Attachment 2A. HCCs Sept 2023 - Oct 2024-GLOUCESTER COUNTY SCHOOL BOARD(Total Account)_HCC-01_20260318 03_32 PM.xlsx
XLSX spreadsheet 685 KB Posted
- Attached to
- RFP 26-025-CJ GCPS- Employee Medical, Stop Loss, Dental, Vision, Disability & Voluntary Benefits Coverage
- Solicitation number
- RFP-115259
- Issued by
- Frederick County, Virginia
About this file
This is a High Cost Claimant (HCC) analysis report prepared by Anthem Blue Cross and Blue Shield for the Gloucester County School Board covering the period October 2023 through September 2024. The report identifies and segments 37 high-cost claimants with medical and pharmacy claims exceeding $50,000 during the measurement period, representing members enrolled in the school board's health insurance plan. The analysis categorizes claimants by demographic information, benefit package, health conditions, and claim amounts to support utilization review and care management initiatives.
The report details total medical claims of $3,653,816 and pharmacy claims of $2,126,415, aggregating to $5,780,231 across the identified high-cost population. Primary health conditions driving costs include malignant neoplasms (cancer), digestive system disorders, circulatory system conditions, and musculoskeletal conditions. The claimants range in age from birth to 65+ years, with the majority concentrated in the 45-64 age bands. The data is segmented by inpatient, outpatient, and professional medical services, with specialty drug spending representing a significant portion of pharmacy costs at 9,387.2% of total pharmacy spend. The report indicates medical claims paid through the latest data loaded in February 2026, with the analysis run on March 18, 2026, providing current-year utilization data for the school board's health plan management and care coordination efforts.
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HCC-01_Visualization
HCC-01_1
| High Cost Claimant without Member Name > $50,000 | |
| GLOUCESTER COUNTY SCHOOL BOARD | Segmentation: Total Account |
Current: Oct 2023 - Sep 2024 • Prior 1: Jan 1111 - Jan 1111 • Prior 2: Jan 1111 - Jan 1111 | Data Set: Medical & Pharmacy | Paid/Incurred: Paid
| Segmentation | Member Details | Claim Details | |||
| Rank | Group ID | Subgroup | Benefit |
Package ID Scrambled Claimant ID Prior Period
| HCC | Age | |
| Bands | Relationship | Active |
| (Yes/No) | Member Engaged | Primary |
Health Condition Category Primary Medical Diagnosis Contributing to High Cost Secondary Medical Diagnosis Contributing
| to High Cost | Primary Medical Diagnosis Claim |
| Amount | Secondary |
Medical Diagnosis Claim
| Amount | All Other Medical Diagnosis Claim |
| Amount | Inpatient |
Medical Claim Amount Outpatient Medical Claim Amount Professional Medical Claim Amount Medical Total Claim Amount Percent Specialty Drug Spend under Medical Primary Pharmacy Indication Contributing to High Cost Pharmacy Total Claim Amount Percent Specialty Drug Spend under Pharmacy Total Claim Amount Most Recent Month Medical Claim
| Amount | Most | ||
| Recent Month Pharmacy Claim Amount | Medical Claim Amount PMPM | Pharmacy Claim Amount PMPM | Total Claim Amount PMPM |
