Attachment M_Medical Claims Data_clean.xlsx
XLSX spreadsheet 24 KB Posted
- Attached to
- RFP for Medical & Pharmacy Benefits
- Solicitation number
- S-44300-00014758
- Issued by
- Marion County, Oregon
About this file
This file is a medical claims data attachment for the Oregon Public Employees' Benefit Board (PEBB) Request for Proposal for Medical and Pharmacy Benefits Services. The attachment provides detailed historical claims data spanning January 2023 through December 2024, organized by plan type (Kaiser, Moda, Providence Choice, and Providence Statewide) and geographic region to enable prospective vendors to develop competitive proposals. The data encompasses monthly incurred claims broken down by employee months, member months, medical allowed amounts, medical net pay, pharmacy allowed amounts, and pharmacy net pay. The RFP solicits comprehensive medical and pharmacy benefit administration services for PEBB's membership base, with proposal submission required by November 14, 2025, through the Proposal Technologies Network, Inc.'s online platform at www.proposaltech.com. All official RFP documents are posted on OregonBuys, and vendors must address specific questionnaires, plan specifications, and demonstrate comprehensive network access and pricing strategies.
The claims data reveals PEBB's significant benefit program scale, with regional analysis showing employee enrollment concentrated in the I-5 Corridor (approximately 357,000-883,000 member months for 2024) and Portland Metro Area (169,000-385,000 member months), supplemented by coverage in Central Oregon, Southern Oregon, Oregon Coast, Eastern Oregon, and out-of-state locations. Relative risk scores by region range from 90 to 111, indicating variation in population health profiles across service areas. The RFP emphasizes diverse business participation through Attachment E's Certification of Business Inclusion and Diversity (COBID) provisions, suggesting potential set-aside or preference opportunities for disadvantaged business enterprises. While specific contract value and incumbent vendor information are not disclosed in this attachment, the comprehensive historical claims data and multi-year analysis period (2023-2024) indicate a sophisticated procurement designed to facilitate thorough vendor evaluation for a substantial, multi-year public employee benefits administration contract.
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Workbook Overview
Oregon PEBB Medical and Pharmacy RFP
This spreadsheet is intended to illustrate PEBB's 2023 and 2024 claims data for you to reference as you develop your proposal.
PEBB Medical & Pharmacy Benefit RFP OregonBuys Bid No. S-44300-00014758 Attachment M Medical Claims Data
Claims Monthly by Plan PEBB Incurred Claims by Month and Plan - 2023 and 2024
| Kaiser | Moda | Providence Choice | Providence Statewide | |||||||||||||||||||||
| Time Period: Incurred Month | Employee Months Med | Member Months Med | Allowed Amount Med | Net Pay Med | Allowed Amount Rx | Net Pay Rx | Employee Months Med | Member Months Med | Allowed Amount Med | Net Pay Med | Allowed Amount Rx | Net Pay Rx | Employee Months Med | Member Months Med | Allowed Amount Med | Net Pay Med | Allowed Amount Rx | Net Pay Rx | Employee Months Med | Member Months Med | Allowed Amount Med | Net Pay Med | Allowed Amount Rx | Net Pay Rx |
