 $11,651.46 0.00 -24.44% -77.14%Narcotic Analgesics 95.64% $112,282 $1.23 $32.40 0.46 95.28% $0.85 $28.32 0.36 45.35% -9.56%HRT 63.09% $103,900 $1.14 $58.73 0.23 59.02% $1.09 $62.56 0.21 4.55% -10.94%Antibiotics 99.71% $94,865 $1.04 $16.42 0.76 99.64% $0.97 $15.28 0.76 7.81% -20.61%Anticoagulants 76.02% $94,608 $1.04 $113.44 0.11 77.65% $0.94 $95.72 0.12 9.93% 22.35%




Page 23 of 106





Paid perRx

Rx perMember

PercentGeneric

PaidPMPM

Paid perRx

Rx perMember

Variancein PMPM

PMPMTrend

Hypertension/Cardiac 99.70% $84,162 $0.92 $3.81 2.91 99.28% $1.00 $4.86 2.46 -7.23% -14.81%Osteoporosis 91.24% $73,038 $0.80 $164.13 0.06 96.99% $0.24 $61.22 0.05 240.83% 15.94%Migraines 89.88% $68,958 $0.76 $95.64 0.09 91.94% $0.64 $81.90 0.09 17.45% -17.39%Androgens 55.25% $67,999 $0.75 $375.68 0.02 55.93% $0.49 $315.57 0.02 52.85% 10.29%Cystic Fibrosis 0.00% $66,631 $0.73 $1,448.50 0.01 6.07% $1.49 $3,663.44 0.00 -50.86% 17.74%Smoking Cessation 53.82% $56,391 $0.62 $165.86 0.04 48.35% $0.35 $181.61 0.02 76.52% 29.17%Erectile Dysfunction 0.00% $54,639 $0.60 $260.19 0.03 0.00% $0.51 $163.02 0.04 16.58% 1.69%Over Active Bladder 86.68% $45,295 $0.50 $92.82 0.06 80.04% $0.43 $104.98 0.05 16.19% -19.35%Immunosuppressants 91.34% $37,028 $0.41 $133.68 0.04 86.84% $0.52 $166.51 0.04 -21.98% -8.89%Antiplatelets 82.06% $27,937 $0.31 $66.83 0.06 87.10% $0.18 $44.84 0.05 66.43% 3.33%Colony Stimulating Factors 0.00% $26,581 $0.29 $4,430.17 0.00 0.00% $0.26 $3,328.81 0.00 10.32% 61.11%Growth Hormones 0.00% $25,815 $0.28 $1,843.92 0.00 0.00% $0.99 $3,006.40 0.00 -71.42% 33.33%Allergy 97.97% $25,447 $0.28 $9.06 0.37 96.70% $0.30 $11.32 0.32 -6.70% -56.25%NSAIDS/COX-2 98.77% $24,281 $0.27 $15.67 0.20 99.66% $0.19 $13.52 0.17 41.61% -28.95%Infertility 40.63% $18,386 $0.20 $287.28 0.01 38.96% $0.37 $422.80 0.01 -44.93% -23.08%Antifungals 98.51% $17,646 $0.19 $32.80 0.07 99.66% $0.10 $21.55 0.06 87.27% -13.64%Thyroid 90.88% $17,237 $0.19 $3.47 0.65 87.87% $0.32 $6.09 0.62 -40.08% -5.00%Biliary Cirrhosis 100.00% $13,224 $0.15 $330.61 0.01 100.00% $0.08 $283.89 0.00 90.91% -40.00%Hypnotics 98.67% $12,152 $0.13 $11.53 0.14 97.80% $0.16 $17.62 0.11 -17.82% 0.00%Corticosteroids 99.11% $10,329 $0.11 $7.69 0.18 99.36% $0.26 $18.58 0.17 -57.18% -69.44%Parkinsons Disease 99.02% $8,108 $0.09 $19.83 0.05 97.08% $0.16 $35.22 0.05 -44.50% -40.00%Antianxiety 99.82% $5,964 $0.07 $2.75 0.29 99.73% $0.08 $4.45 0.23 -22.06% 0.00%Alzheimers Disease 100.00% $4,425 $0.05 $83.50 0.01 95.79% $0.04 $33.46 0.01 31.89% -16.67%

Total 179.07% $8,681,936 $95.27 $72.98 1.31 178.08% $76.51 $66.12 13.89 24.51% 2.06%




Page 24 of 106






SPECIALTY 14.61% $3,389,709 $37.20 $4,586.89 0.10 7.83% $28.02 $4,576.01 0.07 32.74% 16.80%



Page 25 of 106






Paid perRx

Rx perMember

PercentGeneric

PaidPMPM

Paid perRx

Rx perMember

Variancein PMPM

MS Agents 14.03% $1,120,506 $12.30 $5,070.16 0.029 5.01% $5.74 $4,962.49 0.014 114.21%Diabetes 64.71% $900,857 $9.89 $136.80 0.867 60.83% $7.95 $140.14 0.681 24.36%Chronic Inflammatory Disease 74.08% $712,897 $7.83 $901.26 0.104 0.00% $0.00 $0.00 0.000 0.00%Stimulants 82.70% $550,858 $6.05 $188.01 0.386 82.50% $4.79 $179.59 0.320 26.32%Hepatitis 52.73% $490,163 $5.38 $8,912.06 0.007 49.66% $2.05 $11,284.80 0.002 162.06%Antivirals 71.11% $447,647 $4.91 $374.91 0.157 75.64% $2.18 $206.30 0.127 124.93%Asthma 28.17% $438,390 $4.81 $102.81 0.562 32.18% $4.14 $99.85 0.498 16.12%OTHER 92.66% $434,571 $4.77 $59.85 0.957 89.47% $3.72 $72.90 0.612 28.23%Oncology 90.45% $380,173 $4.17 $955.21 0.052 93.10% $5.22 $651.21 0.096 -20.03%Dermatology 93.09% $339,952 $3.73 $115.79 0.387 91.24% $3.11 $116.30 0.320 20.18%Antipsychotics 84.83% $243,483 $2.67 $225.24 0.142 79.44% $1.92 $239.60 0.096 39.55%Antidepressants 97.82% $209,826 $2.30 $15.05 1.837 98.19% $2.27 $16.49 1.653 1.39%Anticonvulsants 90.76% $198,761 $2.18 $55.17 0.475 90.74% $1.66 $55.21 0.361 31.30%Cholesterol 92.22% $181,114 $1.99 $19.30 1.236 93.18% $1.74 $18.81 1.111 14.20%Contraceptives 92.84% $152,280 $1.67 $31.13 0.644 92.68% $2.00 $30.10 0.799 -16.56%Ophthalmics 63.55% $128,199 $1.41 $77.89 0.217 66.88% $1.21 $66.35 0.219 15.99%Narcotic Analgesics 95.87% $123,660 $1.36 $31.76 0.513 94.90% $1.06 $31.33 0.405 28.35%Antibiotics 99.49% $119,050 $1.31 $20.09 0.781 99.57% $1.36 $21.06 0.778 -4.24%HRT 62.58% $116,393 $1.28 $60.00 0.256 54.31% $1.01 $57.75 0.210 26.20%Inflammatory Bowel 4.12% $115,103 $1.26 $677.08 0.022 28.56% $1.47 $609.23 0.029 -14.06%Hypertension/Cardiac 99.46% $97,942 $1.08 $4.45 2.901 99.14% $1.10 $5.28 2.506 -2.57%Ulcer/GERD 96.58% $87,009 $0.96 $15.81 0.725 95.92% $0.61 $13.30 0.552 56.16%Migraines 88.75% $83,873 $0.92 $94.35 0.117 91.71% $0.66 $80.92 0.098 39.90%