| 1 | L03319 | L03319~L03319M001 | 6GB7 | 91817265 | N | 55-64 | Spouse/Partner | N | N | Neoplasms - Malignant | Lymphoid Leukemia | Non-Follicular Lymphoma | $780,934 | $5,362 | $300 | $780,934 | $4,158 | $1,505 | $786,596 | 0.0% | NA | $0 | 0.0% | $786,596.38 | $0 | $0 | $54.26 | $0.00 | $54.26 |
| 2 | L03319 | L03319~L03319M001 | 6GB7 | 91066779 | N | 55-64 | Employee/Self | Y | N | Neoplasms - Malignant | Malignant Neoplasm Of Corpus Uteri | Other Deforming Dorsopathies | $236,902 | $1,471 | $1,442 | $0 | $235,353 | $4,462 | $239,815 | 9,084.9% | CANCER | $302,682 | 9,724.7% | $542,496.51 | $1,638 | $24,954 | $16.54 | $20.88 | $37.42 |
| 3 | L03319 | L03319~L03319M001 | 6GB7 | 84189513 | N | 55-64 | Employee/Self | Y | N | Neoplasms - Malignant | Malignant Neoplasm Of Breast | Secondary Malignant Neoplasm Of Oth | $70,751 | $28,765 | $78,515 | $49,360 | $101,035 | $27,636 | $178,031 | 2,913.7% | CANCER | $178,720 | 9,577.9% | $356,751.04 | -$7,985 | $16,359 | $12.28 | $12.33 | $24.61 |
| 4 | L03319 | L03319~L03319M002 | 6GB6 | 1240982 | N | 55-64 | Employee/Self | Y | N | Ill-Defined Conditions | Abnormalities Of Gait And Mobility | Unspecified Nephritic Syndrome | $5,411 | $843 | $4,558 | $0 | $6,500 | $4,312 | $10,813 | 0.0% | CANCER | $333,896 | 9,684.2% | $344,708.45 | $1,270 | $30,800 | $0.75 | $23.03 | $23.78 |
| 5 | L03319 | L03319~L03319MR02 | 6GB6 | 245670148 | N | 55-64 | Employee/Self | Y | Y | Digestive System | Crohns Disease Regional Enteritis | Enc Attention Artificial Openings | $146,236 | $14,063 | $51,728 | $129,473 | $36,246 | $46,309 | $212,028 | 0.0% | INFLAMMATORY CONDITIONS | $79,908 | 9,794.7% | $291,935.85 | $650 | $1,550 | $14.63 | $5.51 | $20.14 |
| 6 | L03319 | L03319~L03319M002 | 6GB6 | 254601116 | N | 55-64 | Employee/Self | Y | N | Neoplasms - Malignant | Malignant Neoplasm Bronchus & Lung | Enc Screening Malignant Neoplasms | $265,827 | $8,400 | $10,066 | $0 | $275,132 | $9,162 | $284,293 | 8,398.4% | DIABETES | $868 | 0.0% | $285,161.45 | $7,971 | $123 | $19.61 | $0.06 | $19.67 |
| 7 | L03319 | L03319~L03319M002 | 6GB6 | 213049299 | N | 45-54 | Spouse/Partner | Y | N | Health Status | Enc Adj & Management Implanted Devc | Other Spondylopathies | $82,523 | $36,708 | $12,647 | $0 | $117,976 | $13,902 | $131,878 | 123.3% | INFLAMMATORY CONDITIONS | $126,858 | 7,728.2% | $258,735.71 | $367 | $14,799 | $9.10 | $8.75 | $17.85 |
| 8 | L03319 | L03319~L03319M002 | 6GB6 | 24958404 | N | 35-44 | Spouse/Partner | Y | Y | Endocrine/Metabolic | Type 2 Diabetes Mellitus | Osteomyelitis | $136,044 | $24,329 | $38,596 | $135,155 | $10,637 | $53,178 | $198,969 | 0.0% | DIABETES | $14,745 | 0.0% | $213,714.31 | $3,113 | $1,457 | $13.73 | $1.02 | $14.74 |
| 9 | L03319 | L03319~L03319M001 | 6GB7 | 89152158 | N | 65+ | Spouse/Partner | Y | Y | Neoplasms - Malignant | Malignant Neoplasm Of Tonsil | Hypotension | $156,558 | $5,646 | $17,187 | $0 | $159,410 | $19,981 | $179,390 | 0.0% | PARKINSONS DISEASE | $2,104 | 0.0% | $181,493.94 | $6,201 | $41 | $12.38 | $0.15 | $12.52 |