| Dec 2024 | 11,492 | 26,581 | $12,806,601.49 | $12,624,411.88 | $2,287,594.24 | $2,239,605.98 | 12,139 | 29,814 | $17,118,731.36 | $15,746,405.70 | $4,781,283.63 | $4,396,688.40 | 18,496 | 46,344 | $25,968,717.15 | $23,811,756.76 | $7,667,486.21 | $7,339,191.64 | 16,884 | 42,091 | $27,193,239.97 | $24,077,117.23 | $7,900,483.98 | $7,567,085.19 |
| Nov 2024 | 11,470 | 26,550 | $12,955,016.34 | $12,789,893.04 | $1,720,589.62 | $1,676,478.15 | 12,148 | 29,783 | $17,241,875.63 | $15,823,631.06 | $4,175,377.56 | $3,837,609.64 | 18,532 | 46,385 | $26,241,563.01 | $24,010,724.62 | $7,126,580.98 | $6,825,094.94 | 16,921 | 42,176 | $26,748,300.44 | $23,449,107.81 | $7,140,440.35 | $6,824,957.43 |
| Oct 2024 | 11,425 | 26,469 | $14,596,539.71 | $14,403,516.49 | $2,110,647.94 | $2,063,608.58 | 12,097 | 29,679 | $18,751,983.31 | $17,128,521.26 | $4,672,057.94 | $4,234,623.48 | 18,560 | 46,416 | $29,289,392.76 | $26,885,191.79 | $8,395,433.61 | $8,055,154.14 | 16,868 | 42,096 | $29,005,976.51 | $24,952,119.94 | $8,373,195.95 | $8,024,579.00 |
| Sep 2024 | 11,390 | 26,472 | $12,219,707.09 | $12,042,400.93 | $1,857,959.80 | $1,810,852.68 | 12,015 | 29,477 | $16,587,057.47 | $15,125,843.94 | $4,235,704.59 | $3,852,321.71 | 18,584 | 46,477 | $26,193,632.92 | $23,997,431.62 | $7,426,987.61 | $7,115,209.61 | 16,836 | 42,058 | $27,238,892.84 | $23,569,244.47 | $7,799,009.05 | $7,454,339.24 |
| Aug 2024 | 11,347 | 26,409 | $13,189,873.15 | $13,002,151.86 | $2,148,594.29 | $2,100,272.85 | 11,929 | 29,320 | $16,778,780.72 | $15,115,129.36 | $4,024,212.45 | $3,584,355.77 | 18,621 | 46,609 | $26,975,256.33 | $24,656,552.06 | $7,686,230.82 | $7,349,572.44 | 16,804 | 42,013 | $27,360,864.05 | $23,192,772.17 | $7,465,359.06 | $7,109,516.07 |
| Jul 2024 | 11,308 | 26,371 | $13,230,826.39 | $13,043,050.53 | $2,170,576.54 | $2,120,227.48 | 11,836 | 29,133 | $16,815,955.11 | $15,281,330.02 | $4,266,795.57 | $3,802,381.92 | 18,653 | 46,715 | $27,940,418.49 | $25,678,267.35 | $7,533,175.32 | $7,180,474.05 | 16,814 | 42,082 | $29,184,678.02 | $25,176,024.74 | $7,841,687.23 | $7,469,669.28 |
| Jun 2024 | 11,245 | 26,270 | $12,181,826.91 | $11,965,953.50 | $1,834,393.11 | $1,783,480.75 | 11,688 | 28,854 | $16,801,666.97 | $15,305,403.12 | $3,870,366.35 | $3,344,910.35 | 18,648 | 46,721 | $26,323,094.58 | $23,815,488.87 | $6,473,598.23 | $6,148,541.93 | 16,762 | 42,019 | $25,481,406.96 | $21,863,691.94 | $6,801,742.04 | $6,458,077.69 |
| May 2024 | 11,187 | 26,152 | $12,939,733.83 | $12,737,462.94 | $2,274,382.72 | $2,221,864.83 | 11,575 | 28,606 | $16,887,684.36 | $15,067,255.29 | $3,911,668.46 | $3,298,651.25 | 18,613 | 46,698 | $27,865,240.71 | $25,333,267.66 | $7,730,883.09 | $7,370,576.47 | 16,745 | 41,984 | $28,143,745.11 | $23,810,321.82 | $7,453,075.82 | $7,078,019.20 |
| Apr 2024 | 11,133 | 26,076 | $11,800,286.94 | $11,595,010.07 | $2,120,750.61 | $2,068,239.34 | 11,476 | 28,439 | $17,084,957.43 | $14,863,601.19 | $3,873,555.67 | $3,223,803.90 | 18,574 | 46,648 | $28,507,316.59 | $25,558,104.19 | $6,795,495.61 | $6,433,631.27 | 16,708 | 41,940 | $27,310,926.67 | $22,799,577.04 | $7,167,424.07 | $6,783,579.91 |
| Mar 2024 | 11,085 | 26,031 | $12,674,955.56 | $12,456,393.01 | $1,819,172.29 | $1,767,390.35 | 11,392 | 28,293 | $16,001,908.51 | $13,811,647.38 | $3,659,381.18 | $2,937,083.41 | 18,551 | 46,619 | $25,356,593.08 | $22,560,037.41 | $6,986,870.05 | $6,622,385.66 | 16,677 | 41,949 | $27,411,174.55 | $22,832,996.67 | $6,976,045.99 | $6,576,518.87 |