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Paid perRx

Rx perMember

PercentGeneric

PaidPMPM

Paid perRx

Rx perMember

Variancein PMPM

Anticoagulants 79.97% $77,757 $0.85 $109.67 0.093 83.73% $0.77 $83.21 0.111 10.42%Pulmonary Hypertension 33.33% $64,855 $0.71 $3,603.06 0.002 52.33% $0.22 $2,095.31 0.001 217.03%Osteoporosis 89.08% $63,279 $0.69 $157.02 0.053 95.21% $0.22 $49.02 0.054 212.72%Androgens 54.34% $62,282 $0.68 $360.01 0.023 49.44% $0.52 $334.12 0.019 32.41%Allergy 93.48% $57,938 $0.64 $19.57 0.390 90.97% $0.59 $20.74 0.340 8.38%Cystic Fibrosis 0.00% $56,881 $0.62 $1,458.48 0.005 1.50% $0.73 $2,193.77 0.004 -14.46%Over Active Bladder 82.92% $56,142 $0.62 $116.96 0.063 77.99% $0.47 $109.44 0.052 30.28%Erectile Dysfunction 0.00% $53,620 $0.59 $200.08 0.035 0.00% $0.71 $129.09 0.066 -17.42%Smoking Cessation 48.38% $43,739 $0.48 $157.90 0.036 48.79% $0.30 $160.89 0.022 60.50%Immunosuppressants 88.81% $41,131 $0.45 $143.81 0.038 85.36% $0.59 $181.66 0.039 -22.86%NSAIDS/COX-2 99.03% $34,665 $0.38 $21.05 0.217 97.62% $0.33 $22.80 0.175 14.40%Corticosteroids 98.62% $32,659 $0.36 $23.68 0.182 99.35% $0.32 $22.19 0.172 12.42%Antiplatelets 80.91% $27,372 $0.30 $62.21 0.058 88.71% $0.15 $35.64 0.051 99.51%Infertility 41.67% $23,546 $0.26 $245.27 0.013 43.61% $0.21 $276.03 0.009 20.70%Biliary Cirrhosis 100.00% $22,838 $0.25 $340.87 0.009 94.97% $0.12 $15.48 0.095 105.50%Antifungals 100.00% $19,936 $0.22 $32.21 0.082 99.49% $0.16 $33.54 0.057 37.92%Growth Hormones 0.00% $19,319 $0.21 $1,609.93 0.002 0.00% $0.70 $3,034.76 0.003 -69.77%Thyroid 91.34% $18,617 $0.20 $3.63 0.675 87.95% $0.34 $6.46 0.628 -39.54%Colony Stimulating Factors 0.00% $16,477 $0.18 $5,492.38 0.000 0.00% $0.36 $3,774.57 0.001 -49.07%Parkinsons Disease 97.36% $14,052 $0.15 $30.95 0.060 97.29% $0.16 $33.09 0.057 -1.22%Hypnotics 99.47% $12,210 $0.13 $10.76 0.150 97.68% $0.19 $19.18 0.120 -29.91%Antianxiety 100.00% $6,113 $0.07 $2.90 0.278 99.68% $0.10 $5.56 0.222 -34.80%Alzheimers Disease 72.22% $5,284 $0.06 $146.78 0.005 74.65% $0.08 $71.23 0.013 -24.72%

Total 179.07% $8,503,421 $93.35 $70.70 15.843 178.08% $65.34 $56.82 13.798 42.87%




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SPECIALTY 9.74% $2,901,118 $31.85 $4,483.95 0.085 6.47% $24.03 $4,179.19 0.069 32.51%



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Variance

% Retail 42.50% 41.30% -2.82% 43.66% 42.62% -3.10%


% Mail Order 1.91% 1.63% -14.53% 1.28% 1.12% 46.10%

% Specialty 0.54% 0.62% 15.47% 0.49% 0.53% 17.40%




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WALGREENS 33.56% 40,359 23.33% $1,983,595 29.76% 22.41% 4.11%


