Exhibit 11a - Cal Yr 2022 City of Miami CIGNA Total Health Insight - Claims paid Feb 2023.pdf

City of Miami

April 20, 2023

Total Health Insight

POWERED BY CONSULTATIVE ANALYTICS

TURN YOUR HEALTH PLAN INTO A GROWTH PLAN.

EXHIBIT 11a

Total Health Insight Overview Medical Pharmacy

High Cost Claimants Specialty Pharmacy Key Conditions Virtual Care Prevention Recommendations Appendix

Agenda

Timeframes

Current period reflects claims incurred betw een January 2022 and December 2022, paid through February 2023

Base period reflects claims incurred betw een January 2021 and December 2021, paid through February 2022

Norm represents Cigna Florida average for government and municipal employers

Categories of Trend

Trend

Non-Catastrophic Medical

Non-Specialty Pharmacy

Catastrophic Medical

Specialty Pharmacy

4,156 Members; 1.2% Contract Size: 2.1 (Norm 2.0) 48.7% M, 51.3% F (Norm: 52.0% M, 48.0% F) Average Age: 36.7 (Norm: 37.7)

MEDICAL

PHARMACY

TOTAL

2.3%

17.0%

1.5%

$593 PMPM

$525 (Norm)

$176 PMPM

$182 (Norm)

$769 PMPM

$707 (Norm)

Plan Spend (PMPM)

Medical: $29.6M

Cost Share: 6.0% (7.7% norm)

Top 3 Diagnostic Categories:

Neoplasms

Musculoskeletal

Gastrointestinal

42 catastrophic claimants during 2022 compared to 44 in 2021 (over $100,000 total cost per individual)

Pharmacy: $8.8M

Cost Share: 5.1% (7.0% norm)

Top 3 Therapeutic Classes:

Anti-Inflam Disease Modifiers

Hypoglycemics

Antivirals, HIV Specific

Utilization Trend: 9%

Generic dispensing rate: 92%

4.6%

-17%

16.1%

17.8%

1.5%

Total Health Insight Summary

Total Health Insight Overview - Pharmacy

DRIVERS OF PHARMACY TREND TREND CONTRIBUTION BY CLASS OBSERVATIONS

SPECIALTY VS NON-SPECIALTY

TREND

ACHIEVED SAVINGS KEY CONDITION MEDICATION ADHERENCE

Overall Rx. Trend

Inflation

Utilization

Drug Mix

Hypertension

Diabetes

Depression

Cholesterol

Plan Compliance

Norm Compliance

17.0%

3.0%

9.1%

4.9%

75% 77%

67% 72%

76% 74%

74% 76%

23% of drug costs were managed through your plan's medical benefit

GDR

Increase

$217,777

Uti lization

Management

$915,782

Cigna

90-Now

$78,790

RationalMed for Cigna

$160,704

Achieved Savings = $1,373,053

Number of patients on specialty medications increased 10.4%

Medications, across medical and Rx benefits, accounts for 29.7% of total spend

234 members (5.3%) on specialty medications, drive $13.6M (38.2%) of total spend

Est. $530,000 savings available through additional programs, including Essential Protection, 90 Now Exclusive, and SaveOnSP

Multi-year Trends

-6% medical trend impact from utilization reductions

Roughly $1.2m in initial Covid-19 costs

+12% medical trend impact from returning utilization pattern

Covid-19 costs increase approximately $2.2m

Medical utilization normalizes

$2.5m decrease in Covid-19 costs

HEALTH RISK PREVENTIONUTILIZATION

92% of members had a medical or pharmaceutical service last year

75% of the population had a physician visit during 2022

59% had at least one preventive service, 51% had an annual physical

Active employee preventive and physical rates exceed norms by 10 percentage points

Breast, cervical and colon cancer screening results all decreased from 2021 levels

Behavioral health issues shifted to a different diagnosis pattern, with anxiety, depression and ADD/ADHD higher

Total Health Insight Overview Medical

Type 2 diabetes medical spend increased to 82% of total

Pre-diabetes prevalence at roughly 7% for both 2021 and 2022

Chronic condition prevalence increased to 52.8% of the population for 2022

2.7% trend due to higher medical utilization, excluding catastrophic claimants

Medical trend components:

Utilization: +2.7% Service Mix: +0.1% Unit Cost: +0.3% Catastrophic: -5.3%

Medical network penetration rate increased to 97.9%

Outpatient facility utilization changes account for nearly all of trend increase for 2022:

ER 18% higher UC 8% higher Surgeries 15% higher

Cigna Care Designation physicians utilization rate at 30% of opportunity (remaining savings potential of over $500k locally from specialists only)

42* individuals in 2022 (44 in 2021)

24 over age 50

25 employees, 10 spouses, 7 dependents

4 were new enrollees on the plan

2 are no longer enrolled in the plan

8 had a positive diagnosis for COVID-19 (within claim experience only)

CONDITIONS

76% of those with a chronic condition had 2 or more

Top chronic medical conditions were:

Hypertension, Hyperlipidemia and Obesity

40% also have a co-existing behavioral health condition

Cancer was the highest diagnostic category by spend, 8 individuals

COSTS

100% of medical spend was in-network

17 individuals had over $100k in medication spend

Specialty medications accounted for roughly 42% of total catastrophic costs

16 individuals reached the catastrophic level in the prior policy year

$244K average cost per individual

ENGAGEMENT

31 impacted by inpatient management

24 engaged with case management

8 engaged with a health coach

15 see a Cigna Collaborative Care Physician

83% medication adherence rate

OVERVIEW

90% have a chronic condition

86% engagement rate

Catastrophic Summary

*catastrophic level of $100,000 per individual

Catastrophic individuals accounted for 1% of the population and 29% of the total spend ($10.2m in combined medical and pharmacy costs)

Top Catastrophic Detail

Acronym Key

Chronic Coaching Programs

AST-Asthma

CAD-Coronary Heart Disease

CHF-Chronic Heart Failure

CPD-Chronic Obstructive Pulmonary Disorder

DEP-Depression

DIA-Diabetes Mellitus

LBP-Low Back Pain

OST-Osteoarthritis

PAD-Peripheral Artery Disease

WGT-Weight Complications

CM/SPCM Programs (Case Mgmt)

TCM-Transition Care Management

COM-Complex

INP-Inpatient

NIC-Neonatal Intensive Care

ONC-Oncology

REH-Rehabilitation

TRN-Transplant

Additional Programs

CCS-Cancer Care Support Program

EAP-Employee Assistance Program

HPHB-Healthy Pregnancies Healthy Babies

LMP-Lif estyle Management Programs

OL-Online Programs

TDS-Treatment Decision Support

WC-Wellness Coaching

WI-Well Informed (Gaps In Care)

MIR-Medical Injectable

Out of in Clinical M/F Age Relshp ICD Major ICD Minor Medical Pharmacy Med Srx Pharm Srx Total ($) Net % Base? Programs

