Exhibit 11b - Cal Yr 2023 City of Miami CIGNA Total Health Insight - Claims paid Feb 2024.pdf

Confidential, unpublished property of Cigna Healthcare.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

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Total Health Insight

April 3, 2024

City of Miami

Powered by Consultative Analytics

EXHIBIT 11 EXHIBIT 11a

Confidential, unpublished property of Cigna Healthcare.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

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute.

Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Agenda

Insights

1. Total Health Insight Overview

▪ Medical

▪ Pharmacy

2. High Cost Claimants

3. Specialty Pharmacy

4. Cancer

5. Prevention

6. Virtual Care

7. Health Equity

8. Recommendations

9. Appendix

Timeframes

• Current period reflects claims incurred between January 2023 and December 2023, paid through February 2024

• Base period reflects claims incurred between January 2022 and December 2022, paid through February 2023

• Norm represents Cigna Florida average for government and municipal employers

EXHIBIT 11a

Confidential, unpublished property of Cigna Healthcare.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

Multi-Year Trend

2020: -6% medical trend, roughly $1.2m in initial Covid-19 costs

2021: +12% medical trend impact from returning utilization pattern, Covid-19 costs increase approximately $2.2m

2022: Medical utilization normalizes, $2.5m decrease in Covid-19 costs

2023: 4 individual claimants exceed

$700k each in total cost, hypoglycemic medications account for more than half of total pharmacy trend

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Total Health Insight Overview

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

How much did we ask members of the plan to pay out of pocket?

Did members use the plan appropriately?

Medical Summary

Major

Lower cost share rate equates to roughly $600k in cost shifted to the City compared to other Florida municipalities

Employee well visit rate exceeds norm by over 11 percentage points

Catastrophic claim spend accounted for 9.5% of the 10.2% medical cost trend

• Spouses incurred higher per capita costs than employees, 1% more across all claims and 3% excluding high cost claimants

• Unique individuals accessing MDLive for any type of care increased 56% from prior year

• ER utilization increased 2% overall, with steerable visits down 10%. Fewer steerable visits were incurred for employees related to injuries, ear/nose/throat and musculoskeletal health issues

• $2.9m in cost savings from case and utilization management programs during 2023

What conditions contributed the most to trend?

DRIVERS OF PHARMACY TREND TREND CONTRIBUTION BY CLASS SPECIALTY VS. NON-SPECIALTY SPEND

OBSERVATIONS ACHIEVED SAVINGS KEY CONDITION MEDICATION

ADHERENCE

Overall Rx. Trend

Inflation

Utilization

Drug Mix

Hypertension

Diabetes

Depression

Cholesterol

Plan Compliance Norm Compliance

↑ 20.4%

↑ 4.4%

↑ 5.1%

↑ 10.9%

77% 77%

69% 72%

75% 74%

75% 76%

22% of drug costs were managed through your plan's medical benefit

GDR

Increase

$302,955

Utilization

Management

$60,644

Cigna

90-Now

$93,126

RationalMe d for Cigna

$81,171

250 members ( 5.6%) are on specialty medications driving $18,406,513 ( 45.6%) of the plan spend during the current period.

Medications across medical and Rx benefits, account for 31.5% of total plan spend.

Estimated $436k additional savings available through Essential Protection utilization management and SaveOnSP combined.

Pharmacy Summary

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Population Health

Top 5 Chronic Conditions Prevalence

• Preventive care and annual physical utilization remained above norms for employees and spouses

• Dependents preventive care rates decreased 5 points and were below norms for 2023

• Cancer screenings improved by 1-2 points in all areas

• Mental health claimant prevalence decreased 4% overall, substance use issues rose by 4

• Among pre-diabetic members, the top 3 co-morbid conditions are obesity, hypertension and depression

Health Risk Highlights

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Catastrophic Summary

Costs ConditionsOverview

Catastrophic claimants accounted for 1% of the population and 35% of total costs, totaling over $14m in combined medical and pharmacy costs, $4m higher than 2022

56* individuals (42 in prior year)

• 32 over age 50, 10 over age 65

• 32 employees, 12 spouses, 12 dependents

• 5 were new enrollees on the plan (3 newborns)

• 5 are no longer enrolled in the plan

• 22 of the individuals also reached the catastrophic level in the prior policy year

• 100% of medical spend was in-network

• 84% of those with a chronic condition had 2 or more

• Hypertension, hyperlipidemia, diabetes and obesity were the most prevalent chronic medical conditions

• 45% also have a co-morbid behavioral diagnosis

• 17 see a Cigna Collaborative Care Physician

• 86% medication adherence rate

• Top individual incurred $920k in total cost

• 22 individuals had over $100k in medication spend

• Specialty medications accounted for 40% of total catastrophic costs

• Top specialty drugs included

Abraxane, Aloxi and Kadcyla (cancers), Stelara and Evrysdi

• Cancer accounted for the highest percentage of costs and number of claimants, 14 individuals

$254K average cost per individual

91% have a chronic condition

*catastrophic level of $100,000 per individual

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Top 10 Catastrophic Detail

Acronym Key

Chronic Coaching Programs

A ST-Asthma

C AD-Coronary Heart Disease

C HF-Chronic Heart Failure

C PD-Chronic Obstructive P ulmonary Disorder

DEP-Depression

DIA-Diabetes Mellitus

LBP-Low Back Pain

O ST-Osteoarthritis

PAD-Peripheral Artery Disease

WGT-Weight Complications

CM/SPCM Programs (Case Mgmt)

TCM-Transition Care Management

C OM-Complex

INP-Inpatient

NIC-Neonatal Intensive Care

O NC-Oncology

REH-Rehabilitation

TRN-Transplant

Additional Programs

C CS-Cancer C are Support Program

EAP-Employee Assistance Program

HPHB-Healthy Pregnancies Healthy Babies

LMP-Lifestyle Management P rograms

O L-Online P rograms

TDS-Treatment Decision Support

WC -Wellness Coaching

WI-Well Informed (Gaps In Care)

