Attachment 2. HCCS over 50k Feb 2024 - Jan 2025-GLOUCESTER COUNTY SCHOOL BOARD(Total Account)_HCC-01_20260317 03_43 PM.pdf

High Cost Claimant without Member Name > $50,000

GLOUCESTER COUNTY SCHOOL BOARD | Segmentation: Total Account Current: Feb 2024 - Jan 2025 • Prior 1: Jan 1111 - Jan 1111 • Prior 2: Jan 1111 - Jan 1111 | Data Set: Medical & Pharmacy | Paid/Incurred: Paid

Member DetailsSegmentation Claim Details

Rank Member

Engaged

Total Claim

Amount

PMPM

Pharmacy Claim

Amount

PMPM

Medical Claim

Amount

PMPM

Total Claim

Amount

Percent Specialty

Drug Spend under

Pharmacy

Pharmacy Total

Claim Amount

Primary Pharmacy Indication

Contributing to High Cost

Percent Specialty

Drug Spend under

Medical

Medical Total

Claim Amount

Professional Medical

Claim Amount

Outpatient Medical

Claim Amount

Inpatient Medical

Claim Amount

All Other Medical

Diagnosis Claim

Amount

Secondary Medical

Diagnosis Claim

Amount

Primary Medical

Diagnosis Claim

Amount

Secondary Medical

Diagnosis Contributing to High Cost

Primary Medical

Diagnosis Contributing to High Cost

Active (Yes/No)Group ID

Most Recent Month

Medical Claim

Amount

Most Recent Month

Pharmacy Claim

AmountSubgroup

Benefit Package

ID

Prior Period

HCC

Age

Bands Relationship

Scrambled Claimant

ID

Primary Health

Condition Category

1 $28.71N $20.32$8.39$24,280$678$412,874.14 97.5%$292,271CANCER 84.1%$120,603$4,812$115,790$0$2,680$3,830$114,093Enc Screening Malignant NeoplasmsMalignant Neoplasm Of Corpus UteriNeoplasms - MalignantYN6GB7L03319~L03319M001L03319 91066779 55-64 Employee/Self

2 $22.44Y $0.04$22.41$0$41,701$322,737.66 0.0%$520VACCINATIONS COVID19 22.2%$322,218$58,791$163,392$100,036$85,157$78,615$158,446Encounter For Other AftercareMal Neo Bone & Ac Oth & Uns SitesNeoplasms - MalignantYN6GB6L03319~L03319M002L03319 774227794 35-44 Employee/Self

3 $21.14Y $20.27$0.87$837$2,076$304,039.37 95.9%$291,504CANCER 0.0%$12,535$4,557$7,978$0$5,485$1,908$5,142Flu D/T Oth Id Influenza VirusAbnormalities Of Gait And MobilityIll-Defined ConditionsYN6GB6L03319~L03319M002L03319 1240982 55-64 Employee/Self

4 $19.79Y $13.70$6.09$18,001$17,268$284,639.50 95.2%$197,056CANCER 78.1%$87,583$18,455$78,844-$9,716$8,905$13,796$64,883Secondary Malignant Neoplasm Of OthMalignant Neoplasm Of BreastNeoplasms - MalignantYN6GB7L03319~L03319MR01L03319 84189513 55-64 Employee/Self

5 $15.12N $11.59$3.53$16,029$409$217,431.43 80.7%$166,644INFLAMMATORY CONDITIONS 6.4%$50,787$16,016$34,772$0$10,185$3,895$36,708MigraineOther SpondylopathiesMusculoskeletal SystemYN6GB6L03319~L03319M002L03319 213049299 45-54 Spouse/Partner

6 $13.94N $12.52$1.42$31,964$983$200,466.94 99.9%$180,104CANCER 0.0%$20,363$9,664$10,699$0$5,507$4,404$10,452Introp Postprc Comp D/O Crc Sys NecMalignant Neoplasm Of BreastNeoplasms - MalignantYN6GB6L03319~L03319M002L03319 350504463 55-64 Employee/Self

7 $13.53N $4.12$9.41$161$0$194,587.59 96.8%$59,259INFLAMMATORY CONDITIONS 0.0%$135,328$17,837$29,196$88,295$14,850$27,796$92,682Cervical Disc DisordersOther SpondylopathiesMusculoskeletal SystemYN6GB6L03319~L03319M002L03319 89044321 45-54 Employee/Self