HEALTHPARTNERS 9.55% 11,490 7.16% $609,235 5.58% 4.47% 60.45%

TARGET 13.64% 16,408 7.15% $607,588 14.25% 8.20% -12.88%

Total 70.56% 84,865 77.71% $6,608,111 59.46% 70.40% 10.38%





% PaidPaid

TrendCVS PHARMACARE SPECIALTY PHARM 0.53% 627 34.08% $2,958,925 0.40% 29.05% 17.32% 10.83%

WALGREENS 33.78% 40,187 21.91% $1,902,409 30.60% 21.11% 3.78% -6.09%


HEALTHPARTNERS 9.25% 11,003 7.02% $609,400 5.42% 4.57% 53.58% -1.96%

TARGET 12.85% 15,285 5.90% $512,293 13.65% 7.90% -25.28% -17.48%

Total 68.97% 82,043 77.40% $6,719,410 58.95% 69.51% 10.86% -23.81%




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Drug Therapeutic Brand / Rx Claims Paid / RxName Class Generic Prior Current %Change Prior Current %Change Prior Current %ChangeHumira* Chronic Inflammatory DisBrand 124 140 12.90% $422,691 $602,565 42.55% $3,408.80 $4,304.03 26.26%Humalog Diabetes Brand 680 669 -1.62% $298,198 $323,298 8.42% $438.53 $483.26 10.20%Enbrel* Chronic Inflammatory DisBrand 48 80 66.67% $164,130 $308,477 87.95% $3,419.37 $3,855.97 12.77%Rebif* MS Agents Brand 42 50 19.05% $229,948 $305,781 32.98% $5,474.95 $6,115.62 11.70%Adderall Stimulants Generic 861 964 11.96% $227,464 $259,259 13.98% $264.19 $268.94 1.80%Lantus Diabetes Brand 827 836 1.09% $246,668 $232,207 -5.86% $298.27 $277.76 -6.88%Copaxone* MS Agents Brand 54 40 -25.93% $302,568 $230,625 -23.78% $5,603.11 $5,765.62 2.90%Glatopa* MS Agents Generic 31 57 83.87% $122,330 $223,093 82.37% $3,946.14 $3,913.91 -0.82%Gilenya* MS Agents Brand 33 33 0.00% $184,270 $220,534 19.68% $5,583.93 $6,682.85 19.68%Advair Asthma Brand 709 580 -18.19% $209,094 $193,638 -7.39% $294.91 $333.86 13.21%Tecfidera* MS Agents Brand 24 26 8.33% $132,318 $160,290 21.14% $5,513.24 $6,165.02 11.82%Imatinib* Oncology Generic 5 or Under 22 0.00% $0 $155,575 0.00% $0.00 $7,071.60 0.00%Victoza Diabetes Brand 189 249 31.75% $102,104 $148,653 45.59% $540.23 $597.00 10.51%Methylphenidate Stimulants Generic 793 843 6.31% $121,042 $139,735 15.44% $152.64 $165.76 8.60%Xyrem* OTHER Brand 13 12 -7.69% $120,084 $121,218 0.94% $9,237.23 $10,101.51 9.36%Truvada Antivirals Brand 5 or Under 83 0.00% $0 $119,500 0.00% $0.00 $1,439.76 0.00%Atripla Antivirals Brand 42 47 11.90% $94,453 $114,640 21.37% $2,248.88 $2,439.15 8.46%Letairis* Pulmonary Hypertension Brand 5 or Under 12 0.00% $0 $104,155 0.00% $0.00 $8,679.57 0.00%Aubagio* MS Agents Brand 5 or Under 17 0.00% $0 $98,981 0.00% $0.00 $5,822.41 0.00%Ibrance* Oncology Brand 5 or Under 11 0.00% $0 $94,364 0.00% $0.00 $8,578.52 0.00%

Total 4,470 4,771 6.73% $2,977,362 $4,156,588 39.61% $666.08 $871.22 30.80%





Page 32 of 106




Drug Therapeutic Brand / Rx Claims Paid / RxName Class Generic Prior Current %Change Prior Current %Change Prior Current %ChangeLevothyroxine Thyroid Generic 4,636 4,452 -3.97% $13,835 $12,815 -7.37% $2.98 $2.88 -3.36%Atorvastatin Cholesterol Generic 4,238 4,333 2.24% $7,248 $1,926 -73.43% $1.71 $0.44 -74.27%Lisinopril Hypertension/Cardiac Generic 4,303 4,251 -1.21% $902 $501 -44.44% $0.21 $0.12 -42.86%Omeprazole Ulcer/GERD Generic 3,514 3,165 -9.93% $2,584 $1,137 -56.00% $0.74 $0.36 -51.35%Metformin Diabetes Generic 2,887 2,998 3.84% $2,296 $1,966 -14.39% $0.80 $0.66 -17.50%Simvastatin Cholesterol Generic 3,004 2,576 -14.25% $572 $239 -58.15% $0.19 $0.09 -52.63%Amlodipine Hypertension/Cardiac Generic 2,390 2,575 7.74% $331 $254 -23.30% $0.14 $0.10 -28.57%Sertraline Antidepressants Generic 2,311 2,344 1.43% $1,863 $687 -63.09% $0.81 $0.29 -64.20%Hydrochlorothiazide Hypertension/Cardiac Generic 2,603 2,335 -10.30% $362 $170 -52.98% $0.14 $0.07 -50.00%Metoprolol Hypertension/Cardiac Generic 2,345 2,301 -1.88% $15,251 $9,417 -38.25% $6.50 $4.09 -37.08%Bupropion Antidepressants Generic 1,911 1,951 2.09% $45,954 $20,562 -55.25% $24.05 $10.54 -56.17%Fluticasone Allergy Generic 1,885 1,849 -1.91% $5,300 $1,785 -66.33% $2.81 $0.97 -65.48%Atenolol Hypertension/Cardiac Generic 1,908 1,810 -5.14% $216 $205 -4.79% $0.11 $0.11 0.00%Fluoxetine Antidepressants Generic 1,865 1,760 -5.63% $9,882 $1,524 -84.58% $5.30 $0.87 -83.58%Citalopram Antidepressants Generic 1,639 1,728 5.43% $272 $204 -24.88% $0.17 $0.12 -29.41%Trazodone Antidepressants Generic 1,730 1,543 -10.81% $1,275 $1,111 -12.86% $0.74 $0.72 -2.70%Losartan Hypertension/Cardiac Generic 1,365 1,538 12.67% $648 $421 -35.00% $0.47 $0.27 -42.55%Lisinopril-Hctz Hypertension/Cardiac Generic 1,458 1,372 -5.90% $245 $146 -40.36% $0.17 $0.11 -35.29%Ventolin Asthma Brand 1,372 1,342 -2.19% $25,190 $33,425 32.69% $18.36 $24.91 35.68%Gabapentin Anticonvulsants Generic 5 or Under 1,313 0.00% $0 $4,915 0.00% $0.00 $3.74 0.00%