MIR-Medical Injectable

Out of Date of in Clinical

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

1 F 50-59 EE Neoplasms Leukemia $857,660 $1,754 $59,499 $871 $919,783 0% 03/24 N O NC,TRN,WI

2 M 65+ SP Neoplasms C are/Neoplas $111,335 $7,013 $710,412 $0 $828,760 0% 03/24 Y O NC,WI

3 M 65+ EE Neoplasms C are/Neoplas $513,072 $6,188 $134,259 $100,464 $753,982 0% 02/24 N O NC,WI

4 F 50-59 EE Neoplasms C are/Neoplas $214,064 $210 $511,047 $0 $725,322 0% 03/24 Y C OM,DIA,ONC,WC,WGT,WI

5 M 50-59 EE Skin Infections $624,207 $2,154 $1,784 $23,689 $651,833 0% 03/24 Y C OM,WI

6 F 1-17 DEP Newborns Morbidity Non Mat $594,202 $992 $16,532 $0 $611,727 0% 03/24 N NIC

7 M 30-39 EE Gastrointestinal Stom/Int/Pan $23,607 $3,171 $0 $355,513 $382,291 24% 03/24 Y WI

8 M 60-64 EE C irculatory Hypertensive $374,818 $951 $207 $0 $375,975 0% 10/23 N C OM,EAP,WI

9 F 50-59 SP Neoplasms C are/Neoplas $26,313 $592 $338,708 $0 $365,613 0% 03/24 Y WI

10 F 60-64 EE Neoplasms C are/Neoplas $343,239 $2,647 $0 $5,826 $351,712 0% 03/24 Y

O NC,WI

Latest Cat

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· 31% of cancer patients also have a diagnosis of diabetes

· Different than most groups, prostate cancer was the top cancer type by prevalence

· Unique individuals with a prostate cancer screening increased 6% during the year

Cancer Summary

Cancer screening rates

80%

60%

40%

20%

0%

Current

Norm

Breast Cancer Cervical Cancer Colon Cancer

71% 65% 37%

66% 60% 48%

Cancer prevalence by age band

24.0%

18.0%

12.0%

6.0%

0.0%

Male

Female

<01 1-17 18-29 30-39 40-49 50-59 60-64 65+

0.0% 0.0% 0.7% 1.6% 2.9% 6.1% 10.9% 23.1%

0.0% 0.3% 0.8% 1.9% 5.2% 6.6% 10.3% 12.4%

Prevalence and cost by condition Condition # of

Members Prevalence Cancer Cost

Per Patient Total Plan

Spend

Male Rep. 35 0.8% $35,578 $1,245,238

Neoplastic Disease 29 0.7% $24,480 $709,909

Dermatology 24 0.6% $1,994 $47,856

Breast 24 0.6% $93,576 $2,245,826

Thyroid 17 0.4% $3,445 $58,560

Gastrointestinal 10 0.2% $12,747 $127,471

Female Rep. 7 0.2% $29,959 $209,713

CNS 4 0.1% $7,169 $28,677

Hepatobiliary 3 0.1% $30,612 $91,835

Other 4 0.1% $190,980 $763,920

Total 146 3.5% $37,870 $5,529,005

Specialty Pharmacy Executive Summary

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Pharmacy and medical drug plan spend

100%

75%

50%

25%

0%

RA/Psoriasis/Crohn's

Antivirals, HIV

Specific

Cancer

Spinal Muscular

Atrophy

Pulmonary

Hypertension

All Other

47.9%

13.9%

10.1%

6.0%

6.0%

16.1%

Cancer

Cancer Antiemetic

RA/Psoriasis/Crohn's

Immune Related

Neutropenia

All Other

47.1%

10.6%

10.3%

6.5%

4.9%

20.6%

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 $96.88 $111.25 14.8% $93.55

Medical SRx HCP/Home

Infusion

$13.08 $10.08 -22.9% $21.23

Medical SRx

Outpatient/Inpatient

$38.71 $50.49 30.4% $15.35

Total Specialty Rx $148.67 $171.82 15.6% $130.13

Other Pharmacy $79.49 $101.07 27.1% $105.50

Specialty Pharmacy & Medical - Top Drug Spend

Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Top drugs by spend

• The top fifteen Specialty Pharmacy and Medical drugs accounted for 56.5% ($4,832,556) of the total Specialty plan spend ($8,5 56,898) in the current period.

• The Specialty Top Drugs by Plan Spend(PMPM) are: Stelara ($24.74), Abraxane ($11.06), and Humira(Cf) Pen ($7.26).

Rank Plan Spend (PMPM) Members Claims

Base Current Drug Name Condition Base Current Trend Norm Plan Spend Base Current Base Current

1 1 Stelara(SRx) RA/Psoriasis/Crohn's $13.74 $24.74 80.0% $6.55 $1,232,003 6 6 51 65

- 2 Abraxane Cancer - $11.06 - $0.36 $550,771 - 1 - 25

10 3 Humira(Cf) Pen(SRx)

RA/Psoriasis/Crohn's $4.34 $7.26 67.2% $9.39 $361,535 5 6 31 52

17 4 Kadcy la Cancer $2.68 $6.80 154.0% $0.38 $338,708 1 1 4 10

3 5 Ev ry sdi(SRx) Spinal Muscular Atrophy $7.36 $6.70 -9.1% $0.40 $333,460 1 1 15 13

2 6 Biktarvy(SRx) Antiv irals, HIV Specific $8.45 $6.47 -23.4% $2.70 $322,227 12 10 112 85

8 7 Uptrav i(SRx) Pulmonary Hypertension $4.98 $5.06 1.6% $0.49 $252,147 1 1 12 11

21 8 Aloxi Cancer Antiemetic $2.31 $4.81 108.3% $0.03 $239,724 1 5 2 17

19 9 Rinv oq(SRx) RA/Psoriasis/Crohn's $2.48 $4.72 90.4% $1.64 $234,982 3 4 20 37

9 10 Key truda Cancer $4.56 $4.12 -9.7% $2.19 $205,001 1 2 6 6

6 11 Sky rizi Pen(SRx) RA/Psoriasis/Crohn's $5.34 $4.02 -24.9% $3.50 $199,931 4 2 36 30

27 12 Kesimpta Pen(SRx)Multiple Sclerosis $1.81 $3.40 87.6% $0.51 $169,100 1 2 12 20

18 13 Norditropin Flexpro(SRx)

Growth Hormone Deficiency $2.65 $2.98 12.6% $1.40 $148,418 2 2 15 18

5 14 Neulasta Neutropenia $5.96 $2.46 -58.7% $0.70 $122,692 1 4 20 10

7 15 Enty vio RA/Psoriasis/Crohn's $5.19 $2.45 -52.8% $0.20 $121,856 3 1 18 6

All Other Specialty $76.82 $74.78 -2.6% $99.68 $3,724,342 206 224 1,035 1,148

Total $148.67 $171.82 15.6% $130.13 $8,556,898 234 250 1,389 1,553

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Pathwell Specialty – Solutions that work together to improve oncology outcomes

Pathwell Specialty is a new national medical injection/infusion network and benefit that excludes high-cost providers and offers dedicated customer support.