8 $11.03N $0.04$10.99$4$2,367$158,619.43 0.0%$553DIABETES 61.7%$158,067$10,223$123,707$24,137$10,152$34,940$112,975Benign Neo Colon Rect Anus CanalMalignant Neoplasm Bronchus & LungNeoplasms - MalignantYN6GB6L03319~L03319M002L03319 254601116 55-64 Employee/Self

9 $11.03Y $0.26$10.77$712$551$158,591.85 0.0%$3,684ANTICOAGULATION 0.0%$154,908$16,108$112,337$26,463$16,135$26,493$112,280Cerebral InfarctionMalignant Neoplasm Of TonsilNeoplasms - MalignantYN6GB7L03319~L03319M001L03319 89152158 65+ Spouse/Partner

10 $10.36Y $1.17$9.19$696$0$148,964.08 0.0%$16,786DIABETES 0.0%$132,178$32,494$277$99,407$23,150$14,785$94,244Orthopedic AftercareType 2 Diabetes MellitusEndocrine/MetabolicYN6GB6L03319~L03319M002L03319 24958404 35-44 Spouse/Partner

11 $10.30Y $0.08$10.23$215$3,939$148,162.28 0.0%$1,084HEART DISEASE 0.0%$147,078$15,002$4,937$127,139$8,443$7,707$130,929Sequelae Of Cerebrovascular DiseaseCerebral InfarctionCirculatory SystemYN6GB7L03319~L03319M001L03319 774227965 55-64 Employee/Self

12 $10.15N $9.29$0.85$25,007$89$145,903.52 99.5%$133,636INFLAMMATORY CONDITIONS 0.0%$12,267$7,153$5,114$0$5,040$2,032$5,196Enc Screening Malignant NeoplasmsHemorrhoids Perian Venous ThrombDigestive SystemYN6GB6L03319~L03319M002L03319 89224664 45-54 Employee/Self

13 $8.32N $0.08$8.23$0$0$119,576.54 0.0%$1,180ANAPHYLAXIS 0.0%$118,396$12,834$35,112$70,451$7,168$25,491$85,738Other SpondylopathiesNonrheumatic Aortic Valve DisordersCirculatory SystemYN6GB7L03319~L03319M001L03319 91809870 65+ Spouse/Partner

14 $7.82N $6.93$0.90$0$0$112,517.72 96.2%$99,601GI DISORDERS 0.0%$12,917$6,307$28,762-$22,152-$19,843$652$32,109Type 2 Diabetes MellitusMalignant Neoplasm Of BreastNeoplasms - MalignantNN6GB7L03319~L03319MR01L03319 89532810 55-64 Employee/Self

15 $7.56N $5.56$2.00$0$0$108,693.46 98.0%$79,904INFLAMMATORY CONDITIONS 0.0%$28,790$20,036$8,754$0$15,958$5,763$7,070Crohns Disease Regional EnteritisEnc Attention Artificial OpeningsHealth StatusNN6GB6L03319~L03319MR02L03319 245670148 55-64 Employee/Self

16 $7.22N $7.18$0.04$8,737$30$103,854.53 81.0%$103,227INFLAMMATORY CONDITIONS 0.0%$627$627$0$0$87$88$453PsoriasisSpondylosisMusculoskeletal SystemYN6GB7L03319~L03319M001L03319 91701320 55-64 Employee/Self

17 $7.18N $0.01$7.17$0$0$103,194.04 0.0%$96IRREGULAR HEART BEAT 0.0%$103,098$8,497$0$94,601$202$121$102,775Enc Gen Exam No Complaint Suspct DxAtrial Fibrillation And FlutterCirculatory SystemYN6GB7L03319~L03319M001L03319 122913337 35-44 Employee/Self

18 $6.96N $0.17$6.79$673$2,723$100,048.36 0.0%$2,402ANTICOAGULATION 0.0%$97,647$10,213$82,010$5,424$1,289$673$95,685Enc Gen Exam No Complaint Suspct DxAtrial Fibrillation And FlutterCirculatory SystemYN6GB7L03319~L03319M001L03319 89638175 55-64 Employee/Self

