CITY_OF_EDINBURG_000243483_AL_-_City_of_Edinburg_Monthly_Financial_(Mar_'23_to_Sept_'23).pdf
PDF 585 KB Posted
- Attached to
- Group Employee Medical Insurance FY 2026-2027
- Solicitation number
- RFP 2026-018
- Issued by
- Hidalgo County, Texas
About this file
This is a Blue Insight Monthly Financial Dashboard for the City of Edinburg's group employee medical insurance coverage provided by Blue Cross and Blue Shield of Texas for the period March 1, 2023 through September 30, 2023. The dashboard presents comprehensive health plan performance metrics and financial analysis for the municipality's employee population.
During the reporting period, the City of Edinburg maintained 1,743 total members comprising 1,092 subscribers and 651 dependents under their medical plan. The overall paid claims totaled $4,094,098, with medical claims reaching $2,908,982 and pharmacy claims totaling $1,185,116. The paid per employee per month (PEPM) was $536 overall, consisting of $381 for medical services and $155 for pharmacy. The plan demonstrated strong network utilization at 99.4 percent in-network paid percentage with a 65.0 percent discount rate. Spend by service category showed outpatient services at $250 PEPM, inpatient at $188 PEPM, professional services at $248 PEPM, and pharmacy at $240 PEPM. High-cost claimants accounted for 30.9 percent of total paid claims, with the top diagnostic cost drivers being neoplasms ($81 PEPM), health status issues ($41 PEPM), and digestive conditions ($30 PEPM). The plan's performance compared favorably to benchmark standards, with plan share performance of 83.4 percent against the benchmark.
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Blue Insight℠ Monthly Financial Dashboard
03/01/2023 to 09/30/2023
CITY OF EDINBURG 000243483: ALL
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association © Copyright 2026 Health Care Service Corporation. All rights reserved.
Mar 2022 - Sep 2022
Mar 2023 - Sep 2023 % Change Benchmark
Allowed $5,107,284 0.0%
Paid $4,094,098 0.0%
Paid PEPM $535.74 0.0% $925.89
Medical Plan Performance
Plan Share 78.4% 83.4%
In-Network Paid % 99.8% 99.4%
Discount % 73.7% 65.0%
Members 1,743 0.0%
Subscribers 1,092 0.0%
Dependents 651 0.0%
Key Metrics
Paid
PEPM
0.0%
Utilization
Cost and Case Mix
High Cost Claimants
Benchmark
Claimant Distribution
% of Total Paid % of Total Unique Members
Dollar Range Prior Current Benchmark Prior Current Benchmark
No Claims 0.0% 0.0% 0.0% 0.0% 22.4% 20.3%
$50K and - 0.0% 69.1% 57.3% 0.0% 77.0% 78.8%
$50K-$100K 0.0% 7.3% 14.1% 0.0% 0.3% 0.6%
$100K-$300K 0.0% 15.9% 17.9% 0.0% 0.3% 0.3%
$300K and + 0.0% 7.8% 10.7% 0.0% 0.1% 0.1%
HCC Subtotal 0.0% 30.9% 42.7% 0.0% 0.6% 1.0%
CITY OF EDINBURG 000243483: ALL.
Executive Financial Dashboard
Month by Month Comparison (Paid PEPM)
HCC Overall Benchmark
Prior Current Prior Current
March $0 $0 $0 $0 $927
April $0 $0 $0 $0 $828
May $0 $0 $0 $0 $927
June $0 $0 $0 $0 $979
July $0 $0 $0 $0 $889
August $0 $0 $0 $0 $982
September $0 $0 $0 $0 $950
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
$0 $0 $0 $0 $0
Spend by Service Category (Paid PEPM)
HCC Overall Benchmark
Inpatient Prior $0 $0
Current $39 $74 $188
Outpatient Prior $0 $0
Current $61 $176 $250
Professional Prior $0 $0
Current $31 $131 $248
Pharmacy Prior $0 $0
Current $35 $155 $240
Top Diagnostic Categories (Paid PEPM)
HCC Overall Benchmark
Prior Current Prior Current
Neoplasms $0 $72 $0 $81 $83
Health Status $0 $2 $0 $41 $64
Digestive $0 $7 $0 $30 $49
Symptoms/Ill-Defined $0 $2 $0 $24 $38
Circulatory $0 $9 $0 $23 $68
• Claims are reported on a paid basis.
• Benchmarks are based on BCBSTX's non-HMO book of business. The Paid PEPM benchmark metrics are age/gender adjusted to the client's population.
• Benchmarks are based on the current period Mar 2023 - Sep 2023.
• High Cost Claimants are defined as members with paid expenses greater than $50K within the reporting period.
• The Discount % metric excludes Medicare Primary.
• Prior HCC includes spend for HCC identified throughout the full prior period. Current includes only spend for HCC identified within the current period.
• The report includes Medical and Pharmacy claims.
• Reporting Segments: ALL
• Characteristics: ALL
• Group/Sections: ALL
Overall Financial Summary
Mar 2022 - Sep 2022
Mar 2023 - Sep 2023
% Change Mar 2022 - Feb 2023
Total
Paid (Medical) $2,908,982 0.0% $0
HCA Draft Amount $0 0.0% $0
Pharmacy Paid $1,185,116 0.0% $0
Overall $4,094,098 0.0% $0
PEPM
Paid (Medical) $381 0.0% $0
HCA Draft Amount $0 0.0% $0
Pharmacy Paid $155 0.0% $0
Overall $536 0.0% $0
Report prepared on 7/2/2026
CITY OF EDINBURG 000243483: ALL.
Executive Financial Dashboard - Supporting Data
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