*Number of providers as of February 2023. Subject to change. **Effective

July 1, 2022, for Select clients and January 1, 2023, for National and Middle Market clients. *** Cigna Healthcare analysis 2022 based on commercial national book of business. Individual results and savings will vary and are not guaranteed. Savings vary by market, funding type and utilization and are subject to change.

Robust, high-performing Open Access Plus (OAP)-based national network of more than 28,000 local, affordable providers and pharmacies*

Dedicated care management team that guides members and providers to in-network providers

Optimized drug coverage management of affordable, clinically appropriate specialty medications

Integrated strategy with benefit optimization that looks across pharmacy and medical benefits to maximize savings

Comprehensive whole-person health approach that offers additional support through programs like:

Caregiver Bridge, FoodsmartTM, Oncology Consult Service, and

HelloFresh

The new Cigna Pathwell Specialty®** Network has driven 15%+ reduction to medical specialty spend.***

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Oncology Consult Service is not just a second opinion The Cigna Healthcare

Difference:*

• Automatically initiated on customer’s behalf as part of the prior authorization process prior to treatment

• Targeted to those cases likely to benefit from a consultative review

- $3,800 fee per completed consult for ASO clients

• Customer’s provider and consulting physicians work together on customer’s behalf, and consult service facilitates medical record exchange

• No delays in treatment and most reviews complete in under a week

• Consulting physicians are experts from National Cancer Institutes

Standard Second Opinion Experience:

• Available for all cases, regardless of diagnostic and treatment complexity

• Customer, or in some cases second opinion service initiates the process, which often happens after treatment has begun

• Customer must coordinate with second opinion reviewer and their provider, including sharing of medical records

• Length of review may delay treatment

*This is an average and not guaranteed

$23,644 saved on essential medications may drive better adherence and improved future health outcomes

Patient Assurance Program - Performance

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Top Customer Savings by Drug

Drug Name Customers

PAP

Scripts

Customer

Spend

Customer

Sav ings

Ozempic 126 797 $19,925 $8,275

Mounjaro 113 619 $15,475 $7,522

Farxiga 42 294 $7,350 $1,885

Other 174 910 $22,750 $5,961

Total 343 2,620 $65,500 $23,644

• 100% of PAP customers fi l led medications for other conditions including Hypertension, Diabetes and Cholesterol

• The total pharmacy cost of the 343 PAP customers was $3,430,312, 32% of total pharmacy spend in the current period

• Total customer savings of $23,644 was achieved on eligible drugs with cost share greater than $25 per month saved

Summary

Base Current

PAP Customer Total Sav ings $13,606 $23,644

Sav ings PMPM $0.27 $0.47

Av erage Per Script Savings $9 $9

PAP Script Count 1,471 2,620

% of Total Scripts 2.3% 4.0%

Scripts Per Customer 6.9 7.6

Without PAP Cost Share Per Script $34 $34

With PAP Cost Share Per Script $25 $25

PAP Customer Count 213 343

% of Total Population 6.5% 10.5%

Detail Cost share breakdown

Without

PAP

With

PAP

Customer $89,169 $65,525

Manufacturer $0 $23,644

Client $1,814,305 $1,814,305

343 customers with

$25 / script cost share

$23,644

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 $341,219 or $6.85 PMPM equates to a reduction of total specialty pharmacy spend by 6.2%

• 65 customers represents 46% of specialty pharmacy utilizers, 2% of all pharmacy utilizers

• Top impacted drugs by plan savings are Biktarvy, Stelara, Humira

• Manufacturer Copay Assistance is net of program costs

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Savings by Condition

Condition Customers Scripts

Current

Plan Spend Plan Sav ings

HIV 21 175 $623,435 $98,214

Arthritis 19 174 $995,744 $97,451

Cancer 5 17 $219,541 $37,647

All Other 22 187 $1,940,579 $107,907

Total 65 553 $3,779,299 $341,219

Total drug spend: $3,779,299

Employer spend: $3,438,080

(including any SaveOnSP program passthroughs)

Manufacturer copay assistance: $341,219

(Including customer cost share reduction to $0)

$19,805

$3,759,494

$341,219

$3,438,080

$0

Saves client $321,414 and eliminates $19,805 in cost share for 65 customers.

* Per Cigna Book of Business, Specialty Drug Management represents an Additional $1.50 PMPM of cost savings and 1.25% of Additional member impact.

Program Description

Pharmacy Drug Management – Essential Protection Opportunity

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Opportunity DetailSavings & Impact

Current Drug List: Standard 2023

Managed Drug Class Current Essential Opportunity

Estimated Savings $60,644 $155,612 $94,968

Savings (PMPM)* $1.22 $3.12 $1.90

Percent of Total Drug Cost 0.6% 1.5% 0.9%

Estimated Member Impact 57 241 204

Percent of Members Impacted* 1.3% 5.4% 4.5%

Therapeutic Class

Impacted

Members

Estimated

Sav ings

Neprilysin Inhibitors 20 $28,812

Hypoglycemics 62 $21,106

Lipid Lowering 10 $10,849

Asthma Related 16 $7,784

Acne Agents 14 $5,259

Kidney/Urinary 2 $5,002

ACE/ARB 2 $3,526

Estrogenic/Androgenic/Progest 13 $3,291

Hyperglycemics 5 $1,877

Anticonvulsants 4 $1,282

Program Element Current Essential

Baseline

Prior Authorization

Step Therapy

Quantity Level Limit

Cigna’s Essential protection package protects clients and customers against potentially harmful, ineffective and unnecessary drug treatments and rising drug costs.

Leverages integrated medical/pharmacy data, clinical expertise and our connection to network doctors to ensure safe prescribing and access to the most appropriate medications, helping clients and customers achieve their best health.

The Essential protection package is optimized by drug list to ensure expected performance and actively administered throughout the year to react to emerging market events.