Total 47,364 47,536 0.36% $134,224 $93,412 -30.41% $2.83 $1.97 -30.66%





Page 33 of 106





Professional 17,171,776.47 3,923,909.71 0 189,071.57 $21,284,758

Hospital IP 3,975,670.28 5,101,403.86 0 90,154.95 $9,167,229

Hospital OP 6,419,771.21 3,894,143.78 0 248,430.13 $10,562,345

Pharmacy 9,298,655.22 0 0 0 $9,298,655



Total 37,861,820.64 13,048,333.12 0 538,182.46 $51,448,336


Members 7,437 2,634 0 223 10,294

Percent Members 72.25% 25.59% 0.00% 2.17% 100.00%



Current Year



Page 34 of 106





Professional 15,097,247.83 3,655,457.32 0 211,168.9 $18,963,874

Hospital IP 3,709,688.29 3,896,223.06 0 270,202.52 $7,876,114

Hospital OP 5,768,018.17 3,970,657.73 0 678,526.63 $10,417,203

Pharmacy 7,381,759.73 1,637,393.48 0 0 $9,019,153

DME, Transportation, Other 831,381.43 129,533.01 0 16,218.6 $977,133


Total 32,788,095.44 13,289,264.6 0 1,176,116.65 $47,253,477


Members 7,364 4,930 0 227 12,521

Percent Members 58.81% 39.37% 0.00% 1.81% 100.00%



Prior Year



Page 35 of 106







Jan 2016 7,572 3,740 2,273 1,467

Feb 2016 7,559 3,737 2,272 1,465

Mar 2016 7,595 3,749 2,276 1,473

Apr 2016 7,610 3,767 2,295 1,472

May 2016 7,595 3,762 2,297 1,465

Jun 2016 7,626 3,768 2,297 1,471

Jul 2016 7,576 3,750 2,289 1,461

Aug 2016 7,581 3,758 2,300 1,458

Sep 2016 7,590 3,760 2,300 1,460

Oct 2016 7,616 3,751 2,281 1,470

Nov 2016 7,611 3,754 2,290 1,464

Dec 2016 7,601 3,742 2,276 1,466

Total 91,132 45,038 27,446 17,592

Average 7,594 3,753 2,287 1,466

Current Year



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Jan 2015 7,612 3,776 2,293 1,483