1 F 50-59 EE Neoplasms Care/Neoplas $168,778 $431 $521,072 $11,326 $701,606 0% N ONC,WI

2 F 50-59 SP Neoplasms Care/Neoplas $290,915 $129 $381,749 $0 $672,792 0% N ONC,WI

3 F 18-29 DEP Int/Ext Injury Comp Surgical $475,428 $6,550 $61,896 $12,874 $556,748 0% Y TRN,WI

4 M 65+ SP Neoplasms Care/Neoplas $205,581 $6,902 $335,824 $0 $548,307 0% N ONC,WI

5 M 50-59 SP Bil Tract/Liv er Gallbladder $475,682 $4,694 $0 $35,344 $515,720 1% Y TRN,WI

6 F 1-17 DEP Neurological Neuro CNS $16,491 $0 $0 $367,002 $383,493 0% Y WI

7 F 40-49 EE Gastrointestinal Stom/Int/Pan $54,578 $643 $248,033 $50,235 $353,489 0% Y WI

8 F 60-64 EE Neurological Neuro CNS $3,925 $847 $0 $346,976 $351,749 0% Y WI

9 F <1 DEP Newborns Morbidity Non-Mat. $321,993 $0 $0 $0 $321,993 3% N NIC

10 M 60-64 EE Neurological Head Trauma $313,206 $5,528 $0 $0 $318,733 4% Y COM,INP,WI

Cat

Cancer Summary

131 individuals w ith eligibility in the current period had a cancer episode, or 3.2% prevalence

Average cost per patient for these episodes w as $25,304 for a total of $3,314,806

The primary cancer type w as Neoplastic Disease w ith 0.7% prevalence and $400,721 in total plan spend

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Prevalence and cost by condition Condition # of

Members Prev alence Cancer Cost

Per Patient Total Plan

Spend Neoplastic Disease 30 0.7% $13,357 $400,721

Breast 22 0.5% $71,582 $1,574,808

Male Rep. 21 0.5% $19,801 $415,827

Thyroid 18 0.4% $8,157 $146,822

Dermatology 16 0.4% $3,885 $62,152

Female Rep. 9 0.2% $18,046 $162,416

Gastrointestinal 9 0.2% $8,957 $80,612

Eye 3 0.1% $4,088 $12,264

Other 7 0.2% $65,598 $459,183

Total 131 3.2% $25,304 $3,314,806

Cancer screening rates

80%

60%

40%

20%

0%

Current

Norm

Breast Cancer Cervical Cancer Colon Cancer

70% 64% 35%

65% 60% 48%

*BOB study results 2 months prior to treatment initiation to 9 months post for patients with no evidence of a cancer episode in the preceding year

SpecialtyPharmacy Executive Summary

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Pharmacy and medical drug plan spend

100%

75%

50%

25%

0%

RA/Psoriasis/Crohn's Antivirals, HIV Specif ic Cancer Spinal Muscular Atrophy Pulmonary Hypertension All Other

36.8%

19.3%

11.2%

7.6%

7.2%

17.9%

Cancer RA/Psoriasis/Crohn's Neutropenia Cancer Antiemetic Osteoporosis All Other

28.5%

18.9%

11.8%

8.9%

7.3%

24.6%

Medical Specialty Rx-HCP / Home Infusion & OP/IP Percent of current plan spend by condition

Base Current Norm

Pharmacy Specialty Rx - Percent of current plan spend by condition

Account summary(PMPM basis)

Base Current Trend Norm Plan Spend

Pharmacy Specialty Rx $82.24 $96.84 17.8% $85.68

Medical SRx HCP/Home Infusion

$12.01 $13.07 8.8% $22.43

Medical SRx Outpatient/Inpatient

$31.80 $38.69 21.7% $15.07

Total Specialty Rx $126.05 $148.60 17.9% $123.17

Other Pharmacy $68.51 $79.51 16.1% $96.49

Specialty Pharmacy & Medical - Top Therapeutic Class Trend

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Therapeutic class trend driver analysis by plan spend

Top 3 therapeutic classes account for 52% of total specialty spend

Top 3 medications, Stelara, Biktary, and Evrysdi, account for 20% of total specialty spend

Non-Specialty pharmacy spend driven by hypoglycemic and insulins for diabetes, combined diabetes spend is $26.65 PMPM, which would be #2 on this list

Rank Plan Spend PMPM Benefit Drug Spend Current

PMPM

Unique

Members Utilizing

Members

Base Current Therapeutic Class Condition Base Current Trend Norm Pharmacy Medical Current Trend 2 1 Anti-Inflam Disease Modifiers RA/Psoriasis/Crohn's $27.24 $33.03 21.3% $28.10 $28.45 $4.57 36 20.0%

1 2 Antineoplastics Cancer $32.24 $25.60 -20.6% $26.80 $10.87 $14.73 25 25.0%

3 3 Antivirals, HIV Specific Antivirals, HIV Specific $18.41 $18.69 1.5% $9.00 $18.69 - 40 11.1%

7 4 Hematopoietic Agents Other Blood Disorders $5.27 $12.38 134.8% $1.61 $6.23 $6.15 7 16.7%

5 5 Gene Therapy Agents Spinal Muscular Atrophy

$6.75 $7.36 9.1% $0.30 $7.36 - 1 -

6 6 Seborrhea/Psoriasis RA/Psoriasis/Crohn's $5.83 $7.11 22.0% $8.11 $7.11 - 6 20.0%

8 7 Vasodilators Pulmonary Hypertension

$4.53 $7.00 54.5% $1.33 $7.00 - 3 50.0%

4 8 Multiple/Lateral Sclerosis Multiple Sclerosis $8.21 $6.51 -20.7% $4.39 $5.07 $1.44 5 -28.6%

16 9 GI Other RA/Psoriasis/Crohn's $0.76 $5.18 583.0% $0.26 - $5.18 3 200.0%

11 10 Antiemetic Cancer Antiemetic $1.65 $4.62 179.9% $0.32 - $4.62 2 -

All Other Specialty $15.17 $21.12 39.2% $42.94 $6.05 $15.07 134 8.1%

Total $126.05 $148.60 17.9% $123.17 $96.84 $51.76 234 10.4%

12Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2023 Cigna

Specialty meds account for over half of drug spend despite being used by less than 2% of population.

Biosimilars hold tremendous promise for cost savings for patients, plans and our entire health care system through healthy competition.

Cigna Pharmacy commercial formulary actions in 2023

Cigna Pharmacy will co-prefer certain biosimilars on commercial formularies alongside Humira

Current Humira customers will continue to receive coverage

New users will go through prior auth process to receive coverage for biosimilars

New preferred biosimilars will be added to Rx Claims Connect for auto-approval consideration

Evernorth Express Scripts will take the same action for commercial formularies.

Humira®

#1 drug by worldwide sales in 20211

$20 billion in sales in 20211

1. AbbVie: Full-Year and Fourth-Quarter 2021 Financial Reports.

https://investors.abbvie.com/news-releases/news-release-details/abbvie-reports-full-year-and-fourth-quarter-2021-financial. Feb 2, 2022.

SaveOnSP maximizes copay assistance from drug manufacturers for certain specialty medications by reducing customer cost share to $0 and sharing 75% of the maximized savings with the client within qualifying plans.

Without SaveOnSP With SaveOnSP

Customer cost share: $0

Customer Spend Manufacturer Copay Assistance Employer Spend

SaveOnSP: Specialty Copay Assistance - Opportunity

Estimated plan savings of $280,798 or $5.63 PMPM equates to a reduction of total specialty pharmacy spend by 5.8%

45 customers represents 35% of specialty pharmacy utilizers, 1% of all pharmacy utilizers

Top impacted drugs by plan savings are Verzenio, Stelara, Humira

Manufacturer Copay Assistance is net of program costs

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Savings by Condition

Condition Customers Scripts Current

Plan Spend Plan Savings

Arthritis 17 109 $647,802 $82,548

Cancer 4 32 $440,164 $65,676

Psoriasis 9 71 $770,882 $41,458

All Other 16 114 $953,401 $91,116

Total 45 326 $2,812,249 $280,798

Total drug spend: $2,812,249

Employer spend: $2,531,450 (including any SaveOnSP program passthroughs)

Manufacturer copay assistance: $280,798 (Including customer cost share reduction to $0)

$16,285

$2,795,964

$280,798

$2,531,450

$0

Saves client $264,513 and eliminates $16,285 in cost share for 45 customers.