Opportunity by Therapeutic Class

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Preventive Care Summary

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Well visit completion rates

80%

60%

40%

20%

0%

Base

Current

Norm

Pediatric Adult

78.1% 45.5%

71.3% 43.7%

69.9% 36.3%

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

58.9% 61.0% 56.9% 58.6%

57.8% 60.8% 51.9% 56.3%

49.6% 58.8% 55.6% 53.1%

Employee Spouse Dependent Total

46.7% 52.5% 55.9% 50.9%

46.4% 48.3% 50.3% 48.1%

35.3% 45.7% 53.6% 42.9%

Current period OV & preventive utilization

100.0%

75.0%

50.0%

25.0%

0.0%

PCP/SPC OV Annual Phy sical

74.2% 48.1%

80.1% 68.9%

61.5% 37.5%

74.3% 47.4%

83.9% 47.6%

All Ages

<18

18-39

40-49

50+

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Onsite Clinic Activity

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Virtual Care

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Health Equity Health inequities impact your workforce. Social determinants of health (SDOH) affect health, employee productivity and your costs.

80%-90% of overall health outcomes are impacted by SDOH1

30% or more of African American/Black, Hispanic/Latino, LGBTQ+, and younger employees said they considered switching employers because of their health benefits2

Workforce impacts Cost impact

$135 billion Potential economic gain per year if racial disparities in health are eliminated, including $93 billion in excess medical care costs and $42 billion in untapped or unused productivity of your workforce3

Health impacts

• Race

• Ethnicity

• Culture

• Age

• Sexual orientation

• Gender identity/ expression

• Cognitive, sensory, physical disabilities

• Geographic location

• Education

• Literacy

• Income level

• Language

Creating data-driven solutions for equitable outcomes

Connecting into local communities

Embedding health equity into the core of our business

• SDOH screenings through care management programs – and referrals when needs are identified

• Specialized training for providers to identify and support those facing SDOH impacts – and help to resolve those barriers

• MoreThanRxSM rural-focused care

• 24/7 interpretation in 240 languages

• Benefit translation in over 200 languages

(including Braille)

• FindHelp.com provides community resources such as transportation, food assistance, and other services

• 90% of The Cigna Group Foundation grants focused on addressing SDOH

1. World Health Organization, Social determinants of health (who.int) Accessed October 2023. 2. By Jenny Cordina, Megan Greenfield, Lindsay Purcell, and Jeris Stueland. “ How employers can help advance health equity in the workplace ” McKinsey & Company. December 3, 2021. https://www.mckinsey.com/industries/healthcare/our-insights/inc ome-alone-may -be-insufficient -how-employers-can-help -advanc e-health-equity-in -the-workplace. 3. W.K.. Kellogg Foundation, ” The Business Case for Racial Equity: A Strategy for Growth.” https://www.wkkf.org/news -and-media/article/2018/04/updated -study -outlines-potential-gains -to -u-s -economy-and-a-pathway-for-economic-growth/. Accessed October 2023.

Social Determinants Index (SDI): Total Population

34% 27% 22% 17% Very High

Scarce Resources

High

Limited Resources

Medium

Adequate Resources

Low

Vast Resources

Top Domains driving Health Disparities:

Food Access & Education

City of Miami https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

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Health Equity – Chronic Conditions

• Education factors include items such as high school and college education degree completion. Food

Access measures the impact of distance to grocery stores and level of governmental assistance programs

• Isolating diabetic members, individuals living in areas of high to very high SDI increase from 61% to 63%

• Children living in Scarce resource areas are 5 points less compliant with annual pediatric visits than the group average

How Do Results Vary by SDI Categories?

(rolling 12 months)

Very High High Medium Low

Annual Physicals (All) 51% 57% 55% 56%

Employee 54% 56% 54% 54%

Spouse 53% 57% 61% 57%

Children 45% 57% 55% 60%

Utilization per K

Office Visits 4,375 4,658 4,857 5,730

ER Visits 415 345 359 331

Urgent Care Visits 499 592 650 680

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Recommendations

• Add Essential Utilization Management pharmacy program for 1/1/2025, expected savings are $95k

• Add SaveOnSP: Specialty Copay Assistance pharmacy program for 1/1/2025, expected savings are $341k

• Cigna Pathwell Specialty program upcoming for 1/1/2025, with Oncology Consult Service and Caregiver Bridge

• New Well-Being Solution with Virgin Pulse upcoming for 2025

• Increase communication of new and existing behavioral health capabilities across membership, specifically dependents, and inclusive of EAP

• Consider adding the Omada Complete (diabetes and hypertension support) program for 2025