| Feb 2024 | 11,046 | 25,981 | $13,456,290.05 | $13,270,121.13 | $1,881,423.56 | $1,832,960.28 | 11,320 | 28,117 | $14,658,502.04 | $12,609,574.11 | $3,455,551.94 | $2,701,353.04 | 18,548 | 46,600 | $24,517,394.02 | $21,424,176.61 | $6,251,536.62 | $5,873,515.00 | 16,657 | 41,954 | $25,713,008.29 | $21,131,423.68 | $6,605,630.56 | $6,196,439.86 |
| Jan 2024 | 11,017 | 25,928 | $12,334,458.17 | $12,136,333.72 | $1,903,076.12 | $1,852,390.93 | 11,218 | 27,900 | $15,175,350.80 | $12,921,661.81 | $3,873,013.57 | $2,897,260.89 | 18,583 | 46,697 | $26,420,193.49 | $22,640,116.41 | $6,871,557.15 | $6,366,802.96 | 16,661 | 42,029 | $27,651,700.70 | $21,979,292.75 | $7,066,290.40 | $6,528,589.18 |
| Dec 2023 | 11,210 | 26,337 | $11,020,300.54 | $10,879,256.16 | $1,633,051.39 | $1,590,298.03 | 10,676 | 26,474 | $14,637,354.15 | $13,379,219.23 | $3,640,003.72 | $3,428,616.12 | 18,462 | 46,495 | $25,429,931.79 | $23,193,204.63 | $6,677,249.27 | $6,380,442.76 | 16,789 | 42,438 | $27,398,616.27 | $23,860,137.38 | $6,969,418.63 | $6,659,985.18 |
| Nov 2023 | 11,183 | 26,302 | $12,316,108.51 | $12,168,513.62 | $1,700,001.07 | $1,658,170.52 | 10,626 | 26,314 | $13,720,713.59 | $12,499,142.14 | $3,688,065.56 | $3,499,376.60 | 18,459 | 46,456 | $25,730,043.83 | $23,437,975.50 | $7,113,287.10 | $6,818,749.97 | 16,843 | 42,524 | $26,063,517.69 | $22,622,712.88 | $7,339,157.63 | $7,034,975.31 |
| Oct 2023 | 11,103 | 26,135 | $15,423,741.69 | $15,274,465.99 | $1,719,518.24 | $1,677,251.39 | 10,493 | 25,967 | $13,787,627.93 | $12,369,766.84 | $3,927,220.80 | $3,736,149.45 | 18,384 | 46,353 | $26,806,049.99 | $24,519,582.57 | $7,019,993.70 | $6,707,031.13 | 16,824 | 42,489 | $26,342,950.26 | $22,895,827.19 | $7,284,521.09 | $6,970,652.98 |
| Sep 2023 | 11,072 | 26,069 | $10,637,551.63 | $10,493,983.50 | $1,727,841.70 | $1,683,079.27 | 10,380 | 25,723 | $12,737,376.11 | $11,519,073.24 | $3,517,872.23 | $3,340,884.75 | 18,368 | 46,301 | $23,591,045.92 | $21,238,723.36 | $6,272,476.32 | $5,978,848.46 | 16,806 | 42,490 | $25,575,640.03 | $22,180,371.29 | $6,839,876.73 | $6,513,752.29 |
| Aug 2023 | 11,006 | 25,942 | $11,736,387.16 | $11,570,847.54 | $1,731,390.56 | $1,687,530.64 | 10,227 | 25,365 | $12,377,203.95 | $10,877,003.27 | $3,450,925.05 | $3,232,261.08 | 18,352 | 46,268 | $26,498,284.66 | $23,903,364.07 | $6,483,762.71 | $6,145,529.20 | 16,771 | 42,501 | $27,057,184.27 | $23,258,991.15 | $6,668,466.31 | $6,313,620.31 |
| Jul 2023 | 11,034 | 26,018 | $10,331,979.88 | $10,175,067.36 | $1,493,149.17 | $1,450,738.78 | 10,162 | 25,147 | $12,403,602.47 | $10,709,601.23 | $3,569,265.60 | $3,325,375.77 | 18,389 | 46,368 | $20,840,434.28 | $18,809,635.04 | $6,086,064.49 | $5,781,433.81 | 16,863 | 42,691 | $23,306,433.79 | $19,690,522.62 | $6,401,533.36 | $6,072,812.34 |
| Jun 2023 | 10,956 | 25,943 | $10,428,608.76 | $10,266,225.09 | $1,795,592.29 | $1,746,060.05 | 10,016 | 24,839 | $12,303,505.50 | $10,980,423.48 | $3,405,202.36 | $3,158,213.32 | 18,373 | 46,331 | $24,220,038.01 | $21,631,822.41 | $6,744,291.89 | $6,416,217.34 | 16,848 | 42,711 | $27,135,051.32 | $23,118,365.39 | $6,821,021.44 | $6,477,319.91 |
| May 2023 | 10,871 | 25,821 | $12,427,473.94 | $12,257,889.25 | $1,668,967.42 | $1,622,213.52 | 9,880 | 24,572 | $12,268,991.51 | $10,717,596.81 | $3,349,992.08 | $3,124,475.18 | 18,320 | 46,230 | $24,852,955.86 | $22,041,783.84 | $6,564,005.98 | $6,215,818.43 | 16,823 | 42,715 | $26,299,093.86 | $22,044,636.94 | $6,900,571.49 | $6,544,822.85 |