Partnering to seamlessly integrate GoodRx® generic drug pricing at retail point-of-sale

Most generic drugs Applies to non-specialty generic medications filled at any in-network retail pharmacy where GoodRx discount cards are accepted

Benefit checks ensured By staying in benefit, clinical safety and formulary checks ensure the claim is safe and compliant

Point-of-sale experience Member has a seamless experience at point-of-sale without going to a discount card or pharmacy site for possible lower generic prices

Member deductible Claim included in member deductible for more transparency to drug claims trends and actual customer cost

Price Assure Powered by GoodRx

More affordable medication coverage Price Assure Powered by GoodRx.

Available January 1, 2023

Auto-enrollment:

no contract changes needed

No member action required

Current

Virtual Care

Demographic Summary Current Norm

Employee 55% 55%

Spouse 17% 22%

Dependent 27% 23%

% of Total Membership 27% 25%

% Male 39% 43%

% Female 61% 57%

Average Member Age 38.5 40.4

MDLive Provider

41%

Cigna Provider 1,459

-8%

Behavioral Provider 2,496

-9%

Visits & Trend by Provider (Current)

Utilization & Trend Base

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Estimated Savings of $29,220 if 10% of acute medical visits (Office, Urgent, Convenience Care) were redirected to MDLIVE

Total Visits 4,470 4,164 -7%

Total Unique Members 1,112 1,102 -1%

Members with Multiple Visits 577 593 3%

% of Total Member Utilization 27% 27% -1%

Trend

Top 5 Medical Care Conditions Base Current

End, Nutr, Met 20.9% 21.3%

General Medical 13.7% 15.9%

Gastrointestinal 8.6% 9.0%

Circulatory 8.6% 6.7%

Ear, Nose, Throat 3.8% 6.3%

Top 5 Behavioral Health Conditions Base Current

Reactive Stress Disorders 44.0% 30.3%

Anxiety 16.0% 25.4%

Depression 19.6% 22.2%

Other 7.9% 7.7%

ADD/ADHD 3.8% 7.4%

Preventive Care Summary

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Well visit completion rates

80%

60%

40%

20%

0%

Base

Current

Norm

Pediatric Adult

73.4% 43.3%

78.2% 45.5%

70.3% 37.0%

Base

Current

Norm

60%

45%

30%

15%

0%

Well visit completion ratesPreventive care utilization (all services)

80%

60%

40%

20%

0%

Base

Current

Norm

Employee Spouse Dependent Total

59.7% 60.2% 56.2% 58.5%

58.8% 60.9% 57.0% 58.5%

48.2% 58.9% 56.0% 52.6%

Employee Spouse Dependent Total

45.3% 47.9% 52.9% 48.4%

46.7% 52.4% 55.9% 50.9%

35.9% 46.7% 53.8% 43.5%

Current period OV & preventive utilization 100.0%

75.0%

50.0%

25.0%

0.0% PCP/SPC OV Annual Physical

74.9% 50.9%

81.4% 75.9%

62.4% 40.6%

78.4% 50.5%

83.0% 47.2%

All Ages

<18

18-39

40-49

50+

2022 Onsite Clinic Activity

Cigna Total Behavioral Health - Executive Summary

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Behavioral Health Claimants

Top Conditions by Prevalence

Clinical & Member Interactions Engagement Types Base Current Trend Customer Engagement 154 85 -44.8% Health Care Provider Engagement 158 260 64.6%

Access and Crisis Support 391 336 -14.1% Customer Advocacy 711 884 24.3%

Total Interactions 1,414 1,565 10.7%

Unique Members w/ clinical interaction 396 465 17.4% Percent of Members w/ cl inical interaction 9.6% 11.2% 16.0%

Total Membership Base Current Trend Average Number of Employees 1,989 2,006 0.8% Average Number of Members 4,107 4,156 1.2%

Behav ioral Health Members

Average Number of Claimants 432 429 -0.7%

Mental Health 428 424 -1.1% Substance Use Disorder 12 11 -13.7%

Catastrophic Claimants(>$100k in BH) 1 2 100.0% Average Age 35.5 36.1 1.7%

Behavioral Virtual visits 2,534 2,325 -8.2% ABA Claimants 9 9 0.0%

Happify Unique Users 8 11 37.5% Happify Active Users 6 8 33.3% iPrevail Unique Users 9 7 -22.2%

Total iPrevail Activities 27 39 44.4%

Key Metrics

11% 10%

54% 53%

13% 15%

34% 33%

97% 98%

Percent of Total Membership

Employee Spouse Dependents Member Network

Uti lization

100%

75%

50%

25%

0%

% of Behavioral Health Claimants

Curr % Behavioral Health Members

3%

8%

25%

27%

29%

10% of the total membership had a claim w ith a behavioral health provider in the current period

Average age of employees w ith behavioral health claims w as 44.8 years

98.2% of members used an in-netw ork behavioral health provider in the current period

Virtual Care utilization w ith behavioral providers decreased by -8.2% in the current period. There w ere 0 MD Live behavioral visits, 0 Talkspace visits, and 27 Ginger visits during the current period

11.2% of the total population had a behavioral health interaction during the current period

Anxiety

Reactive Stress Disorders

Depression

ADD/ADHD

Bipolar Disorder

Base Current

Base % of Behavioral Members

26%

32%

24%

5%

2%

Recommendations

WHY?RECOMMENDATIONOPPORTUNITY AREA

By 2030, Specialty drugs are likely to represent 70%- 80% of total healthcare spend

Specialty drug spend under the pharmacy benefit was $4.8m or 55% of the total pharmacy spend.

SaveonSP Program

Increases manufacturer copay assistance use for both plan sponsors and customers. The program works beyond plan copays and out-of-pocket requirements

Leverages an exclusive partnership between SaveonSP and Cigna/Express Scripts

Targets 95+ specialty drugs in several therapy classes

Estimated savings of $280k ($5.63 PMPM)

Applies only to specialty medications dispensed through Accredo

Program fee equal to 25% of realized savings

Must begin on plan start or renewal date

Decreases customer responsibility for select specialty drugs to $0

Tier 1/Cigna Care Designation physician usage rate at 30% of opportunity

Consider structuring physician benefit levels to add a differential for the usage of Tier 1/Cigna Care Designation providers. Distribute educational materials at mobile clinic center related to Tier 1 specialists

Over $500k in potential remaining savings from usage of Tier 1 specialists locally (surgery - $163k, orthopedics - $143k, hematology - $143k)

Increased chronic condition prevalence rate during 2022, diabetes prevalence at 9% of population

Consider adding the Omada Complete program for a future policy year

Omada Complete will combine both support for existing type 2 diabetics and hypertensives with pre-diabetes weight loss coaching and prevention efforts

Mental health support needs remained at levels higher than pre-pandemic results

Promote new behavioral capabilities across membership, including EAP, digital/virtual options and new therapy solutions (for example Brightline and Bicycle Health)