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Appendix

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Key Metrics by Group

Key metrics Base Current Trend

Members

Average Number of Employees 1,867 1,878 0.6%

Average Number of Members 3,976 3,962 -0.3%

Cost Trend

Plan Spend $35,944,227 $40,842,842 13.6%

Plan Spend PMPM $753 $859 14.0%

Performance Indicators

Cat Claimants in Excess Per K 10.1 13.6 35.5%

Network Penetration 98.1% 98.6% 0.5%

Network Discounts 68.1% 68.3% 0.2%

Generic Rx Util ization Rate 91.9% 92.3% 0.4%

Chronic Percent of Population 49.2% 51.7% 2.5%

Chronic Percent of Cost 78.1% 81.6% 3.5%

Health and Wellness

Total Health Engagement - % of pop 47.3% 48.6% 1.3%

Health Maintenance Engagement 44.6% 45.4% 0.8%

Health Improvement Engagement 6.6% 8.1% 1.5%

Preventive Care Util ization 58.6% 56.5% -2.1%

Health Assessment Penetration 0.6% 0.4% -0.2%

Gaps in Care Rule Compliance 82.1% 77.7% -4.4%

Base Current Trend

136 142 4.2%

178 189 6.3%

$2,411,312 $2,286,906 -5.2%

$1,130 $1,008 -10.8%

11.2 10.6 -5.9%

95.6% 98.8% 3.2%

71.5% 72.1% 0.6%

91.5% 92.7% 1.2%

79.1% 77.6% -1.5%

95.8% 96.2% 0.4%

51.0% 51.4% 0.4%

44.8% 44.2% -0.6%

15.5% 16.8% 1.3%

58.5% 52.4% -6.1%

0.0% 0.0% 0.0%

87.2% 81.7% -5.5%

Actives Under65 Retirees Over65 Retirees

Base Current Trend

208 200 -3.9%

252 240 -4.7%

$1,403,738 $1,490,136 6.2%

$465 $518 11.3%

4.0 8.3 109.9%

94.9% 93.2% -1.7%

71.0% 56.9% -14.1%

91.1% 93.4% 2.3%

84.2% 87.8% 3.6%

91.4% 95.0% 3.6%

20.9% 26.0% 5.1%

17.9% 25.2% 7.3%

3.8% 4.1% 0.3%

34.5% 39.1% 4.6%

0.4% 0.0% -0.4%

100.0% 0.0% -100.0%

Executive Summary Total Excluding Over 65 Retirees

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

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

Av erage Number of Employees 2,003 2,020 0.8%

Av erage Number of Members 4,154 4,151 -0.1%

Av erage Employee Age 48.0 48.4 0.9%

Cost Trend

Plan Spend - Medical $29,564,880 $32,557,201 10.1%

Plan Spend - Pharmacy $8,790,690 $10,572,547 20.3%

Total Plan Spend $38,355,571 $43,129,749 12.4%

Medical Plan Spend PMPM $593.15 $653.60 10.2% $535.44

Pharmacy Plan Spend PMPM $176.37 $212.32 20.4% $199.05

Total Plan Spend PMPM $769.52 $865.92 12.5% $734.49

Performance Indicators

Cat Claimants in Excess Per K 10.1 13.5 33.4% 10.4

Cat Plan Spend PMPM(Med+Rx) $224.86 $294.61 31.0% $198.50

Non-Cat Plan Spend PMPM(Med + Rx) $544.65 $571.31 4.9% $535.99

Network Penetration 97.9% 98.6% 0.7% 98.8%

Current PMPM Trend

Variance from Norm

$865.92 12.5% 17.9%

$821.55 13.3% 21.0%

$44.37 -0.2% -20.2%

$653.60 10.2% 22.1%

$618.20 10.8% 25.6%

$212.32 20.4% 6.7%

$203.34 21.5% 9.0%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures

Chronic Percent of Population 50.4% 52.9% 2.5% 47.0%

Chronic Percent of Cost 79.2% 82.4% 3.2% 78.7%

Total Health Engagement - % of Pop 47.5% 48.7% 1.2% 42.3%

Prev entive Care Utilization 58.6% 56.3% -2.3% 53.1%

Well Visit Completions 50.9% 48.1% -2.8% 42.9%

Health Assessment Completions 0.6% 0.4% -0.2% 14.6%

Gaps in Care Rule Compliance 82.4% 83.1% 0.7% 80.9%

Pharmacy Indicators

Generic Dispensing Rate 91.8% 92.4% 0.5% 92.0%

Generic Substitution Rate 97.3% 98.5% 1.2% 98.3%

Specialty Plan Spend PMPM (Rx Only) $96.88 $111.25 14.8% $93.55

Specialty Plan Spend PMPM (Med Only ) $51.80 $60.57 16.9% $36.58

Non-Specialty Plan Spend PMPM (Rx only) $79.49 $101.07 27.1% $105.50

Prescriptions PMPY(Retail adjusted) 15.15 15.69 3.5% 16.07

Medical & Rx Spend

PMPM Spend

Employ er Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Medical & Rx Trend

Actives

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

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

Av erage Number of Employees 1,867 1,878 0.6%

Av erage Number of Members 3,976 3,962 -0.3%

Av erage Employee Age 46.9 47.3 0.8%

Cost Trend

Plan Spend - Medical $27,693,349 $30,893,605 11.6%

Plan Spend - Pharmacy $8,250,878 $9,949,237 20.6%

Total Plan Spend $35,944,227 $40,842,842 13.6%

Medical Plan Spend PMPM $580.45 $649.79 11.9% $535.44

Pharmacy Plan Spend PMPM $172.94 $209.27 21.0% $199.05

Total Plan Spend PMPM $753.39 $859.06 14.0% $734.49

Performance Indicators

Cat Claimants in Excess Per K 10.1 13.6 35.5% 10.4

Cat Plan Spend PMPM(Med+Rx) $222.58 $297.45 33.6% $198.50

Non-Cat Plan Spend PMPM(Med + Rx) $530.82 $561.60 5.8% $535.99

Network Penetration 98.1% 98.6% 0.5% 98.8%

Current PMPM Trend

Variance from Norm

$859.06 14.0% 17.0%

$815.58 14.9% 20.1%

$43.48 0.5% -21.8%

$649.79 11.9% 21.4%

$614.88 12.7% 24.9%

$209.27 21.0% 5.1%

$200.70 22.1% 7.6%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures

Chronic Percent of Population 49.2% 51.7% 2.5% 47.0%

Chronic Percent of Cost 78.1% 81.6% 3.5% 78.7%

Total Health Engagement - % of Pop 47.3% 48.6% 1.3% 42.3%

Prev entive Care Utilization 58.6% 56.5% -2.1% 53.1%

Well Visit Completions 51.5% 48.5% -3.0% 42.9%

Health Assessment Completions 0.6% 0.4% -0.2% 14.6%

Gaps in Care Rule Compliance 82.1% 77.7% -4.4% 80.9%

Pharmacy Indicators

Generic Dispensing Rate 91.9% 92.3% 0.5% 92.0%

Generic Substitution Rate 97.3% 98.5% 1.2% 98.3%

Specialty Plan Spend PMPM (Rx Only) $99.75 $114.21 14.5% $93.55

Specialty Plan Spend PMPM (Med Only ) $52.94 $62.95 18.9% $36.58

Non-Specialty Plan Spend PMPM (Rx only) $73.20 $95.06 29.9% $105.50

Prescriptions PMPY(Retail adjusted) 14.15 14.67 3.7% 16.07

Medical & Rx Spend

PMPM Spend

Employ er Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Medical & Rx Trend

Under 65 Retirees

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

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

Av erage Number of Employees 136 142 4.2%