Feb 2015 7,593 3,770 2,292 1,478

Mar 2015 7,589 3,771 2,298 1,473

Apr 2015 7,623 3,790 2,314 1,476

May 2015 7,609 3,782 2,310 1,472

Jun 2015 7,593 3,769 2,298 1,471

Jul 2015 7,588 3,754 2,284 1,470

Aug 2015 7,622 3,751 2,274 1,477

Sep 2015 7,577 3,737 2,268 1,469

Oct 2015 7,557 3,732 2,268 1,464

Nov 2015 7,564 3,736 2,271 1,465

Dec 2015 7,566 3,732 2,263 1,469

Total 91,093 45,100 27,433 17,667

Average 7,591 3,758 2,286 1,472

Prior Year



Page 37 of 106







Jan 2016 7,572 $4,488,443 $592.77 $3,541,703 $467.74

Feb 2016 7,559 $4,481,907 $592.92 $4,239,044 $560.79

Mar 2016 7,595 $4,496,974 $592.10 $4,380,492 $576.76

Apr 2016 7,610 $4,510,417 $592.70 $4,573,015 $600.92

May 2016 7,595 $4,500,083 $592.51 $5,201,060 $684.80

Jun 2016 7,626 $4,512,336 $591.70 $4,369,435 $572.97

Jul 2016 7,576 $4,486,043 $592.14 $4,531,363 $598.12

Aug 2016 7,581 $4,490,452 $592.33 $4,468,789 $589.47

Sep 2016 7,590 $4,494,219 $592.12 $4,223,935 $556.51

Oct 2016 7,616 $4,498,828 $590.71 $4,081,577 $535.92

Nov 2016 7,611 $4,492,269 $590.23 $4,264,854 $560.35

Dec 2016 7,601 $4,485,762 $590.15 $5,690,375 $748.64

Total 91,132 $53,937,731 $53,565,640 99.31%

Average 7,594 $4,494,811 $591.87 $4,463,803 $587.78





Page 38 of 106







Jan 2015 7,612 $4,382,113 $575.68 $3,797,656 $498.90

Feb 2015 7,593 $4,373,323 $575.97 $3,412,764 $449.46

Mar 2015 7,589 $4,370,339 $575.88 $4,066,332 $535.82

Apr 2015 7,623 $4,384,641 $575.19 $4,412,285 $578.81

May 2015 7,609 $4,376,122 $575.12 $3,747,879 $492.56

Jun 2015 7,593 $4,364,128 $574.76 $4,445,837 $585.52

Jul 2015 7,588 $4,352,489 $573.60 $4,076,387 $537.21

Aug 2015 7,622 $4,356,819 $571.61 $3,872,488 $508.07

Sep 2015 7,577 $4,337,716 $572.48 $4,468,647 $589.76

Oct 2015 7,557 $4,328,635 $572.80 $3,925,901 $519.51

Nov 2015 7,564 $4,334,346 $573.02 $4,257,483 $562.86

Dec 2015 7,566 $4,335,515 $573.03 $4,295,997 $567.80

Total 91,093 $52,296,184 $48,779,655 93.28%

Average 7,591 $4,358,015 $574.10 $4,064,971 $535.49





Page 39 of 106












Page 40 of 106





Female 50,376 4,198 55.28% 53.54%

Male 40,756 3,396 44.72% 46.46%

Total 91,132 7,594 100.00% 100.00%





Policyholder 44,627 3,719 48.97% 48.81%

Dependent 46,505 3,875 51.03% 51.19%

Total 91,132 7,594 100.00% 100.00%



Page 41 of 106





Female 50,378 4,198 55.30% 53.55%

Male 40,715 3,393 44.70% 46.45%

Total 91,093 7,591 100.00% 100.00%





Policyholder 44,884 3,740 49.27% 49.20%

Dependent 46,209 3,851 50.73% 50.80%

Total 91,093 7,591 100.00% 100.00%



Page 42 of 106




Age RangeFemale



Under 1 0 24 0 42 66 0.87%

1 - 4 0 131 0 172 303 3.99%

5 - 9 0 264 0 228 492 6.47%

10 - 14 0 251 1 267 519 6.83%

15 - 19 2 310 0 307 619 8.14%

20 - 24 9 296 12 267 584 7.68%

25 - 29 100 78 65 51 294 3.87%

30 - 34 195 58 146 36 435 5.72%

35 - 39 261 85 138 85 569 7.49%

40 - 44 226 94 153 88 561 7.38%

45 - 49 268 89 186 77 620 8.16%

50 - 54 319 96 234 89 738 9.71%

55 - 59 369 94 230 103 796 10.47%

60 - 64 423 64 246 107 840 11.05%

65 Over 74 11 46 34 165 2.17%

Total 2,246 1,945 1,457 1,953 7,601 100.00%



Current Year



Page 43 of 106




Age RangeFemale



Under 1 0 28 0 36 64 0.85%

1 - 4 0 144 0 163 307 4.06%

5 - 9 0 246 1 236 483 6.38%

10 - 14 0 268 0 254 522 6.90%

15 - 19 2 308 0 307 617 8.15%

20 - 24 11 288 13 271 583 7.71%

25 - 29 97 61 64 60 282 3.73%

30 - 34 185 63 126 36 410 5.42%

35 - 39 260 71 143 79 553 7.31%

40 - 44 227 99 148 75 549 7.26%

45 - 49 260 81 184 89 614 8.12%

50 - 54 321 106 229 86 742 9.81%

55 - 59 409 90 226 108 833 11.01%

60 - 64 409 66 276 99 850 11.23%

65 Over 69 10 45 33 157 2.08%

Total 2,250 1,929 1,455 1,932 7,566 100.00%



Prior Year



Page 44 of 106








Page 45 of 106





COB Savings




Other Savings






Claims$19,894,723 $8,506,323 $9,873,188 $8,681,936 $1,056,178 $0 $48,012,348


Provider Tax $339,754 $138,235 $142,605 $108,991 $7,122 $0 $736,706



Current Year



Page 46 of 106





COB Savings

COB SavingsWorkers Compensation $158 $0 $15,746 $0 $0 $0 $15,904No-Fault $2,406 $0 $270 $0 $0 $0 $2,676Third Party Liability $21 $0 $0 $0 $0 $0 $21Occupational Health $0 $0 $0 $0 $0 $0 $0Other Insurance: Under 65 $456,521 $819,573 $1,025,491 $0 $23,590 $0 $2,325,176Other Insurance: Over 65 $116,808 $19,184 $59,893 $0 $332 $0 $196,216Total: $575,913 $838,757 $1,101,400 $0 $23,922 $0 $2,539,992


Benefit Design SavingsDeductibles $226,484 $6,297 $15,502 $0 $6,843 $0 $255,126Copayments/Coinsurance $1,128,354 $94,559 $380,720 $1,101,034 $153,456 $0 $2,858,123Other Member Liability $52 $1,755 $4,133 $0 $0 $0 $5,941Total: $1,354,890 $102,611 $400,355 $1,101,034 $160,299 $0 $3,119,190

Other Savings

Other SavingsUCR Limits $84,675 $0 $0 $0 $0 $0 $84,675Ineligible Services $18,486 $5,514 $21 $0 $67,771 $0 $91,792Total: $103,160 $5,514 $21 $0 $67,771 $0 $176,466





Claims$17,909,009 $7,484,934 $9,830,810 $8,503,421 $922,237 $0 $44,650,412


Provider Tax $300,916 $117,483 $136,210 $115,476 $7,082 $0 $677,166



Prior Year



Page 47 of 106






CVS/SPECIALTY # $2,958,925 68













CVS PHARMACY # $552,701 1,321







TWIN CITIES ANESTHESIA ASSOCIATES PA $328,409 295





Page 48 of 106



Top 25 Medical Providers - All Service CategoriesProvider Claims ClaimantsLAKEVIEW HOSPITAL $310,539 90

TWIN CITIES ORTHOPEDICS,PA $309,085 196





Page 49 of 106





REGIONS HOSPITAL-RAD/ACUTE/SLEEP $3,392,796 1,016


CHILDRENS HEALTH CARE-ST PAUL $1,194,438 175



UNITED HOSPITAL $991,016 207

HEALTHEAST ST JOHNS & MIDWAY $959,240 223




CVS PHARMACY # $654,085 1,367

HENNEPIN COUNTY MEDICAL CENTER $638,608 52







ST MARYS HOSP-ROCHESTER/TRANSPLANT $337,025 5 or under


WALGREENS $313,744 628

CREATIVE CARE,INC $313,613 5 or under





Page 50 of 106



Top 25 Medical Providers - All Service CategoriesProvider Claims ClaimantsPARK NICOLLET METHODIST HOSPITAL-ACUTE $306,932 57






Page 51 of 106






UNITED HOSPITAL 242 $1,657,168




CVS PHARMACY # 1,321 $552,701



TWIN CITIES ANESTHESIA ASSOCIATES PA 295 $328,409


















Page 52 of 106



Top 25 Medical Providers - All Service CategoriesProvider Claimants ClaimsVIRTUWELL 258 $16,058






Page 53 of 106






CVS PHARMACY # 1,367 $654,085

REGIONS HOSPITAL-RAD/ACUTE/SLEEP 1,016 $3,392,796












TARGET CLINIC MINNESOTA 283 $14,173












Page 54 of 106



Top 25 Medical Providers - All Service CategoriesProvider Claimants ClaimsSUBURBAN RADIOLOGIC CONSULTANTS 235 $39,744