| Apr 2023 | 10,832 | 25,747 | $10,515,368.06 | $10,369,835.27 | $1,455,604.66 | $1,412,772.14 | 9,753 | 24,299 | $10,365,080.30 | $9,099,495.17 | $2,936,886.62 | $2,717,072.45 | 18,328 | 46,242 | $24,682,632.86 | $21,991,656.02 | $5,829,428.85 | $5,499,606.38 | 16,826 | 42,811 | $24,423,971.66 | $20,446,555.09 | $5,937,517.91 | $5,602,583.14 |
| Mar 2023 | 10,771 | 25,641 | $11,621,359.41 | $11,442,123.42 | $1,779,386.13 | $1,730,817.60 | 9,653 | 24,093 | $12,750,008.78 | $11,085,178.93 | $3,103,158.61 | $2,863,711.15 | 18,267 | 46,148 | $26,410,232.47 | $23,464,419.63 | $6,673,427.22 | $6,286,976.15 | 16,804 | 42,827 | $28,355,603.56 | $23,491,150.47 | $7,089,074.94 | $6,706,286.19 |
| Feb 2023 | 10,720 | 25,518 | $10,082,902.18 | $9,929,817.64 | $1,548,168.65 | $1,503,812.70 | 9,580 | 23,961 | $10,694,678.46 | $9,295,974.48 | $2,716,401.66 | $2,480,419.79 | 18,238 | 46,173 | $23,278,893.12 | $20,472,789.01 | $5,483,394.46 | $5,118,993.06 | 16,784 | 42,799 | $24,627,107.11 | $19,990,039.25 | $5,747,942.65 | $5,360,210.26 |
| Jan 2023 | 10,664 | 25,446 | $10,529,115.13 | $10,374,654.87 | $1,783,186.03 | $1,735,661.25 | 9,468 | 23,648 | $12,087,160.48 | $10,296,749.93 | $2,809,047.83 | $2,500,410.70 | 18,274 | 46,285 | $24,260,924.92 | $20,146,942.02 | $5,864,874.74 | $5,381,991.39 | 16,772 | 42,814 | $24,498,255.13 | $18,956,063.50 | $6,455,402.54 | $5,938,912.39 |
PEBB Medical & Pharmacy Benefit RFP OregonBuys Bid No. S-44300-00014758 Attachment M Medical Claims Data
Claims By Region with Risk
| Jan 24 to Dec 24 | Jan 23 to Dec 23 | |||||||||||||
| Region | Employee Months Med | Member Months Med | Relative Risk Score | Allowed Amount Med | Net Pay Med | Allowed Amount Rx | Net Pay Rx | Employee Months Med | Member Months Med | Relative Risk Score | Allowed Amount Med | Net Pay Med | Allowed Amount Rx | Net Pay Rx |
| Portland Metro Area | 169,902 | 385,374 | 110 | $223,915,589 | $207,773,655 | $54,714,172 | $51,310,563 | 161,859 | 371,431 | 106 | $199,710,734 | $184,831,504 | $46,286,701 | $44,132,217 |
| I-5 Corridor | 357,083 | 880,287 | 109 | $503,318,277 | $449,127,093 | $129,617,624 | $121,754,072 | 343,506 | 855,070 | 105 | $444,359,257 | $392,168,849 | $113,263,409 | $107,106,274 |
| Central Oregon | 29,072 | 73,196 | 111 | $42,060,654 | $36,633,965 | $10,924,345 | $10,116,780 | 27,460 | 69,672 | 109 | $38,522,755 | $33,947,076 | $8,820,240 | $8,307,494 |
| Southern Oregon | 49,108 | 126,321 | 109 | $72,757,354 | $64,079,399 | $18,421,308 | $16,980,860 | 47,386 | 122,581 | 103 | $63,602,314 | $55,354,739 | $17,506,548 | $16,524,001 |
| Oregon Coast | 22,321 | 51,945 | 106 | $31,786,082 | $28,867,860 | $8,099,819 | $7,528,684 | 21,697 | 50,356 | 106 | $30,638,331 | $27,508,055 | $7,453,451 | $7,053,578 |
| Eastern Oregon | 55,942 | 158,804 | 95 | $101,800,233 | $87,916,230 | $20,709,806 | $19,080,107 | 54,730 | 156,026 | 91 | $90,579,617 | $77,122,460 | $18,696,388 | $17,610,753 |
| Out of State | 16,850 | 50,098 | 90 | $27,186,958 | $24,220,759 | $5,968,421 | $5,621,396 | 17,665 | 53,645 | 82 | $24,302,499 | $21,387,706 | $5,387,274 | $5,096,542 |
PEBB Medical & Pharmacy Benefit RFP OregonBuys Bid No. S-44300-00014758 Attachment M Medical Claims Data
File details come from the government source that posted it. Updated .