Av erage Number of Members 178 189 6.3%

Av erage Employee Age 62.8 62.9 0.3%

Cost Trend

Plan Spend - Medical $1,871,500 $1,663,596 -11.1%

Plan Spend - Pharmacy $539,812 $623,310 15.5%

Total Plan Spend $2,411,312 $2,286,906 -5.2%

Medical Plan Spend PMPM $876.99 $733.51 -16.4% $535.44

Pharmacy Plan Spend PMPM $252.96 $274.95 8.7% $199.05

Total Plan Spend PMPM $1,129.95 $1,008.46 -10.8% $734.49

Performance Indicators

Cat Claimants in Excess Per K 11.2 10.6 -5.9% 10.4

Cat Plan Spend PMPM(Med+Rx) $276.06 $234.53 -15.0% $198.50

Non-Cat Plan Spend PMPM(Med + Rx) $853.89 $773.92 -9.4% $535.99

Network Penetration 95.6% 98.8% 3.2% 98.8%

Current PMPM Trend

Variance from Norm

$1,008.46 -10.8% 37.3%

$945.45 -10.8% 39.3%

$63.00 -10.8% 13.3%

$733.51 -16.4% 37.0%

$687.86 -16.7% 39.7%

$274.95 8.7% 38.1%

$257.59 10.3% 38.1%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures

Chronic Percent of Population 79.1% 77.6% -1.5% 47.0%

Chronic Percent of Cost 95.8% 96.2% 0.4% 78.7%

Total Health Engagement - % of Pop 51.0% 51.4% 0.4% 42.3%

Prev entive Care Utilization 58.5% 52.4% -6.1% 53.1%

Well Visit Completions 38.2% 40.2% 2.0% 42.9%

Health Assessment Completions 0.0% 0.0% 0.0% 14.6%

Gaps in Care Rule Compliance 87.2% 81.7% -5.5% 80.9%

Pharmacy Indicators

Generic Dispensing Rate 91.5% 92.7% 1.2% 92.0%

Generic Substitution Rate 97.3% 98.6% 1.3% 98.3%

Specialty Plan Spend PMPM (Rx Only) $32.71 $48.62 48.6% $93.55

Specialty Plan Spend PMPM (Med Only ) $26.12 $10.70 -59.0% $36.58

Non-Specialty Plan Spend PMPM (Rx only) $220.25 $226.33 2.8% $105.50

Prescriptions PMPY(Retail adjusted) 37.69 36.98 -1.9% 16.07

Medical & Rx Spend

PMPM Spend

Employ er Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Medical & Rx Trend

Over 65 Retirees

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

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

Av erage Number of Employees 208 200 -3.9%

Av erage Number of Members 252 240 -4.7%

Av erage Employee Age 74.2 74.5 0.5%

Cost Trend

Plan Spend - Medical $1,092,433 $1,294,115 18.5%

Plan Spend - Pharmacy $311,306 $196,021 -37.0%

Total Plan Spend $1,403,738 $1,490,136 6.2%

Medical Plan Spend PMPM $361.02 $448.88 24.3% $535.44

Pharmacy Plan Spend PMPM $104.08 $68.78 -33.9% $199.05

Total Plan Spend PMPM $465.10 $517.66 11.3% $734.49

Performance Indicators

Cat Claimants in Excess Per K 4.0 8.3 109.9% 10.4

Cat Plan Spend PMPM(Med+Rx) $55.01 $134.52 144.5% $198.50

Non-Cat Plan Spend PMPM(Med + Rx) $410.08 $383.14 -6.6% $535.99

Network Penetration 94.9% 93.2% -1.7% 98.8%

Current PMPM Trend

Variance from Norm

$486.20 16.5% -33.8%

$473.28 18.1% -30.3%

$12.93 -22.6% -76.7%

$448.88 24.3% -16.2%

$437.41 26.3% -11.2%

$37.32 -33.9% -81.2%

$35.86 -34.0% -80.8%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures

Chronic Percent of Population 84.2% 87.8% 3.6% 47.0%

Chronic Percent of Cost 91.4% 95.0% 3.6% 78.7%

Total Health Engagement - % of Pop 20.9% 26.0% 5.1% 42.3%

Prev entive Care Utilization 34.5% 39.1% 4.6% 53.1%

Well Visit Completions 26.2% 27.9% 1.7% 42.9%

Health Assessment Completions 0.4% 0.0% -0.4% 14.6%

Gaps in Care Rule Compliance 100.0% 0.0% -100.0% 80.9%

Pharmacy Indicators

Generic Dispensing Rate 91.1% 93.4% 2.3% 92.0%

Generic Substitution Rate 98.5% 99.4% 1.0% 98.3%

Specialty Plan Spend PMPM (Rx Only) $57.01 $31.91 -44.0% $93.55

Specialty Plan Spend PMPM (Med Only ) $45.13 $67.30 49.1% $36.58

Non-Specialty Plan Spend PMPM (Rx only) $25.53 $20.01 -21.6% $105.50

Prescriptions PMPY(Retail adjusted) 6.75 6.21 -7.9% 16.07

Medical & Rx Spend

PMPM Spend

Employ er Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Medical & Rx Trend

Total with Over 65 Retirees

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

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

Av erage Number of Employees 2,212 2,220 0.4%

Av erage Number of Members 4,406 4,391 -0.3%

Av erage Employee Age 50.4 50.7 0.6%

Cost Trend

Plan Spend - Medical $30,657,328 $33,851,390 10.4%

Plan Spend - Pharmacy $9,101,996 $10,768,568 18.3%

Total Plan Spend $39,759,324 $44,619,958 12.2%

Medical Plan Spend PMPM $579.86 $642.40 10.8% $535.44

Pharmacy Plan Spend PMPM $172.28 $204.49 18.7% $199.05

Total Plan Spend PMPM $752.14 $846.89 12.6% $734.49

Performance Indicators

Cat Claimants in Excess Per K 9.8 13.2 35.3% 10.4

Cat Plan Spend PMPM(Med+Rx) $215.16 $285.87 32.9% $198.50

Non-Cat Plan Spend PMPM(Med + Rx) $536.98 $561.02 4.5% $535.99

Network Penetration 97.4% 97.8% 0.4% 98.8%

Current PMPM Trend

Variance from Norm

$837.97 12.6% 14.1%

$795.63 13.4% 17.2%

$42.34 -0.5% -23.8%

$642.40 10.8% 20.0%

$608.31 11.5% 23.6%

$195.57 18.9% -1.7%

$187.32 20.0% 0.4%

Demographics & Financial Population Health & Pharmacy Base Current Trend Norm

Population Health Measures

Chronic Percent of Population 52.4% 54.8% 2.4% 47.0%

Chronic Percent of Cost 79.7% 82.8% 3.1% 78.7%

Total Health Engagement - % of Pop 46.1% 47.6% 1.5% 42.3%

Prev entive Care Utilization 57.2% 55.3% -1.9% 53.1%

Well Visit Completions 49.5% 47.0% -2.5% 42.9%

Health Assessment Completions 0.6% 0.4% -0.2% 14.6%

Gaps in Care Rule Compliance 82.4% 83.1% 0.7% 80.9%

Pharmacy Indicators

Generic Dispensing Rate 91.8% 92.4% 0.6% 92.0%

Generic Substitution Rate 97.3% 98.5% 1.2% 98.3%

Specialty Plan Spend PMPM (Rx Only) $94.62 $106.93 13.0% $93.55

Specialty Plan Spend PMPM (Med Only ) $51.41 $60.94 18.5% $36.58

Non-Specialty Plan Spend PMPM (Rx only) $74.12 $93.31 25.9% $105.50

Prescriptions PMPY(Retail adjusted) 14.68 15.17 3.4% 16.07

Medical & Rx Spend

PMPM Spend

Employ er Paid - Medical Member Paid - Medical Employer Paid - Pharmacy Member Paid - Pharmacy