Page 55 of 106






Total Claims: Per Member Per Month $564.55 $458.40 23.16% 8.83%









Current Year



Page 56 of 106















Prior Year



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Page 58 of 106









1 - 250 960 $107,990 12.75% 0.22% 19.65% 0.35%

250 - 500 753 $279,246 22.74% 0.81% 32.49% 1.27%

500 - 1000 1,161 $844,188 38.16% 2.56% 49.41% 3.65%

1000 - 2500 1,741 $2,861,298 61.27% 8.52% 69.39% 9.89%

2500 - 5000 1,153 $4,081,683 76.58% 17.03% 81.48% 18.15%

5000 - 10000 785 $5,505,076 87.00% 28.49% 89.31% 28.80%

10000 - 15000 317 $3,910,106 91.21% 36.64% 92.82% 37.12%

15000 - 25000 280 $5,402,052 94.93% 47.89% 96.00% 48.95%

25000 - 35000 137 $4,032,976 96.75% 56.29% 97.39% 56.91%

35000 - 50000 96 $3,944,164 98.02% 64.50% 98.36% 64.72%

50000 - 75000 66 $3,840,573 98.90% 72.50% 99.13% 73.66%

75000 - 100000 34 $2,900,994 99.35% 78.54% 99.47% 79.42%

100000 - 125000 17 $1,956,578 99.58% 82.62% 99.65% 83.19%

125000+ 32 $8,345,427 100.00% 100.00% 100.00% 100.00%

7,532 $48,012,348






Page 59 of 106









1 - 250 983 $107,954 13.08% 0.24% 21.08% 0.41%

250 - 500 798 $294,261 23.70% 0.90% 34.35% 1.44%

500 - 1000 1,198 $877,467 39.65% 2.87% 51.34% 4.02%

1000 - 2500 1,740 $2,841,027 62.80% 9.23% 71.06% 10.70%

2500 - 5000 1,152 $4,067,786 78.13% 18.34% 82.55% 19.22%

5000 - 10000 701 $4,903,326 87.46% 29.32% 90.14% 30.42%

10000 - 15000 332 $4,061,936 91.88% 38.42% 93.40% 38.79%

15000 - 25000 262 $5,019,606 95.37% 49.66% 96.32% 50.58%

25000 - 35000 137 $4,026,148 97.19% 58.68% 97.62% 58.57%

35000 - 50000 82 $3,369,975 98.28% 66.22% 98.56% 66.72%

50000 - 75000 59 $3,658,000 99.07% 74.42% 99.24% 75.48%

75000 - 100000 22 $1,862,711 99.36% 78.59% 99.53% 80.73%

100000 - 125000 21 $2,369,845 99.64% 83.90% 99.70% 84.54%

125000+ 27 $7,190,371 100.00% 100.00% 100.00% 100.00%

7,514 $44,650,412






Page 60 of 106





Number ofClaimants





1 - 250 3,935 $381,175 $4,196,481 52.24% 11.96% 8.74%

250 - 500 1,507 $536,219 $6,257,419 72.25% 28.78% 21.77%

500 - 1000 1,144 $802,424 $9,426,570 87.44% 53.96% 41.41%

1000 - 2500 900 $1,312,105 $25,942,394 99.39% 95.12% 95.44%

2500 - 5000 46 $155,510 $2,189,485 100.00% 100.00% 100.00%

5000 - 10000 0 $0 $0 100.00% 100.00% 100.00%

10000+ 0 $0 $0 100.00% 100.00% 100.00%

Total 7,532 $3,187,434 $48,012,348


Current Year Actual




Page 61 of 106





Number ofClaimants





1 - 250 3,976 $388,573 $3,848,421 52.91% 12.48% 8.62%

250 - 500 1,441 $516,337 $5,469,347 72.09% 29.07% 20.87%

500 - 1000 1,165 $823,012 $9,527,654 87.60% 55.50% 42.21%

1000 - 2500 889 $1,234,929 $22,868,655 99.43% 95.17% 93.42%

2500 - 5000 42 $143,738 $2,890,897 99.99% 99.79% 99.90%

5000 - 10000 1 $6,660 $45,439 100.00% 100.00% 100.00%

10000+ 0 $0 $0 100.00% 100.00% 100.00%

Total 7,514 $3,113,249 $44,650,412


Prior Year Actual




Page 62 of 106




















Current Year



Page 63 of 106




















Current Year



Page 64 of 106























Current Year



Page 65 of 106




Principal Diagnosis ClaimsUrethral Stricture, Unspecified $96,376



















Current Year



Page 66 of 106




Principal Diagnosis ClaimsPain In Left Knee $83,020



















Current Year



Page 67 of 106




Principal Diagnosis ClaimsPseudarthrosis After Fusion Or Arthrodesis $71,575














Subserosal Leiomyoma Of Uterus $60,620



Current Year



Page 68 of 106




Principal Diagnosis ClaimsAbdominal Aortic Aneurysm, Without Rupture $59,623Pain Due To Internal Orthopedic Prosthetic Devices, Implants And Grafts, InitialEncounter $59,281












Unilateral Post-traumatic Osteoarthritis, Right Knee $56,370





Current Year



Page 69 of 106




Principal Diagnosis ClaimsOsteomyelitis, Unspecified $55,575



















Current Year



Page 70 of 106




Principal Diagnosis ClaimsOsteoarthritis Of Knee, Unspecified $52,490











Acute On Chronic Systolic (congestive) Heart Failure $48,854






Current Year



Page 71 of 106




Principal Diagnosis ClaimsMigraine Without Aura, Intractable, Without Status Migrainosus $47,330



















Current Year



Page 72 of 106
















Intestinal Adhesions [bands] With Obstruction (postprocedural) (postinfection) $42,345







Current Year



Page 73 of 106




Principal Diagnosis ClaimsGastro-esophageal Laceration-hemorrhage Syndrome $41,403

















Current Year



Page 74 of 106




Principal Diagnosis ClaimsUnspecified Sequelae Of Unspecified Cerebrovascular Disease $38,954



















Current Year



Page 75 of 106























Current Year



Page 76 of 106




Principal Diagnosis ClaimsOther Ascites $35,206








Poisoning By Propionic Acid Derivatives, Intentional Self-harm, Initial Encounter $34,448











Current Year



Page 77 of 106




Principal Diagnosis ClaimsEncounter For Therapeutic Drug Level Monitoring $33,408







Anemia, Unspecified $32,869Displaced Intraarticular Fracture Of Right Calcaneus, Initial Encounter For ClosedFracture $32,769










Current Year



Page 78 of 106




Principal Diagnosis ClaimsInfections Of Kidney In Pregnancy, Third Trimester $32,014







Vascular Disorder Of Intestine, Unspecified $31,372












Current Year



Page 79 of 106




Principal Diagnosis ClaimsAtherosclerotic Heart Disease Of Native Coronary Artery With Unstable Angina Pectoris $30,162






Hyperlipidemia, Unspecified $29,895Other Generalized Epilepsy And Epileptic Syndromes, Not Intractable, Without StatusEpilepticus $29,894











Current Year



Page 80 of 106




Principal Diagnosis ClaimsEncounter For Other Preprocedural Examination $29,127















Current Year



Page 81 of 106









Headache $27,503














Current Year



Page 82 of 106









Malignant Neoplasm Of Left Ovary $26,557














Current Year



Page 83 of 106




Principal Diagnosis ClaimsParkinson's Disease $25,600















Total $25,020,710


Current Year



Page 84 of 106




Principal Diagnosis Claims

Total Above $25,000 $15,470,710



Current Year



Page 85 of 106




Principal Diagnosis ClaimsSubarachnoid Hemorrhage $851,373

Lipidoses $558,515


Malignant Neoplasm Of Upper Lobe, Bronchus Or Lung $408,230



Acute And Chronic Respiratory Failure $303,079


Spinal Stenosis In Cervical Region $298,704

Encounter For Antineoplastic Chemotherapy $276,372



Polyarticular Juvenile Rheumatoid Arthritis, Chronic Or Unspecified $207,913

Acute Lymphoid Leukemia, Without Mention Of Having Achieved Remission $206,067

Malignant Neoplasm Of Breast (female), Unspecified $201,035


Malignant Neoplasm Of Rectum $187,472


Prior Year



Page 86 of 106




Principal Diagnosis ClaimsEncounter For Antineoplastic Chemotherapy $179,408

Atrial Fibrillation $171,844

Other Malignant Neoplasm Of Unspecified Site $168,269

Malignant Neoplasm Of Kidney, Except Pelvis $161,081

Malignant Melanoma Of Skin Of Upper Limb, Including Shoulder $159,719


Anemia Of Other Chronic Disease $147,336



Spondylolisthesis, Congenital $133,443

Iliotibial Band Syndrome, Right Leg $124,234


Other Mechanical Complication Of Other Internal Orthopedic Device, Implant, And Graft $123,687