Shifting diagnosis pattern among behavioral health claim prevalence during 2022. Reductions in stress disorders and substance use offset by increases in anxiety, depression and ADD/ADHD

Appendix

Key Metrics by Group

Actives Under65 Retirees Over65 Retirees Base Current Trend

Members Average Number of Employees 1,847 1,869 1.2%

Average Number of Members 3,922 3,979 1.5%

Cost Trend Plan Spend $34,548,897 $35,946,307 4.0%

Plan Spend PMPM $734 $753 2.6%

Performance Indicators Cat Claimants in Excess Per K 10.2 10.1 -1.4%

Percent of Population Age 40+ 44.8% 45.7% 0.9%

Network Penetration 97.3% 98.1% 0.8%

Network Discounts 68.7% 68.1% -0.6%

Generic Rx Uti lization Rate 91.6% 91.9% 0.3%

Chronic Percent of Population 47.6% 51.7% 4.1%

Chronic Percent of Cost 77.5% 80.0% 2.5%

Health and Wellness Total Health Engagement - % of pop 47.3% 46.8% -0.5%

Health Maintenance Engagement 43.9% 44.2% 0.3%

Health Improvement Engagement 7.6% 6.6% -1.0%

Preventive Care Utilization 58.3% 58.6% 0.3%

Health Assessment Penetration 0.9% 0.6% -0.3%

Gaps in Care Rule Compliance 82.0% 82.2% 0.2%

Base Current Trend

143 136 -4.4%

185 178 -3.9%

$2,779,789 $2,411,323 -13.3%

$1,252 $1,130 -9.8%

27.0 11.2 -58.4%

88.0% 88.7% 0.7%

98.3% 95.6% -2.7%

73.3% 71.5% -1.8%

90.1% 91.5% 1.4%

77.5% 77.9% 0.4%

95.2% 95.6% 0.4%

54.0% 51.0% -3.0%

48.0% 44.8% -3.2%

15.5% 15.5% 0.0%

63.8% 58.5% -5.3%

1.1% 0.0% -1.1%

83.6% 85.9% 2.3%

Base Current Trend

218 208 -4.5%

265 252 -4.7%

$1,456,766 $1,403,738 -3.6%

$460 $465 1.2%

7.6 4.0 -47.5%

93.2% 93.2% 0.0%

94.6% 94.9% 0.3%

78.3% 71.0% -7.3%

89.0% 91.1% 2.1%

88.7% 88.5% -0.2%

93.4% 92.8% -0.6%

21.2% 20.2% -1.0%

20.9% 17.1% -3.8%

3.2% 3.8% 0.6%

35.1% 34.5% -0.6%

0.4% 0.4% 0.0%

80.5% 82.5% 2.0%

Executive Summary

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Total Plan Spend

Total Employer Paid

Total Member Paid

Medical Spend PMPM

Employer Paid - Medical

Pharmacy Spend PMPM

Employer Paid - Pharmacy

Base Current Trend Norm

Members Average Number of Employees 1,989 2,006 0.8% Average Number of Members 4,107 4,156 1.2% Average Employee Age 47.6 48.0 0.9%

Cost Trend Plan Spend - Medical $29,902,783 $29,564,881 -1.1% Plan Spend - Pharmacy $7,425,903 $8,792,782 18.4% Total Plan Spend $37,328,686 $38,357,663 2.8% Medical Plan Spend PMPM $606.82 $592.76 -2.3% $525.29 Pharmacy Plan Spend PMPM $150.74 $176.35 17.0% $182.17 Total Plan Spend PMPM $757.56 $769.11 1.5% $707.46

Performance Indicators Cat Claimants in Excess Per K 10.7 10.1 -5.7% 9.8 Cat Plan Spend PMPM(Med+Rx) $245.34 $220.44 -10.2% $191.63 Non-Cat Plan Spend PMPM(Med + Rx) $512.22 $548.67 7.1% $515.83 Network Penetration 97.4% 97.9% 0.5% 98.3%

Current PMPM Trend

Variance from Norm

$769.11 1.5% 8.7%

$724.68 1.8% 10.8%

$44.43 -2.9% -16.4%

$592.76 -2.3% 12.8%

$557.38 -2.4% 14.9%

$176.35 17.0% -3.2%

$167.30 18.8% -1.2%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures Chronic Percent of Population 48.9% 52.8% 3.9% 44.3% Chronic Percent of Cost 78.8% 81.0% 2.2% 75.7% Total Health Engagement - % of Pop 47.8% 47.0% -0.8% 38.2% Preventive Care Utilization 58.5% 58.5% 0.0% 52.6% Well Visit Completions 48.4% 50.9% 2.5% 43.5% Health Assessment Completions 0.9% 0.6% -0.3% 13.0% Gaps in Care Rule Compliance 82.1% 82.4% 0.3% 79.8%

Pharmacy Indicators Generic Dispensing Rate 91.5% 91.8% 0.4% 91.2% Generic Substitution Rate 97.1% 97.3% 0.2% 97.2% Specialty Plan Spend PMPM (Rx Only) $82.24 $96.84 17.8% $85.68 Specialty Plan Spend PMPM (Med Only) $43.82 $51.76 18.1% $37.50 Non-Specialty Plan Spend PMPM (Rx only) $68.51 $79.51 16.1% $96.49 Prescriptions PMPY(Retail adjusted) 14.12 15.15 7.3% 16.18

Medical & Rx Spend

PMPM Spend

Employer Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Medical & Rx Trend

Total Excluding Over65 Retirees

Actives

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Total Plan Spend

Total Employer Paid

Total Member Paid

Medical Spend PMPM

Employer Paid - Medical

Pharmacy Spend PMPM

Employer Paid - Pharmacy

Base Current Trend Norm

Members Average Number of Employees 1,847 1,869 1.2% Average Number of Members 3,922 3,979 1.5% Average Employee Age 46.5 46.9 1.0%

Cost Trend Plan Spend - Medical $27,648,734 $27,693,337 0.2% Plan Spend - Pharmacy $6,900,163 $8,252,970 19.6% Total Plan Spend $34,548,897 $35,946,307 4.0% Medical Plan Spend PMPM $587.55 $580.05 -1.3% $525.29 Pharmacy Plan Spend PMPM $146.68 $172.92 17.9% $182.17 Total Plan Spend PMPM $734.23 $752.97 2.6% $707.46

Performance Indicators Cat Claimants in Excess Per K 10.2 10.1 -1.4% 9.8 Cat Plan Spend PMPM(Med+Rx) $234.56 $217.61 -7.2% $191.63 Non-Cat Plan Spend PMPM(Med + Rx) $499.67 $535.36 7.1% $515.83 Network Penetration 97.3% 98.1% 0.8% 98.3%

Current PMPM Trend

Variance from Norm

$752.97 2.6% 6.4%

$709.72 2.9% 8.5%

$43.25 -3.4% -18.6%

$580.05 -1.3% 10.4%

$545.38 -1.2% 12.5%

$172.92 17.9% -5.1%

$164.34 19.7% -3.0%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures Chronic Percent of Population 47.6% 51.7% 4.1% 44.3% Chronic Percent of Cost 77.5% 80.0% 2.5% 75.7% Total Health Engagement - % of Pop 47.3% 46.8% -0.5% 38.2% Preventive Care Utilization 58.3% 58.6% 0.3% 52.6% Well Visit Completions 48.6% 51.5% 2.9% 43.5% Health Assessment Completions 0.9% 0.6% -0.3% 13.0% Gaps in Care Rule Compliance 82.0% 82.2% 0.2% 79.8%