| 10 | L03319 | L03319~L03319M001 | 6GB7 | 774227794 | N | 35-44 | Employee/Self | Y | Y | Neoplasms - Malignant | Encounter For Other Aftercare | Mal Neo Bone & Ac Oth & Uns Sites | $78,615 | $64,821 | $36,784 | $67,073 | $98,030 | $15,118 | $180,220 | 3,480.3% | CONTRACEPTION | $701 | 0.0% | $180,921.04 | $11,723 | $133 | $12.43 | $0.05 | $12.48 |
| 11 | L03319 | L03319~L03319M002 | 6GB6 | 350504463 | N | 55-64 | Employee/Self | Y | N | Neoplasms - Malignant | Malignant Neoplasm Of Breast | Pain Not Elsewhere Classified | $15,140 | $1,661 | $5,713 | $0 | $16,956 | $5,558 | $22,514 | 0.0% | CANCER | $148,742 | 9,983.9% | $171,256.60 | $670 | $15,063 | $1.55 | $10.26 | $11.81 |
| 12 | L03319 | L03319~L03319M002 | 6GB6 | 89224664 | N | 45-54 | Employee/Self | Y | N | Digestive System | Hemorrhoids Perian Venous Thromb | Abdominal And Pelvic Pain | $5,196 | $1,894 | $7,409 | $0 | $7,240 | $7,259 | $14,499 | 0.0% | INFLAMMATORY CONDITIONS | $138,115 | 9,958.0% | $152,613.94 | $170 | $13,072 | $1.00 | $9.53 | $10.53 |
| 13 | L03319 | L03319~L03319MR01 | 6GB7 | 89532810 | N | 55-64 | Employee/Self | N | N | Neoplasms - Malignant | Malignant Neoplasm Of Breast | Encounter For Other Aftercare | $56,858 | $5,442 | -$17,254 | -$22,152 | $50,992 | $16,205 | $45,045 | 463.9% | GI DISORDERS | $89,598 | 9,546.7% | $134,643.39 | $897 | $9,919 | $3.11 | $6.18 | $9.29 |
| 14 | L03319 | L03319~L03319M001 | 6GB7 | 91809870 | N | 65+ | Spouse/Partner | Y | N | Circulatory System | Nonrheumatic Aortic Valve Disorders | Other Spondylopathies | $85,808 | $24,769 | $10,222 | $70,451 | $38,072 | $12,276 | $120,799 | 0.0% | ANAPHYLAXIS | $1,394 | 0.0% | $122,193.28 | $24,812 | $342 | $8.33 | $0.10 | $8.43 |
| 15 | L03319 | L03319~L03319M002 | 6GB6 | 89044321 | N | 45-54 | Employee/Self | Y | N | Musculoskeletal System | Cervical Disc Disorders | Other Spondylopathies | $27,796 | $4,387 | $6,211 | $0 | $30,440 | $7,954 | $38,394 | 0.0% | INFLAMMATORY CONDITIONS | $75,233 | 9,773.4% | $113,627.36 | $2,142 | $7,003 | $2.65 | $5.19 | $7.84 |
| 16 | L03319 | L03319~L03319M001 | 6GB7 | 122913337 | N | 35-44 | Employee/Self | Y | N | Circulatory System | Atrial Fibrillation And Flutter | Dizziness And Giddiness | $107,616 | $1,142 | $566 | $94,601 | $4,160 | $10,563 | $109,325 | 0.0% | IRREGULAR HEART BEAT | $144 | 0.0% | $109,468.57 | $150 | $5 | $7.54 | $0.01 | $7.55 |
| 17 | L03319 | L03319~L03319M001 | 6GB7 | 91701320 | N | 55-64 | Employee/Self | Y | N | Musculoskeletal System | Spondylosis | Conjunctivitis | $353 | $115 | $392 | $0 | $0 | $861 | $861 | 0.0% | INFLAMMATORY CONDITIONS | $105,477 | 7,867.3% | $106,338.14 | $0 | $7,050 | $0.06 | $7.28 | $7.34 |
| 18 | L03319 | L03319~L03319M001 | 6GB7 | 89158029 | N | 55-64 | Spouse/Partner | Y | N | Musculoskeletal System | Osteoarthritis Of Hip | Cholecystitis | $40,462 | $18,660 | $20,138 | $0 | $67,587 | $11,674 | $79,261 | 0.0% | DIABETES | $14,952 | 0.0% | $94,213.16 | $21,866 | $1,896 | $5.47 | $1.03 | $6.50 |