Medical & Rx Trend

Confidential, unpublished property of Cigna Healthcare. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2024 Cigna Healthcare.

Behavioral Health Summary

Behavioral Health Claimants

Top Conditions by Prevalence

Clinical & Member Interactions Engagement Types Base Current Trend

Customer Engagement 82 88 7.3%

Health Care Prov ider Engagement 266 219 -17.7%

Access and Crisis Support 332 378 13.9%

Customer Advocacy 890 827 -7.1%

Total Interactions 1,570 1,512 -3.7%

Unique Members w/ clinical interaction 469 492 4.9% Percent of Members w/ clinical interaction 11.3% 11.9% 5.0%

Total Membership Base Current Trend

Av erage Number of Employees 2,003 2,020 0.8%

Av erage Number of Members 4,154 4,151 -0.1%

Behavioral Health Members

Av erage Number of Claimants 430 412 -4.1%

Mental Health 425 406 -4.4%

Substance Use Disorder 11 15 38.1%

Catastrophic Claimants(>$100k in BH) 2 1 -50.0%

Av erage Age 36.1 36.1 -0.0%

Behav ioral Virtual visits 2,319 1,975 -14.8%

ABA Claimants 9 15 66.7%

Happif y Unique Users 12 7 -41.7%

Happif y Active Users 8 5 -37.5% iPrev ail Unique Users 7 0 -100.0%

Total iPrev ail Activities 39 0 -100.0%

Key Metrics

10% 10%

53% 52%

15% 13%

33% 35%

98% 97%

Percent of Total Membership

Employ ee Spouse Dependents Member Network

Utilization

100%

75%

50%

25%

0%

% of Behav ioral Health Claimants

Base % Behav ioral Health Members Curr % of Behavioral Health Members

3%

7%

22%

26%

31% Reactive Stress Disorders

Anxiety

Depression

ADD/ADHD

Autism

Base Current

• 10% of the total membership had a claim with a behavioral health provider in the current period

• Average age of employees with behavioral health claims was 45.7 years

• Virtual Care utilization with behavioral providers decreased by -14.8% in the current period. There were 0 MD Live behavioral visits, 25 Talkspace visits, and 0

Headspace Care visits during the current period

• 11.9% of the total population had a behavioral health interaction during the current period

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

27%

29%

25%

8%

2%

Behavioral Health - Customer & Clinical Interactions

Behavioral Interactions Summary

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

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 for substance use disorders, eating disorders, 88 14 autism, intensive care management, bipolar, l ifestyle management programs

Health Care Prov ider Engagement Collaborating with healthcare providers to prov ide optimal care

Includes inpatient and outpatient uti lization management and complex psychiatric case 219 92 management & narcotics therapy management

Access and Crisis Support Offering behav ioral triage and after hours support to customers who reach out to or are transferred to behav ioral health 378 107

Includes behavioral intake and assessment, emergent referrals (seen in less than 6 hours), referral to a care manager, referral to an outpatient provider and coordinated appointment scheduling

Customer Adv ocacy Fielding customer requests

Includes benefit information and clarification, claims status and adjustment requests, 827 208 collaboration with CCC and other health providers

Total Interactions 1,512

Unique Customers Engaged 492

Member Cost Share

• Medical cost share remained at $35.40 PMPM, and compares to a norm of

$43.10 PMPM

• Medical cost share as a percent of total plan spend decreased from 6.0% to

5.4%, and compares to a norm of 8.1%

$60

$45

$30

$15

$0

Base

Current

Norm

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Deductible/Copay Coinsurance Total

$23 $12 $35

$23 $13 $35

$31 $12 $43

12%

9%

6%

3%

0%

Base

Current

Norm

Deductible/Copay Coinsurance Total

3.9% 2.1% 6.0%

3.5% 1.9% 5.4%

5.8% 2.3% 8.0%

Account summary (PMPM basis) Base Current Trend

Plan Costs

Total Plan Spend - Medical $593.15 $653.60 10.2%

Cost Share - Medical $35.40 $35.40 -0.0%

Net Employer Paid - Medical $557.74 $618.20 10.8%

Cost sharing per member - medical only

Cost share as % of total plan spend - medical only o f T o ta l S p en d

Total Plan Spend by Condition

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Base Current Norm 28.0%

21.0%

14.0%

7.0%

0.0%

Top conditions by plan spend

Top ICD conditions PMPM Claimants per 1k Spend per Claimant

Trend

ICD Category Base Current Contributio n

Norm Base Current Trend Base Current Trend

Neoplasms $78.37 $124.83 8.6% $73.54 182.5 191.3 4.8% $5,153 $7,831 52.0%

Musculoskeletal $55.92 $69.70 2.6% $66.60 285.5 295.8 3.6% $2,350 $2,827 20.3%

Gen Med Diag $55.07 $49.11 -1.1% $40.68 828.4 711.9 -14.1% $798 $828 3.8%

Circulatory $46.41 $47.77 0.3% $42.17 214.5 223.8 4.3% $2,596 $2,561 -1.4%

Gastrointestinal $48.79 $43.07 -1.1% $40.41 177.2 184.8 4.3% $3,304 $2,797 -15.4%