Pharmacy Indicators Generic Dispensing Rate 91.6% 91.9% 0.3% 91.2% Generic Substitution Rate 97.1% 97.3% 0.2% 97.2% Specialty Plan Spend PMPM (Rx Only) $85.05 $99.71 17.2% $85.68 Specialty Plan Spend PMPM (Med Only) $43.62 $52.91 21.3% $37.50 Non-Specialty Plan Spend PMPM (Rx only) $61.64 $73.21 18.8% $96.49 Prescriptions PMPY(Retail adjusted) 13.13 14.14 7.7% 16.18

Medical & Rx Spend

PMPM Spend

Employer Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Medical & Rx Trend

Under 65 Retirees

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Total Plan Spend

Total Employer Paid

Total Member Paid

Medical Spend PMPM

Employer Paid - Medical

Pharmacy Spend PMPM

Employer Paid - Pharmacy

Base Current Trend Norm

Members Average Number of Employees 143 136 -4.4% Average Number of Members 185 178 -3.9% Average Employee Age 62.2 62.8 0.9%

Cost Trend Plan Spend - Medical $2,254,049 $1,871,511 -17.0% Plan Spend - Pharmacy $525,740 $539,812 2.7% Total Plan Spend $2,779,789 $2,411,323 -13.3% Medical Plan Spend PMPM $1,015.34 $877.00 -13.6% $525.29 Pharmacy Plan Spend PMPM $236.82 $252.96 6.8% $182.17 Total Plan Spend PMPM $1,252.16 $1,129.95 -9.8% $707.46

Performance Indicators Cat Claimants in Excess Per K 27.0 11.2 -58.4% 9.8 Cat Plan Spend PMPM(Med+Rx) $473.91 $283.63 -40.2% $191.63 Non-Cat Plan Spend PMPM(Med + Rx) $778.24 $846.33 8.7% $515.83 Network Penetration 98.3% 95.6% -2.7% 98.3%

Current PMPM Trend

Variance from Norm

$1,129.95 -9.8% 59.7%

$1,059.34 -10.7% 61.9%

$70.61 6.1% 32.9%

$877.00 -13.6% 67.0%

$825.75 -14.8% 70.3%

$252.96 6.8% 38.9%

$233.59 8.1% 37.9%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures Chronic Percent of Population 77.5% 77.9% 0.4% 44.3% Chronic Percent of Cost 95.2% 95.6% 0.4% 75.7% Total Health Engagement - % of Pop 54.0% 51.0% -3.0% 38.2% Preventive Care Utilization 63.8% 58.5% -5.3% 52.6% Well Visit Completions 45.4% 38.2% -7.2% 43.5% Health Assessment Completions 1.1% 0.0% -1.1% 13.0% Gaps in Care Rule Compliance 83.6% 85.9% 2.3% 79.8%

Pharmacy Indicators Generic Dispensing Rate 90.1% 91.5% 1.4% 91.2% Generic Substitution Rate 97.4% 97.3% -0.1% 97.2% Specialty Plan Spend PMPM (Rx Only) $22.72 $32.71 44.0% $85.68 Specialty Plan Spend PMPM (Med Only) $47.94 $26.12 -45.5% $37.50 Non-Specialty Plan Spend PMPM (Rx only) $214.10 $220.25 2.9% $96.49 Prescriptions PMPY(Retail adjusted) 35.03 37.69 7.6% 16.18

Medical & Rx Spend

PMPM Spend

Employer Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Over 65 Retirees

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Total Plan Spend

Total Employer Paid

Total Member Paid

Medical Spend PMPM

Employer Paid - Medical

Pharmacy Spend PMPM

Employer Paid - Pharmacy

Base Current Trend Norm

Members Average Number of Employees 218 208 -4.5% Average Number of Members 265 252 -4.7% Average Employee Age 73.9 74.2 0.3%

Cost Trend Plan Spend - Medical $1,107,038 $1,092,433 -1.3% Plan Spend - Pharmacy $349,728 $311,306 -11.0% Total Plan Spend $1,456,766 $1,403,738 -3.6% Medical Plan Spend PMPM $348.56 $361.02 3.6% $525.29 Pharmacy Plan Spend PMPM $110.95 $104.08 -6.2% $182.17 Total Plan Spend PMPM $459.52 $465.10 1.2% $707.46

Performance Indicators Cat Claimants in Excess Per K 7.6 4.0 -47.5% 9.8 Cat Plan Spend PMPM(Med+Rx) $105.68 $79.86 -24.4% $191.63 Non-Cat Plan Spend PMPM(Med + Rx) $353.84 $385.24 8.9% $515.83 Network Penetration 94.6% 94.9% 0.3% 98.3%

Current PMPM Trend

Variance from Norm

$417.46 2.1% -41.0%

$400.76 2.6% -38.8%

$16.70 -8.9% -68.6%

$361.02 3.6% -31.3%

$346.43 4.2% -28.6%

$56.45 -6.2% -69.0%

$54.33 -6.3% -67.9%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures Chronic Percent of Population 88.7% 88.5% -0.2% 44.3% Chronic Percent of Cost 93.4% 92.8% -0.6% 75.7% Total Health Engagement - % of Pop 21.2% 20.2% -1.0% 38.2% Preventive Care Utilization 35.1% 34.5% -0.6% 52.6% Well Visit Completions 24.9% 26.2% 1.3% 43.5% Health Assessment Completions 0.4% 0.4% 0.0% 13.0% Gaps in Care Rule Compliance 80.5% 82.5% 2.0% 79.8%

Pharmacy Indicators Generic Dispensing Rate 89.0% 91.1% 2.1% 91.2% Generic Substitution Rate 96.9% 98.5% 1.6% 97.2% Specialty Plan Spend PMPM (Rx Only) $72.68 $57.01 -21.6% $85.68 Specialty Plan Spend PMPM (Med Only) $61.06 $45.13 -26.1% $37.50 Non-Specialty Plan Spend PMPM (Rx only) $20.78 $25.53 22.9% $96.49 Prescriptions PMPY(Retail adjusted) 6.08 6.75 11.0% 16.18

Medical & Rx Spend

PMPM Spend

Employer Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Total Population including Over65 Retirees

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Total Plan Spend

Total Employer Paid

Total Member Paid

Medical Spend PMPM

Employer Paid - Medical

Pharmacy Spend PMPM

Employer Paid - Pharmacy

Base Current Trend Norm

Members Average Number of Employees 2,207 2,214 0.3% Average Number of Members 4,371 4,409 0.9% Average Employee Age 50.2 50.4 0.5%

Cost Trend Plan Spend - Medical $31,009,821 $30,657,328 -1.1% Plan Spend - Pharmacy $7,775,632 $9,104,088 17.1% Total Plan Spend $38,785,452 $39,761,415 2.5% Medical Plan Spend PMPM $591.18 $579.50 -2.0% $525.29 Pharmacy Plan Spend PMPM $148.35 $172.26 16.1% $182.17 Total Plan Spend PMPM $739.53 $751.76 1.7% $707.46

Performance Indicators Cat Claimants in Excess Per K 10.5 9.8 -7.3% 9.8 Cat Plan Spend PMPM(Med+Rx) $236.88 $212.41 -10.3% $191.63 Non-Cat Plan Spend PMPM(Med + Rx) $502.65 $539.35 7.3% $515.83 Network Penetration 96.9% 97.4% 0.5% 98.3%

