12-SCBOCC Experience Report HCC Florida Blue Medical 202312.xlsx

This is a High Cost Claims Summary Experience Report prepared by Florida Blue for the Suwannee County Board of County Commissioners (BOCC) regarding group medical benefits coverage. The report documents claim experiences for the period from October 2023 through December 2023 (current period) and compares this data to the prior period from October 2022 through September 2023. The claims analysis is organized by member and includes detailed breakdowns of inpatient admissions, outpatient visits, professional services, and pharmacy claims for individuals whose total paid claims exceeded the $50,000 threshold during the evaluation periods. The current period shows zero high-cost claims meeting the threshold, while the prior period identified eleven members with claims exceeding this amount, generating total paid claims of $1,082,384.11 against total billed amounts of $3,203,117.60.

The report details individual claim experiences across multiple service categories, with the highest-cost claimant in the prior period accumulating $293,340.00 in total paid claims related to sepsis, acute pancreatitis, and pneumonia requiring 59 inpatient days and two admissions. Notable diagnoses among high-cost claimants include cancer treatment, cardiac disease, orthopedic conditions, and chronic disease management requiring ongoing pharmacy support. The report was generated on February 16, 2024, and is marked as proprietary and confidential information belonging to Florida Blue, serving as an analytical tool for the Suwannee County BOCC to assess medical plan utilization patterns and cost management effectiveness across its employee and retiree populations.