| 19 | L03319 | L03319~L03319M001 | 6GB7 | 774226983 | N | 26-34 | Employee/Self | N | N | Ill-Defined Conditions | Pain In Throat And Chest | Gastro-Esophageal Reflux Disease | $9,841 | $3,294 | $3,004 | $0 | $12,957 | $3,182 | $16,140 | 0.0% | INFLAMMATORY CONDITIONS | $76,430 | 9,918.2% | $92,569.36 | $104 | $0 | $1.11 | $5.27 | $6.39 |
| 20 | L03319 | L03319~L03319M001 | 6GB7 | 890126831 | N | 00-04 | Child/Other Dependent | Y | N | Newborn | Oth Resp Cond Orig Perintl Period | Bacterial Sepsis Of Newborn | $81,525 | $3,448 | $4,392 | $80,783 | $1,260 | $7,322 | $89,365 | 0.0% | SKIN INFECTIONS | $0 | 0.0% | $89,364.71 | $80,783 | $0 | $6.16 | $0.00 | $6.16 |
| 21 | L03319 | L03319~L03319M001 | 6GB7 | 122363294 | N | 55-64 | Employee/Self | Y | N | Neoplasms - Malignant | Malignant Neoplasm Of Breast | Unspecified Lump In Breast | $78,101 | $3,406 | $3,715 | $0 | $73,155 | $12,068 | $85,223 | 0.0% | DEPRESSION | $901 | 0.0% | $86,124.07 | $2,738 | $114 | $5.88 | $0.06 | $5.94 |
| 22 | L03319 | L03319~L03319M001 | 6GB7 | 89457336 | N | 55-64 | Employee/Self | Y | N | Musculoskeletal System | Io Postproc Comp D/O Msk Sys Nec | Osteoarthritis Of Knee | $31,355 | $28,752 | $23,956 | $54,592 | $18,777 | $10,694 | $84,063 | 0.0% | INFLAMMATION/PAIN | $1,222 | 0.0% | $85,284.92 | $140 | $156 | $5.80 | $0.08 | $5.88 |
| 23 | L03319 | L03319~L03319M002 | 6GB6 | 89613137 | N | 45-54 | Employee/Self | Y | Y | Neoplasms - Malignant | Malignant Melanoma Of Skin | Calculus Of Kidney And Ureter | $60,508 | $7,292 | $8,883 | $0 | $14,043 | $62,639 | $76,683 | 7,009.2% | HIGH CHOLESTEROL | $404 | 0.0% | $77,086.22 | $7,757 | $0 | $5.29 | $0.03 | $5.32 |
| 24 | L03319 | L03319~L03319M001 | 6GB7 | 300548958 | N | 35-44 | Employee/Self | Y | N | NA | NA | NA | $0 | $0 | $0 | $0 | $0 | $0 | $0 | 0.0% | INFLAMMATORY CONDITIONS | $72,323 | 9,995.3% | $72,323.41 | $0 | $0 | $0.00 | $4.99 | $4.99 |
| 25 | L03319 | L03319~L03319M001 | 6GB7 | 38714502 | N | 55-64 | Employee/Self | Y | N | Health Status | Enc Gen Exam No Complaint Suspct Dx | Enc Screening Malignant Neoplasms | $334 | $243 | $316 | $0 | $0 | $893 | $893 | 0.0% | INFLAMMATORY CONDITIONS | $70,805 | 9,991.8% | $71,698.26 | $87 | $6,622 | $0.06 | $4.88 | $4.95 |
| 26 | L03319 | L03319~L03319M001 | 6GB7 | 89514155 | N | 45-54 | Employee/Self | Y | N | Digestive System | Ulcerative Colitis | Peritonsillar Abscess | $19,186 | $5,985 | $2,027 | $12,410 | $12,162 | $2,626 | $27,198 | 651.0% | INFLAMMATORY CONDITIONS | $43,811 | 9,281.1% | $71,008.88 | $261 | $6,300 | $1.88 | $3.02 | $4.90 |
| 27 | L03319 | L03319~L03319M001 | 6GB7 | 18545666 | N | 55-64 | Spouse/Partner | N | N | Injury & Poisoning | Intracranial Injury | Pyothorax | $67,058 | $2,924 | $19 | $0 | $0 | $70,000 | $70,000 | 0.0% | NA | $0 | 0.0% | $70,000.23 | $0 | $0 | $4.83 | $0.00 | $4.83 |
| 28 | L03319 | L03319~L03319M001 | 6GB7 | 89673202 | N | 55-64 | Spouse/Partner | Y | N | Health Status | Enc Screening Malignant Neoplasms | Superficial Injury Of Thorax | $4,558 | $265 | $63 | $0 | $3,738 | $1,147 | $4,885 | 0.0% | INFLAMMATORY CONDITIONS | $63,518 | 10,000.0% | $68,403.14 | $0 | $0 | $0.34 | $4.38 | $4.72 |