Current PMPM Trend

Variance from Norm

$743.91 1.6% 5.2%

$701.36 1.8% 7.2%

$42.55 -2.7% -19.9%

$579.50 -2.0% 10.3%

$545.31 -2.0% 12.4%

$164.41 16.4% -9.8%

$156.05 18.1% -7.9%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures Chronic Percent of Population 51.3% 54.9% 3.6% 44.3% Chronic Percent of Cost 79.4% 81.4% 2.0% 75.7% Total Health Engagement - % of Pop 46.2% 45.6% -0.6% 38.2% Preventive Care Utilization 57.1% 57.1% 0.0% 52.6% Well Visit Completions 47.0% 49.4% 2.4% 43.5% Health Assessment Completions 0.9% 0.6% -0.3% 13.0% Gaps in Care Rule Compliance 82.1% 82.4% 0.3% 79.8%

Pharmacy Indicators Generic Dispensing Rate 91.4% 91.8% 0.4% 91.2% Generic Substitution Rate 97.1% 97.3% 0.2% 97.2% Specialty Plan Spend PMPM (Rx Only) $81.66 $94.59 15.8% $85.68 Specialty Plan Spend PMPM (Med Only) $44.86 $51.38 14.5% $37.50 Non-Specialty Plan Spend PMPM (Rx only) $63.47 $74.13 16.8% $96.49 Prescriptions PMPY(Retail adjusted) 13.63 14.67 7.6% 16.18

Medical & Rx Spend

PMPM Spend

Employer Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Member Cost Share

Medical cost share decreased from $35.88 PMPM to $35.38 PMPM, and compares to a norm of $40.32 PMPM

Medical cost share as a percent of total plan spend increased from 5.9% to 6.0%, and compares to a norm of 7.7%

$60

$45

$30

$15

$0

Base

Current

Norm

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Deductible/Copay Coinsurance Total

$23 $13 $36

$23 $12 $35

$29 $11 $40

8%

6%

4%

2%

0%

Base

Current

Norm

Deductible/Copay Coinsurance Total

3.8% 2.1% 5.9%

3.9% 2.1% 6.0%

5.5% 2.1% 7.7%

Account summary (PMPM basis) Base Current Trend

Plan Costs Total Plan Spend - Medical $606.82 $592.76 -2.3%

Cost Share - Medical $35.88 $35.38 -1.4%

Net Employer Paid - Medical $570.93 $557.38 -2.4%

Cost sharing per member - medical only

Cost share as % of total plan spend - medical only of

T ot al Sp en d

Total Plan Spend by Condition

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Base Current Norm 32.0%

24.0%

16.0%

8.0%

0.0%

Top conditions by plan spend

Top ICD conditions PMPM Claimants per 1k Spend per Claimant

Trend ICD Category Base Current Contribution Norm Base Current Trend Base Current Trend

Neoplasms $83.10 $78.32 -0.9% $66.02 180.4 182.4 1.1% $5,526 $5,153 -6.7%

Musculoskeletal $68.45 $55.86 -2.3% $65.65 288.8 285.3 -1.2% $2,844 $2,349 -17.4%

Gen Med Diag $53.73 $55.03 0.2% $43.63 841.3 827.9 -1.6% $766 $798 4.1%

Gastrointestinal $40.56 $48.76 1.5% $39.29 168.0 177.1 5.4% $2,897 $3,304 14.1%

Circulatory $43.10 $46.33 0.6% $40.14 215.0 214.4 -0.3% $2,405 $2,594 7.8%

End/Nutr/Metab $21.83 $26.98 0.9% $19.91 318.8 320.9 0.7% $822 $1,009 22.8%

Pregnancy $23.50 $25.26 0.3% $21.39 23.6 25.5 8.0% $11,937 $11,886 -0.4%

Int/Ext Injury $20.17 $25.18 0.9% $20.97 80.1 83.7 4.5% $3,021 $3,609 19.5%

Neurological $24.15 $23.19 -0.2% $28.74 119.6 118.9 -0.6% $2,424 $2,341 -3.4%

Reproductive $17.72 $22.92 0.9% $16.18 258.4 256.5 -0.7% $823 $1,072 30.3%

All Other $158.43 $130.93 -5.0% $127.44 1226.1 1310.5 6.9% $1,551 $1,199 -22.7%

Total $554.73 $538.76 -2.9% $489.36 961.4 957.3 -0.4% $6,924 $6,753 -2.5%

Neoplasms Musculoskeletal Gen Med Diag Gastrointestinal Circulatory End/Nutr/Metab Pregnancy Int/Ext Injury Neurological Reproductive All Other

Episode Treatment Group Summary

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Distribution of diabetes medical cost by type

Distribution of members by category Distribution of cost by category

100%

75%

50%

25%

0%

Base

Current

Norm

Chronic Maternity Major Minor Healthy

79% 3% 14% 4% 1%

81% 2% 12% 3% 1%

76% 2% 15% 5% 2%

Chronic Maternity Major Minor Healthy NonUser

49% 1% 14% 15% 14% 7%

53% 1% 14% 14% 11% 8%

44% 1% 16% 17% 12% 10%

Base

Current

Norm

60%

45%

30%

15%

0%

Non-User Information Base Current

Average Age 31.4 33.0

Demographic Risk Score 0.93 0.97

Gender Distribution

% Male 62.8% 69.3%

Male Average Age 32.2 33.6

Male Average Enrollment 9.5 9.6

% Female 37.2% 30.7%

Female Average Age 30.1 31.7

Female Average Enrollment 8.7 8.8

Population Demographic Summary

Percent of membership by age band

Average member age increased from 36.3 years to 36.7 years, an increase of 0.9%

The percentage of members in the 40+ age range increased from 46.8% to 47.6%, and compares to a norm of 48.9%

Key metrics overview Base Current Trend Norm

Percent of Pop. Age 40+ 46.8% 47.6% 0.8% 48.9%

Average Member Age 36.3 36.7 0.9% 37.7

Average Employee Age 47.6 48.0 0.9% 48.5

Percent of Population Male 48.5% 48.7% 0.2% 52.0%

Percent of Population Female 51.5% 51.3% -0.2% 48.0%

Percent of plan spend by age band

Average spend by age band Base Current Trend Norm

All Members 40-49 $952 $867 -9.0% $735

50-59 $799 $1,006 25.9% $1,014

60-64 $1,736 $1,314 -24.3% $1,233

65+ $1,363 $1,599 17.3% $917

Excluding Catastrophic 40-49 $572 $613 7.3% $553

50-59 $658 $680 3.3% $701

60-64 $887 $888 0.1% $869

65+ $955 $999 4.5% $689

20%

15%

10%

5%

0% <1 1-17 18-29 30-39 40-49 50-59 60-64 65+

4.5

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0.5

Base Current Norm Demo Fact

28%

21%

14%

7%

0% <1 1-17 18-29 30-39 40-49 50-59 60-64 65+

Base Current Norm

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Population Demographics by Relationship

Percent of members by relationship

Employees represented 48.3% of the population and 57.7% of spend for the current period, versus norms of 50.3% and 58.3%

By relationship type, spouses incurred higher per member costs than employees, $1,038 PMPM for the current period

Excluding Catastrophic Claimants, employees incurred higher per member costs compared to spouses $689 PMPM for the current period