Osteoarthrosis, Localized, Not Specified Whether Primary Or Secondary, Lower Leg $117,577


Prior Year



Page 87 of 106




Principal Diagnosis ClaimsAtrial Fibrillation $115,869


Other Ankle Sprain And Strain $114,431

Coronary Atherosclerosis Of Native Coronary Vessel $113,103

Contracture, Left Elbow $110,717



Malignant Neoplasm Of Other Specified Sites Of Female Breast $109,855






Chronic Or Unspecified Parametritis And Pelvic Cellulitis $100,640

Malignant Neoplasm Of Pancreas, Part Unspecified $99,819


Orchitis And Epididymitis, Unspecified $95,329


Prior Year



Page 88 of 106




Principal Diagnosis ClaimsChronic Myeloid Leukemia, Without Mention Of Having Achieved Remission $93,657

Other Hammer Toe (acquired) $93,028

Quadriplegia, C5-c7, Incomplete $88,174




Malignant Carcinoid Tumor Of The Small Intestine, Unspecified Portion $83,560


Nonunion Of Fracture $83,031

Radiculopathy, Lumbar Region $82,624




Malignant Neoplasm Of Lower Lobe, Bronchus Or Lung $78,194



Regional Enteritis Of Small Intestine $76,282


Prior Year



Page 89 of 106




Principal Diagnosis ClaimsCoronary Atherosclerosis Of Native Coronary Vessel $76,212

Volvulus $75,175

Acute Myocardial Infarction, Subendocardial Infarction, Initial Episode Of Care $74,885

Regional Enteritis Of Small Intestine With Large Intestine $74,801




Unspecified Chest Pain $72,287

Fitting And Adjustment Of Automatic Implantable Cardiac Defibrillator $72,149

Other Polyp Of Sinus $71,379






Other B-complex Deficiencies $68,689

Bilateral Partial Paralysis Of Vocal Cords Or Larynx $68,642


Prior Year



Page 90 of 106




Principal Diagnosis ClaimsCalculus Of Kidney $68,431

Rheumatic Fever Without Heart Involvement $68,283



Leukoplakia Of Oral Mucosa, Including Tongue $67,832



Rectal Prolapse $66,271


Hallux Valgus (acquired) $63,616

Closed Fracture Of Humerus, Supracondylar $63,502

Coronary Atherosclerosis Of Native Coronary Vessel $63,182Unspecified Disorders Of Menstruation And Other Abnormal Bleeding From FemaleGenital Tract $63,127




Other Primary Cardiomyopathies $62,238


Prior Year



Page 91 of 106




Principal Diagnosis ClaimsBell's Palsy $60,179

Cortical Age-related Cataract, Left Eye $59,294


Open Bite Of Left Thumb Without Damage To Nail, Initial Encounter $58,871



Malignant Neoplasm Of Ovary $57,005

Other Complications Due To Internal Joint Prosthesis $56,836

Acute Systolic (congestive) Heart Failure $56,779

Atherosclerosis Of Native Arteries Of Extremities With Ulceration $55,800

Eosinophilia $55,724

Other Mechanical Complication Of Cardiac Electrode, Initial Encounter $55,214

Encounter For Breast Reconstruction Following Mastectomy $54,951

Other And Unspecified Creutzfeldt-jakob Disease $54,832



Cystic Fibrosis Without Mention Of Meconium Ileus $52,860


Prior Year



Page 92 of 106




Principal Diagnosis ClaimsNonpyogenic Meningitis $51,993Osteoarthrosis, Localized, Not Specified Whether Primary Or Secondary, Pelvic RegionAnd Thigh $51,833

Acute Osteomyelitis, Ankle And Foot $51,272


Displacement Of Lumbar Intervertebral Disc Without Myelopathy $51,200Osteoarthrosis, Localized, Not Specified Whether Primary Or Secondary, Pelvic RegionAnd Thigh $51,066


Encephalocele $50,626


Rheumatoid Arthritis $50,062


Unspecified Ventral Hernia Without Mention Of Obstruction Or Gangrene $48,583


Cellulitis Of Right Toe $47,732

Neuralgia, Neuritis, And Radiculitis, Unspecified $47,656

Other Allied Disorders Of Spine $47,536


Prior Year



Page 93 of 106




Principal Diagnosis ClaimsMorbid Obesity $47,517

Cirrhosis Of Liver Without Mention Of Alcohol $47,492


Hodgkin's Disease, Nodular Sclerosis, Unspecified Site, Extranodal And Solid Organ Sites $47,255


Other Specified Diseases Of Pancreas $46,273





Diabetes With Ketoacidosis, Type I [juvenile Type], Uncontrolled $45,760


Osteoarthrosis, Localized, Primary, Lower Leg $45,413



Unspecified Inflammatory Polyarthropathy $44,987



Prior Year



Page 94 of 106




Principal Diagnosis ClaimsPrecocious Sexual Development And Puberty, Not Elsewhere Classified $44,195




Other Pulmonary Embolism And Infarction $42,818

Malignant Neoplasm Of Upper-outer Quadrant Of Female Breast $42,756

Acute Myocardial Infarction, Of Other Anterior Wall, Initial Episode Of Care $42,088










Syncope And Collapse $41,224


Prior Year



Page 95 of 106





Malignant Neoplasm Of Upper-outer Quadrant Of Left Female Breast $40,535Atherosclerotic Heart Disease Of Native Coronary Artery With Other Forms Of AnginaPectoris $40,443



Sensitive Diagnosis $39,926Displaced Fracture Of Acromial Process, Left Shoulder, Initial Encounter For ClosedFracture $39,896


Diabetes Mellitus Without Mention Of Complication, Type I [juvenile Type], Uncontrolled $39,783

Post-traumatic Headache, Unspecified, Not Intractable $39,595


Calculus Of Bile Duct Without Cholangitis Or Cholecystitis Without Obstruction $39,220


Primary Focal Hyperhidrosis $38,812

Other Selective Immunoglobulin Deficiencies $38,399



Prior Year



Page 96 of 106




Principal Diagnosis ClaimsIncisional Hernia Without Mention Of Obstruction Or Gangrene $38,264