| 29 | L03319 | L03319~L03319M002 | 6GB6 | 89412918 | N | 45-54 | Spouse/Partner | Y | N | Health Status | Enc Screening Malignant Neoplasms | Gastritis And Duodenitis | $621 | $450 | $230 | $0 | $0 | $1,301 | $1,301 | 0.0% | INFLAMMATORY CONDITIONS | $65,878 | 9,997.8% | $67,178.57 | $0 | $0 | $0.09 | $4.54 | $4.63 |
| 30 | L03319 | L03319~L03319M001 | 6GB7 | 89176500 | N | 45-54 | Employee/Self | Y | N | Behavioral Health | Reaction Severe Stress & Adjust D/O | Psoriasis | $318 | $308 | $373 | $0 | $0 | $999 | $999 | 0.0% | INFLAMMATORY CONDITIONS | $64,528 | 9,934.9% | $65,527.68 | $0 | $6,367 | $0.07 | $4.45 | $4.52 |
| 31 | L03319 | L03319~L03319M002 | 6GB6 | 226610609 | N | 55-64 | Employee/Self | Y | N | Musculoskeletal System | Other & Unspecified Osteoarthritis | Abnormal Findings Dx Imaging Lung | $50,893 | $5,924 | $6,808 | $0 | $57,062 | $6,562 | $63,624 | 0.0% | DEPRESSION | $943 | 0.0% | $64,567.44 | $348 | $85 | $4.39 | $0.07 | $4.45 |
| 32 | L03319 | L03319~L03319M001 | 6GB7 | 89557540 | N | 12-17 | Child/Other Dependent | Y | N | Nervous System | Other Disorders Of Brain | Oth Congenital Malform Nerv Sys | $57,639 | $4,866 | $1,959 | $56,335 | $1,537 | $6,591 | $64,463 | 0.0% | INFECTIONS | $3 | 0.0% | $64,466.32 | $1,222 | $0 | $4.45 | $0.00 | $4.45 |
| 33 | L03319 | L03319~L03319M001 | 6GB7 | 203183493 | N | 35-44 | Spouse/Partner | Y | N | Behavioral Health | Alcohol Related Disorders | Inguinal Hernia | $27,245 | $19,563 | $17,470 | $22,985 | $36,766 | $4,528 | $64,278 | 0.0% | DEPRESSION | $141 | 0.0% | $64,418.93 | $13,395 | $24 | $4.43 | $0.01 | $4.44 |
| 34 | L03319 | L03319~L03319M002 | 6GB6 | 89658344 | N | 35-44 | Employee/Self | Y | N | Genitourinary System | Obstructive And Reflux Uropathy | Enc For Contraceptive Management | $41,880 | $17,586 | $581 | $0 | $52,783 | $7,264 | $60,047 | 0.0% | INFECTIONS | $0 | 0.0% | $60,047.20 | $188 | $0 | $4.14 | $0.00 | $4.14 |
| 35 | L03319 | L03319~L03319M002 | 6GB6 | 92205129 | N | 55-64 | Spouse/Partner | Y | N | Musculoskeletal System | Spondylosis | Mononeuropathies Of Upper Limb | $47,983 | $5,922 | $4,994 | $0 | $48,879 | $10,020 | $58,899 | 0.0% | INFLAMMATION/PAIN | $294 | 0.0% | $59,193.79 | $5,885 | $75 | $4.06 | $0.02 | $4.08 |
| 36 | L03319 | L03319~L03319M002 | 6GB6 | 89027344 | N | 45-54 | Employee/Self | Y | N | Musculoskeletal System | Cervical Disc Disorders | Injury Musc Fasc Tendon Forarm Levl | $27,251 | $15,148 | $9,008 | $0 | $41,080 | $10,327 | $51,407 | 0.0% | HORMONE SUPPLEMENTATION | $1,227 | 0.0% | $52,634.08 | $16,214 | $84 | $3.55 | $0.08 | $3.63 |
| 37 | L03319 | L03319~L03319M001 | 6GB7 | 249275402 | N | 05-11 | Child/Other Dependent | Y | N | Health Status | Enc Gen Exam No Complaint Suspct Dx | Hypofunction D/O Pituitary Gland | $1,182 | $360 | $74 | $0 | $0 | $1,616 | $1,616 | 0.0% | GROWTH DEFICIENCY | $49,848 | 10,000.0% | $51,464.37 | $0 | $3,648 | $0.11 | $3.44 | $3.55 |
| Total | $2,906,509 | $374,213 | $373,093 | $1,531,999 | $1,634,125 | $487,691 | $3,653,816 | 1,725.5% | $2,126,415 | 9,387.2% | $5,780,231 | $204,776 | $168,040 | $252.06 | $146.69 | $398.75 |
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: 03/18/2026 |
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