Percent of plan spend by relationship

Average spend by relationship Base Current Trend Norm

All Members Employee $988 $920 -6.8% $812

Spouse $870 $1,038 19.3% $928

Dependent $391 $438 12.0% $388

Excluding Catastrophic Employee $657 $689 4.9% $591

Spouse $613 $673 9.8% $697

Dependent $295 $327 10.9% $288

60%

45%

30%

15%

0%

Base Current Norm

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Employee Spouse Dependent

Base Current Norm

80%

60%

40%

20%

0% Employee Spouse Dependent

Inpatient Summary

Non-catastrophic inpatient costs decreased from $56.12 PMPM to $46.45 PMPM, contributing -1.3% of the overall 1.5% plan trend

Utilization decreased from 57.5 to 53.4 admits per thousand and decreased from 354.3 to 241.6 bed days per thousand

Cost per admit decreased from $29,876 to $23,139 and increased for bed days from $4,846 to $5,116

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Account summary (PMPM basis)

Base Current Trend Trend

Contribution

Non-Catastrophic Inpatient $56.12 $46.45 -17.2% -1.3%

Catastrophic Inpatient $97.64 $56.57 -42.1% -5.4%

Total Inpatient $153.76 $103.02 -33.0% -6.7%

All Other Service Categories $603.80 $666.08 10.3% 8.2%

Total Plan Cost $757.56 $769.11 1.5%

Utilization metrics per 1,000 members

Average cost metrics

Base

Current

Norm

Admits Bed Days

57.5 354.3

53.4 241.6

63.7 346.5

$32,000

$24,000

$16,000

$8,000

$0

Base

Current

Norm

Per Admit Per Bed Day

$29,876 $4,846

$23,139 $5,116

$25,562 $4,698

Inpatient - Major Diagnostic Category Summary

Pregnancies w as the top category by plan cost in the current period. Pregnancies cost increased from $9.01 PMPM to $9.62 PMPM, an increase of 6.7%

Cost per case for the Pregnancies category increased from $10,094 to $11,422, an increase of 13.2%

Plan cost for non-catastrophic decreased from $56.12 PMPM to $46.45 PMPM, a decrease of 17.2%

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Cost & utilization trends (excluding catastrophic) $PMPM Admits Per 1,000 Days Per 1,000 Cost Per Case

Base Current Trend Base Current Trend Base Current Trend Base Current Trend

Pregnancies $9.01 $9.62 6.7% 10.7 10.1 -5.7% 32.1 30.1 -6.4% $10,094 $11,422 13.2%

Metabolic $4.73 $4.94 4.4% 3.4 4.1 20.0% 5.6 9.6 71.8% $16,640 $14,487 -12.9%

Respiratory $12.18 $4.06 -66.6% 6.6 2.4 -63.4% 43.3 7.2 -83.3% $22,226 $20,267 -8.8%

Infections $2.98 $3.91 31.3% 1.2 1.4 18.6% 4.1 7.5 80.2% $29,372 $32,530 10.8%

New born $3.29 $3.18 -3.6% 6.6 5.5 -15.8% 16.6 14.4 -12.8% $6,011 $6,887 14.6%

Other $23.93 $20.74 -13.3% 13.9 18.8 35.2% 87.7 70.3 -19.9% $16,731 $13,244 -20.8%

Total Non-Cat $56.12 $46.45 -17.2% 42.4 42.3 -0.1% 189.5 139.1 -26.6% $14,598 $13,155 -9.9%

Catastrophic $97.64 $56.57 -42.1% 15.1 11.1 -26.7% 164.9 102.5 -37.8% $72,752 $61,340 -15.7%

Total $153.76 $103.02 -33.0% 57.5 53.4 -7.1% 354.3 241.6 -31.8% $29,876 $23,139 -22.5%

Outpatient surgical details

Endoscopy procedures per 1,000

Top Outpatient Surgeries

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Plan Spend PMPM Visits per 1k Avg. Spend per Visit Average Age Trend

Type of Surgery Base Current Contribution Norm Base Current Base Current Base Current

Endoscopy $23.40 $19.70 -8.9% $21.18 54.6 61.8 $5,147 $3,823 51.8 52.3

Ovary Removal $2.14 $5.21 7.4% $2.00 1.5 3.4 $17,581 $18,544 37.3 45.0

Cataract $3.04 $4.49 3.5% $1.61 3.7 4.8 $9,992 $11,205 63.8 65.2

Cardiac Cath $6.55 $4.08 -5.9% $5.07 2.9 2.7 $26,889 $18,495 46.7 52.6

Upper GI $3.19 $2.75 -1.1% $3.65 11.2 9.6 $3,416 $3,430 45.8 52.7

Hernia Repair $0.98 $2.28 3.1% $2.25 0.7 2.2 $16,158 $12,611 66.0 57.8

Carpal Tunnel $0.43 $1.08 1.6% $0.66 1.5 2.4 $3,526 $5,385 54.8 52.1

Kidney Stones $0.39 $0.86 1.1% $0.83 0.5 1.0 $9,558 $10,772 48.0 33.8

Skin $1.07 $0.82 -0.6% $0.79 13.2 14.7 $973 $668 57.9 54.5

Middle Ear $0.00 $0.52 1.2% $0.62 0.0 0.7 $0 $8,692 0.0 39.0

All Other $0.45 $0.57 0.3% $1.40 1.0 1.2 $5,541 $5,646 31.0 7.2

Total $41.64 $42.36 1.7% $40.06 90.6 104.4 $5,515 $4,867 51.1 51.8

The total cost of the surgeries, including facility and professional costs have been included in this exhibit

Endoscopy w as the top surgery by plan spend in the current period.

Endoscopy spend decreased from $23.40 PMPM to $19.70 PMPM, a decrease of 15.8%

Endoscopy had the greatest impact on overall trend, contributing -8.9%

60.0

45.0

30.0

15.0

0.0

Base

Current

Norm

Colonoscopy Bladder Uterus Joint Gall Bladder

34.8 8.3 5.1 2.9 3.4

40.4 10.6 5.5 3.8 1.4

44.0 10.0 4.5 5.8 1.8

Facility outpatient utilization per 1,000 members

Facility outpatient cost per visit

Outpatient - Emergency Room and Urgent Care Detail

Emergency room costs increased from $48.69 PMPM to $63.66 PMPM, contributing 2.0% of the overall 1.5% plan trend

Urgent Care w as the largest category of utilization. Utilization per thousand increased from 387.4 to 418.6, and compares to a norm of 364.6

Emergency room w as the largest average cost category. Cost per visit increased from $2,550 to $2,825, and compares to a norm of $2,565

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Base Current Trend Trend

Contribution

Emergency Room $48.69 $63.66 30.7% 2.0%

Urgent Care $14.95 $17.12 14.5% 0.3%

Total Outpatient Facility $175.14 $203.89 16.4% 3.8%

Total Plan Cost $757.56 $769.11 1.5% 1.5%

Base

Current

Norm

ER Urgent Care

229.1 387.4

270.4 418.6

230.8 364.6

Base

Current

Norm

ER Urgent Care

$2,550 $463

$2,825 $491

$2,565 $191

Account summary (PMPM basis)

$3,000

$2,250

$1,500

$750

$0

Emergency Room/Urgent Care Opportunity

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Cost & utilization trends Visits Per 1000 Cost Per Visit PMPM Cost Share %