19 $6.86N $1.33$5.53$1,714$136$98,623.29 0.0%$19,066DIABETES 0.0%$79,558$11,971$67,587$0$20,566$18,660$40,331CholecystitisOsteoarthritis Of HipMusculoskeletal SystemYN6GB7L03319~L03319M001L03319 89158029 55-64 Spouse/Partner

20 $6.28N $0.00$6.28$0$0$90,370.17 0.0%$0SKIN INFECTIONS 0.0%$90,370$8,327$1,260$80,783$5,397$3,448$81,525Bacterial Sepsis Of NewbornOth Resp Cond Orig Perintl PeriodNewbornNN6GB7L03319~L03319M001L03319 890126831 00-04 Child/Other Dependent

21 $5.89N $0.08$5.81$0$0$84,683.05 0.0%$1,090INFLAMMATION/PAIN 0.0%$83,593$10,340$18,660$54,592$23,485$28,752$31,355Osteoarthritis Of KneeIo Postproc Comp D/O Msk Sys NecMusculoskeletal SystemNN6GB7L03319~L03319M001L03319 89457336 55-64 Employee/Self

22 $5.68N $0.06$5.62$38$165$81,730.75 0.0%$888DEPRESSION 0.0%$80,843$12,051$68,792$0$2,467$658$77,718Sleep DisordersMalignant Neoplasm Of BreastNeoplasms - MalignantYN6GB7L03319~L03319M001L03319 122363294 55-64 Employee/Self

23 $5.41N $5.34$0.08$6,445$0$77,809.01 99.4%$76,725INFLAMMATORY CONDITIONS 0.0%$1,084$1,084$0$0$664$208$212Enc Screening Malignant NeoplasmsPsoriasisDiseases of the SkinYN6GB7L03319~L03319M001L03319 89176500 45-54 Employee/Self

24 $5.37N $0.01$5.36$0$0$77,212.36 0.0%$156VACCINATIONS 0.0%$77,056$8,634$68,422$0$5,416$3,470$68,170Enc Plst Recn Srg Flw Proc/Heal InjCarcinoma In Situ Of BreastNeoplasms - MalignantYN6GB6L03319~L03319M002L03319 89576094 55-64 Employee/Self

25 $5.32N $0.00$5.32$4$1,375$76,472.32 0.0%$37DERMATOLOGIC CONDITIONS 0.0%$76,435$10,459$65,976$0$931$3,347$72,157Unspecified Lump In BreastMalignant Neoplasm Of BreastNeoplasms - MalignantYN6GB6L03319~L03319M002L03319 844219933 65+ Employee/Self

26 $5.09N $5.04$0.05$7,283$0$73,198.56 99.9%$72,495INFLAMMATORY CONDITIONS 0.0%$704$704$0$0$322$139$243Abnormalities Of Heart BeatEnc Screening Malignant NeoplasmsHealth StatusYN6GB7L03319~L03319M001L03319 38714502 55-64 Employee/Self

27 $5.06N $0.41$4.65$1,608$47,792$72,739.95 0.0%$5,862ANTICOAGULATION 0.0%$66,878$6,152$60,727$0$6,765$16,552$43,562Chronic Ischemic Heart DiseaseOsteoarthritis Of KneeMusculoskeletal SystemYN6GB6L03319~L03319M002L03319 219388757 65+ Employee/Self

28 $4.92N $4.64$0.28$6,137$334$70,735.74 94.9%$66,753INFLAMMATORY CONDITIONS 0.0%$3,983$1,152$2,831$0$752$400$2,831Sleep DisordersUlcerative ColitisDigestive SystemYN6GB7L03319~L03319M001L03319 89514155 45-54 Employee/Self

29 $4.76N $4.44$0.32$0$0$68,402.52 100.0%$63,782INFLAMMATORY CONDITIONS 0.0%$4,621$882$3,738$0$0$63$4,558PsoriasisEnc Screening Malignant NeoplasmsHealth StatusYN6GB7L03319~L03319M001L03319 89673202 55-64 Spouse/Partner

30 $4.70N $4.61$0.09$22$0$67,588.14 99.9%$66,287INFLAMMATORY CONDITIONS 0.0%$1,301$1,301$0$0$230$450$621Gastritis And DuodenitisEnc Screening Malignant NeoplasmsHealth StatusYN6GB6L03319~L03319M002L03319 89412918 45-54 Spouse/Partner