Displacement Of Cervical Intervertebral Disc Without Myelopathy $38,078

Calculus Of Gallbladder And Bile Duct With Acute Cholecystitis Without Obstruction $38,014Osteoarthrosis, Localized, Not Specified Whether Primary Or Secondary, ShoulderRegion $37,882


Diverticulitis Of Colon (without Mention Of Hemorrhage) $37,488

Acute On Chronic Systolic Heart Failure $37,406





Morbid Obesity $36,136


Osteoarthrosis, Unspecified Whether Generalized Or Localized, Hand $36,030


Displacement Of Lumbar Intervertebral Disc Without Myelopathy $35,968

Acute Kidney Failure, Unspecified $35,910


Prior Year



Page 97 of 106








Closed Fracture Of C5-c7 Level With Unspecified Spinal Cord Injury $35,445


Synovitis And Tenosynovitis, Unspecified $35,327



Ulcerative Colitis, Unspecified $34,844




Unspecified Septicemia $34,400


Postprocedural Intestinal Obstruction $34,159



Prior Year



Page 98 of 106





Sprain Of Right Rotator Cuff Capsule, Initial Encounter $33,676

Unspecified Disorder Of Male Genital Organs $33,636


Ventral Hernia Without Obstruction Or Gangrene $33,477

Encounter For Checking And Testing Of Cardiac Pacemaker Pulse Generator [battery] $33,418




Urinary Tract Infection, Site Not Specified $33,273

Sinoatrial Node Dysfunction $33,157


Occlusion And Stenosis Of Carotid Artery Without Mention Of Cerebral Infarction $33,106Diabetes With Unspecified Complication, Type I [juvenile Type], Not Stated AsUncontrolled $33,055


Closed Trimalleolar Fracture $32,856

Loss Of Weight $32,849


Prior Year



Page 99 of 106




Principal Diagnosis ClaimsOther Postoperative Infection $32,723Diabetes With Neurological Manifestations, Type I [juvenile Type], Not Stated AsUncontrolled $32,660





Umbilical Hernia Without Mention Of Obstruction Or Gangrene $32,476

Sensitive Diagnosis $32,431Osteoarthrosis, Localized, Not Specified Whether Primary Or Secondary, Pelvic RegionAnd Thigh $32,190


Abdominal Pain, Unspecified Site $31,948


Osteoporosis, Unspecified $31,777

Obstructive Hydrocephalus $31,657




Prior Year



Page 100 of 106




Principal Diagnosis ClaimsCervicalgia $31,027Osteoarthrosis, Localized, Not Specified Whether Primary Or Secondary, Pelvic RegionAnd Thigh $30,916









Hidradenitis $30,406



Unspecified Site Of Foot Sprain And Strain $30,287





Prior Year



Page 101 of 106




Principal Diagnosis ClaimsHyperparathyroidism, Unspecified $29,909



Other Inflammatory Disorders Of Male Genital Organs $29,648


Hairy Cell Leukemia Not Having Achieved Remission $29,382

Type 1 Diabetes Mellitus With Diabetic Neuropathy, Unspecified $29,206


Pain In Limb $29,073

Hypogammaglobulinemia, Unspecified $29,040





Calculus Of Bile Duct With Acute And Chronic Cholecystitis Without Obstruction $28,819




Prior Year



Page 102 of 106




Principal Diagnosis ClaimsEncounter For Removal Of Internal Fixation Device $28,696


Hypertrophy Of Nasal Turbinates $28,339Nonspecific (abnormal) Findings On Radiological And Other Examination Of GenitourinaryOrgans $28,311

Poisoning By Other And Unspecified Anticonvulsants $28,092

Pelvic Peritoneal Adhesions, Female (postoperative) (postinfection) $28,028

Ankylosing Spondylitis $28,027Osteoarthrosis, Localized, Not Specified Whether Primary Or Secondary, ShoulderRegion $27,886




Supraspinatus (muscle) (tendon) Sprain And Strain $27,459


Cervicalgia $27,415




Prior Year



Page 103 of 106




Principal Diagnosis ClaimsMechanical Complication Due To Corneal Graft $27,283

Care Involving Other Physical Therapy $27,230



Leiomyoma Of Uterus, Unspecified $27,093Localization-related (focal) (partial) Symptomatic Epilepsy And Epileptic Syndromes WithSimple Partial Seizures, Not Intractable, With Status Epilepticus $27,088

Febrile Convulsions (simple), Unspecified $27,077

Bicipital Tendinitis, Right Shoulder $27,002

Calculus Of Gallbladder With Chronic Cholecystitis Without Obstruction $26,996

Other Chronic Nonalcoholic Liver Disease $26,842

Flatulence, Eructation, And Gas Pain $26,806

Loose Body In Ankle And Foot Joint $26,759

Cardiac Murmur, Unspecified $26,712






Prior Year



Page 104 of 106




Principal Diagnosis ClaimsOsteoarthrosis, Localized, Not Specified Whether Primary Or Secondary, Pelvic RegionAnd Thigh $26,528



Acute Pancreatitis, Unspecified $26,475

Spinal Stenosis, Lumbar Region, Without Neurogenic Claudication $26,432


Dermatochalasis $26,212

Diaphragmatic Hernia Without Mention Of Obstruction Or Gangrene $26,156


Hypo-osmolality And Hyponatremia $26,102

Lumbosacral Spondylosis Without Myelopathy $25,968

Mandibular Hyperplasia $25,941

Closed Fractures Of Other Part Of Distal End Of Radius (alone) $25,924


Acute Myocardial Infarction, Unspecified Site, Subsequent Episode Of Care $25,896

Articular Cartilage Disorder, Pelvic Region And Thigh $25,839

Posterior Subcapsular Polar Senile Cataract $25,791


Prior Year



Page 105 of 106




Principal Diagnosis ClaimsNontraumatic Subacute Subdural Hemorrhage $25,739

Calculus Of Gallbladder With Other Cholecystitis, Without Mention Of Obstruction $25,717


Sprain And Strain Of Other Specified Sites Of Hip And Thigh $25,626



Lesion Of Ulnar Nerve, Left Upper Limb $25,483Laceration Without Foreign Body Of Left Ring Finger Without Damage To Nail, InitialEncounter $25,481

Epilepsy, Unspecified, Without Mention Of Intractable Epilepsy $25,265

Unspecified Intestinal Obstruction $25,257


Hypoparathyroidism $25,028

Total $22,477,050

Total Above $25,000 $13,777,050



Prior Year



Page 106 of 106