Base Current Trend Base Current Trend Base Current Trend Current

Emergency Room

Non-Steerable 192.1 215.6 12% $2,800 $3,233 15% $45 $58 30% 5.7%

Steerable 37.0 54.9 48% $1,253 $1,222 -2% $4 $6 45% 14.4%

Urgent Care 387.4 418.6 8% $463 $491 6% $15 $17 14% 6.7%

Office Visits 3,883.8 3,990.2 3% $152 $157 4% $49 $52 6% 14.3%

Convenience Care 10.5 14.0 33% $40 $33 -16% $0 $0 12% 19.5%

Virtual Care- Medical 35.6 46.4 31% $55 $55 0% $0 $0 13% 13.0%

Total 4,546.5 4,739.7 4% $113 $133 18%

Current period urgent care cost per visit w as $491, compared to emergency room steerable cost per visit of $1,222

In the current period, 228 emergency room visits w ere steerable representing potential redirect savings of up to $191,859

Of the steerable emergency room visits, 99% had a contracted urgent care facility w ithin 10 miles

Steerable emergency room cost share percentage is 14.4%, compared to urgent care at 6.7%

0-5 miles 16+ miles

99%

1%

Urgent Care - nearest facility

Emergency Room Steerable Primary Opportunity for Urgent Care Plan Cost PMPM Total Visits Cost Per Visit Musculoskeletal $77,028 $1.54 61 $1,262.76

Ear,Nose,Throat $76,604 $1.54 56 $1,367.93

Skin $25,735 $0.52 22 $1,169.79

Respiratory $18,225 $0.37 16 $1,139.06

Renal/Urologic $17,382 $0.35 14 $1,241.54

Int/Ext Injury $16,250 $0.33 13 $1,250.03

Gen Med Diag $15,488 $0.31 13 $1,191.42

Infect/Parasit $14,221 $0.29 11 $1,292.84

Gastrointestinal $7,220 $0.14 7 $1,031.42

Other $10,462 $0.21 15 $697.46

Total $278,616 $5.59 228 $1,222.00

UC Av erage Cost Per Visit $380.51

Per Visit Redirect Sav ings $841.49

Opportunity Redirect Sav ings 10% Redirect to Urgent Care $19,186 25% Redirect to Urgent Care $47,965

*UC Average Cost per visit calculation for steerable opportunity excludes outliers >$1,500

Office Visits

81% of individuals ages 40 and above received care from a PCP and or Specialist in the current period

48% of individuals ages 40 and above received an annual physical in the current period

Plan spend for Specialists in the current period w as $32 PMPM compared to $21 PMPM for Primary Care Physicians

Specialist Evaluation & Management cost increased from $22 PMPM to $23 PMPM, an increase of 4.1%

8,000

6,000

4,000

2,000

Base

Current

Norm

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Primary Care Specialist Total

1,815.7 2,067.5 3,883.8

1,903.1 2,086.7 3,990.2

1,971.5 2,056.6 4,028.1

$200

$150

$100

$50

$0

Base

Current

Norm

Primary Care Specialist Total

$124 $176 $152

$130 $182 $157

$130 $185 $158

Office visits per 1,000 members Average plan cost per office visit

% of individuals continuously enrolled for at least 12 months who did not see a PCP/SPC

80%

60%

40%

20%

0%

No OV

% Employee

% Female

All <18 18-39 40-49 50+

21% 14% 33% 19% 14%

41% 0% 28% 76% 73%

37% 49% 36% 30% 36%

CCD visits for PCP and SCP

Cigna Care Designation - Utilization and Cost Statistics

70.2% of plan spend for Cigna Care Designation primary and specialties utilization has the opportunity for Cigna Care utilization

Cigna Care Designation represents applicable services w here a Cigna Care Designation provider w as utilized

Cigna Care Designation opportunity represents applicable services w here a Cigna Care Designation provider w as not utilized, but one is available w ithin 30 miles

Eff iciency opportunity is derived by taking the actual number of members w ho did not see a CCD provider and comparing their cost per episode to the cost for the same types of episodes delivered by CCD providers

Total efficiency opportunity represents the dollar impact if all of the episodes that w ere treated by non CCD providers moved to CCD providers

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

80%

60%

40%

20%

0%

CCD PCP CCD

Opportunity

PCP

CCD SCP CCD

Opportunity

SCP

26% 74% 29% 67%

28% 72% 27% 67%

33% 67% 38% 57%

Base

Current

Norm

Cigna Care Designation opportunity - nearest provider

0 to 10 miles 11 to 20 miles 21 to 30 miles

100%

75%

50%

25%

0%

PCP

SCP

CCD provider efficiency opportunity top markets

Market Client

Episodes

Total Non CCD Provider

Episode Cost

Total CCD Provider

Episode Cost Efficiency

FL South Florida 3,759 $4,799,806 $3,821,095 $978,711

FL Orlando 130 $59,929 $46,279 $13,650

Top CCD Provider Opportunity Markets

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Rank Market CCD Cost Efficiency

Non-CCD Cost Efficiency

Specialty Description Cost Per Episode

Client Episodes

Cost Per Episode

Avg Episode Difference

Efficiency Opportunity

#1 FL South Florida Internal Medicine $925 501 $1,303 $378 $189,308 General Surgery $6,507 83 $8,470 $1,963 $162,929 Orthopedics And Surgery $2,082 105 $3,446 $1,364 $143,212 Hematology $5,142 17 $13,542 $8,401 $142,814 Ophthalmology $843 167 $1,334 $490 $81,881

873 $720,142

#2 FL Orlando Pediatrics $906 2 $2,947 $2,041 $4,082 Orthopedics And Surgery $2,495 5 $3,257 $762 $3,809 Obstetrics And Gynecology $328 12 $451 $122 $1,468 Family Practice $189 100 $200 $11 $1,110 Urology $1,111 2 $1,665 $554 $1,108

121 $11,578

Top opportunity markets detail

Well Informed Gaps in Care - Summary

3,968 members qualif ied for a gap in care evaluation, w ith 1,441 compliant and 2,527 non-compliant w ith evidence-based medicine guidelines

82.4% of rules evaluated w ere compliant w ith evidence-based medicine guidelines, compared to a norm of 79.8%

The greatest number of members w ith gaps w as found in the 50-59 age band, w ith 655 total members

The Diabetes category had the greatest rate of multiple gaps (2 or more), 75%

Current Period ref lects Well Informed Gaps in Care program activity between Jan.2022 and Dec.2022

Rule compliance summary

100%

75%

50%

25%

0%

Current

Norm

Non-Compliant Compliant

17.6% 82.4%

20.2% 79.8%

Compliance by category

100%

75%

50%

25%

0%

Current

Norm

Achieve Targets

Approp.

Monitor.

Approp.

Therapy

Med.

Adhere.

Patient Safety

88.2% 89.4% 74.0% 82.5% 86.5%

87.4% 87.9% 69.3% 90.3% 90.1%

Compliance by condition

100%

75%

50%

25%

0%

Current

Norm

Obesity HTN HPL Diabetes URI

94% 85% 92% 82% 77%

93% 86% 91% 83% 80%

Behavioral Health - Customer & Clinical Interactions

Behavioral Interactions Summary

Current Period ref lects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023 Base Period ref lects claims incurred between Jan. 2021 and Dec. 2021, paid through Feb. 2022

Interaction Type Description Number of

Interactions Customers

Engaged

Customer Engagement Outreaching and coaching customers to better manage their behavioral conditions

Includes coaching and care management…