31 $4.61N $4.59$0.01$5,897$0$66,241.60 99.6%$66,068INFLAMMATORY CONDITIONS 0.0%$174$174$0$0$0$0$174Ankylosing SpondylitisElevated Blood Glucose LevelIll-Defined ConditionsYN6GB7L03319~L03319M001L03319 300548958 35-44 Employee/Self

32 $4.59N $0.20$4.39$186$17,056$66,069.88 0.0%$2,920GI DISORDERS 0.0%$63,150$10,006$53,143$0$4,221$16,423$42,505Benign Prostatic HyperplasiaSleep DisordersNervous SystemYN6GB7L03319~L03319M001L03319 228158712 65+ Spouse/Partner

33 $4.52N $0.08$4.44$106$0$65,026.48 0.0%$1,135DEPRESSION 0.0%$63,891$6,829$57,062$0$6,989$6,009$50,893Abnormal Findings Dx Imaging LungOther & Unspecified OsteoarthritisMusculoskeletal SystemYN6GB6L03319~L03319M002L03319 226610609 55-64 Employee/Self

34 $4.15N $0.02$4.13$15$0$59,694.95 0.0%$302INFLAMMATION/PAIN 0.0%$59,393$10,870$48,523$0$3,937$7,672$47,785Mononeuropathies Of Upper LimbSpondylosisMusculoskeletal SystemYN6GB6L03319~L03319M002L03319 92205129 55-64 Spouse/Partner

35 $4.11N $0.01$4.10$0$0$59,078.73 0.0%$141DEPRESSION 0.0%$58,938$5,037$36,766$17,136$10,806$20,887$27,245Inguinal HerniaAlcohol Related DisordersBehavioral HealthYN6GB7L03319~L03319M001L03319 203183493 35-44 Spouse/Partner

36 $3.81N $0.05$3.76$74$3,310$54,822.68 0.0%$749HYPERTENSION/HEART DISEASE 17.0%$54,073$19,999$19,897$14,177$27,662$11,348$15,063Other Rheumatoid ArthritisCellulitis And Acute LymphangitisDiseases of the SkinYN6GB6L03319~L03319M002L03319 23249550 65+ Employee/Self

37 $3.80N $0.00$3.80$0$49,052$54,572.84 0.0%$0NA 0.0%$54,573$49,709$4,864$0$0$4,864$49,709Malignant Neoplasm Bronchus & LungNeoplasms Of Unspecified BehaviorNeoplasms - Uncertain/UnspecifiedNN6GB7L03319~L03319M001L03319 89439965 65+ Employee/Self

38 $3.74N $2.66$1.09$0$0$53,817.38 99.8%$38,206INFLAMMATORY CONDITIONS 0.0%$15,612$2,795$12,817$0$2,747$3,035$9,830Gastro-Esophageal Reflux DiseasePain In Throat And ChestIll-Defined ConditionsNN6GB7L03319~L03319M001L03319 774226983 26-34 Employee/Self

39 $3.61N $0.01$3.60$48$234$51,938.98 0.0%$164HYPERTENSION/HEART DISEASE 0.0%$51,775$2,082$49,693$0$524$1,390$49,861Pain In Throat And ChestChronic Ischemic Heart DiseaseCirculatory SystemYN6GB7L03319~L03319M001L03319 89641316 45-54 Spouse/Partner

Total $334.89$146.89$188.00$156,894$192,268$4,815,732$2,112,337$2,703,395$450,182$1,482,439$770,774$1,978,204 $400,762 $324,429 13.0% 92.8%

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. and Community Care Health Plan of Georgia, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc.

RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In 17 southeastern counties of New York: Anthem HealthChoice Assurance, Inc., and Anthem HealthChoice HMO, Inc. In these same counties Anthem Blue Cross and Blue Shield HP is the trade name of Anthem HP, LLC. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc. trades as Anthem HealthKeepers providing HMO coverage, and their service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI) underwrites or administers PPO and indemnity policies and underwrites the out-of-network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

This confidential information should not be distributed without prior written consent and should only be used to review health care utilization.

Pharmacy claims runout/paid through date is always set to the Latest Data Loaded month, for every time period. Medical claims runout/paid through date is indicated in the report header.

Latest Data Loaded: 02/2026 Run Date: 03/17/2026