Neurological $23.20 $32.94 1.8% $30.56 118.7 134.7 13.5% $2,346 $2,935 25.1%

End/Nutr/Metab $27.00 $25.40 -0.3% $18.23 321.2 339.4 5.7% $1,009 $898 -11.0%

Renal/Urologic $18.68 $22.04 0.6% $17.17 116.0 117.6 1.3% $1,932 $2,250 16.5%

Int/Ext Injury $25.20 $21.51 -0.7% $20.84 84.0 85.5 1.8% $3,599 $3,018 -16.1%

Pregnancy $25.28 $20.69 -0.9% $22.17 25.5 22.9 -10.3% $11,886 $10,851 -8.7%

All Other $135.20 $141.13 1.1% $122.29 1449.6 1436.5 -0.9% $1,119 $1,179 5.3%

Total $539.12 $598.18 11.0% $494.66 957.9 910.4 -5.0% $6,753 $7,885 16.8%

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

Population Demographic Summary

Percent of membership by age band

• Average member age increased from 36.6 years to 37.2 years, an increase of 1.6%

• The percentage of members in the 40+ age range increased from 47.5% to

48.6%, and compares to a norm of 48.4%

Key metrics overview Base Current Trend Norm

Percent of Pop. Age 40+ 47.5% 48.6% 1.1% 48.4%

Average Member Age 36.6 37.2 1.6% 37.6

Average Employee Age 48.0 48.4 0.9% 48.2

Percent of Population Male 48.7% 49.1% 0.4% 52.1%

Percent of Population Female 51.3% 50.9% -0.4% 47.9%

Percent of plan spend by age band

Average spend by age band Base Current Trend Norm

All Members

40-49 $868 $845 -2.7% $733

50-59 $1,006 $1,197 18.9% $1,061

60-64 $1,322 $1,571 18.8% $1,306

65+ $1,606 $1,842 14.7% $998

Excluding Catastrophic

40-49 $621 $654 5.3% $570

50-59 $693 $746 7.7% $746

60-64 $900 $979 8.8% $887

65+ $964 $892 -7.4% $698

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 reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Population Demographics by Relationship

Percent of members by relationship

• Employees represented 48.7% of the population and 60.0% of spend for the current period, versus norms of 50.7% and 57.9%

• By relationship type, spouses incurred higher per member costs than employees, $1,076 PMPM for the current period

• Excluding Catastrophic Claimants, spouses incurred higher per member costs compared to employees, $736 PMPM for the current period

Percent of plan spend by relationship

Average spend by relationship Base Current Trend Norm

All Members

Employee $921 $1,067 15.9% $824

Spouse $1,040 $1,076 3.5% $989

Dependent $437 $483 10.4% $401

Excluding Catastrophic

Employee $691 $717 3.8% $606

Spouse $675 $736 9.0% $726

Dependent $315 $320 1.7% $300

60%

45%

30%

15%

0%

Base Current Norm

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Employee Spouse Dependent

Base Current Norm

60%

45%

30%

15%

0% Employee Spouse Dependent

Distribution of members by category Distribution of cost by category

Episode Treatment Group Summary

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Non-User Information

Base Current

Average Age 32.0 32.9

Demographic Risk Score 0.93 0.96

Gender Distribution

% Male 66.9% 64.4%

Male Average Age 32.8 33.6

Male Average Enrollment 9.3 10.0

% Female 33.1% 35.6%

Female Average Age 30.3 31.7

Female Average Enrollment 8.0 9.1

100%

75%

50%

25%

0%

Base

Current

Norm

Chronic Maternity Major Minor Healthy

79% 2% 13% 4% 1%

82% 1% 12% 4% 1%

79% 2% 14% 4% 1%

Chronic Maternity Major Minor Healthy NonUser

50% 1% 15% 14% 12% 7%

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

47% 1% 16% 17% 7% 12%

Base

Current

Norm

60%

45%

30%

15%

0%

Distribution of diabetes medical cost by type

Inpatient Summary

• Non-catastrophic inpatient costs increased from $45.90 PMPM to $56.20 PMPM, contributing 1.3% of the overall 12.5% plan trend

• Utilization increased from 48.9 to 58.3 admits per thousand and increased from

225.6 to 274.2 bed days per thousand

• Cost per admit increased from $23,415 to $27,632 and increased for bed days from $5,073 to $5,876

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Account summary (PMPM basis)

Base Current Trend

Trend Contribution

Non-Catastrophic Inpatient $45.90 $56.20 22.4% 1.3%

Catastrophic Inpatient $57.19 $79.09 38.3% 2.8%

Total Inpatient $103.09 $135.29 31.2% 4.2%

All Other Service Categories $666.43 $730.63 9.6% 8.3%

Total Plan Cost $769.52 $865.92 12.5%

Utilization metrics per 1,000 members

Average cost metrics

Base

Current

Norm

Admits Bed Days

48.9 225.6

58.3 274.2

61.4 317.3

$28,000

$21,000

$14,000

$7,000

$0

Base

Current

Norm

Per Admit Per Bed Day

$23,415 $5,073

$27,632 $5,876

$25,904 $5,012

Inpatient - Major Diagnostic Category Summary

• Pregnancies was the top category by plan cost in the current period. Pregnancies cost decreased from $9.29 PMPM to $7.82 PMPM, a decrease of 15.8%

• Cost per case for the Pregnancies category increased from $11,300 to $11,461, an increase of 1.4%

• Plan cost for non-catastrophic increased from $45.90 PMPM to $56.20 PMPM, an increase of 22.4%

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

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 $9.29 $7.82 -15.8% 9.9 8.2 -17.0% 29.1 21.7 -25.6% $11,300 $11,461 1.4%

Musculoskeletal $2.47 $6.65 169.6% 1.4 3.4 133.5% 3.6 15.4 326.9% $20,480 $23,645 15.5%

Circulatory $2.40 $6.17 157.5% 1.9 4.3 125.1% 3.9 15.7 306.5% $14,934 $17,081 14.4%

Nervous $1.59 $5.92 271.0% 1.9 2.6 37.6% 20.5 13.7 -32.9% $9,937 $26,799 169.7%

Metabolic $4.85 $5.76 18.8% 3.9 2.4 -37.5% 8.4 5.8 -31.4% $15,107 $28,686 89.9%

Other $25.30 $23.88 -5.6% 19.7 18.3 -7.3% 63.1 64.1 1.6% $13,648 $15,540 13.9%

Total Non-Cat $45.90 $56.20 22.4% 38.8 39.3 1.3% 128.6 136.4 6.1% $13,329 $17,122 28.5%

Catastrophic $57.19 $79.09 38.3% 10.1 19.0 88.2% 97.0 137.8 42.0% $62,076 $49,318 -20.6%

Total $103.09 $135.29 31.2% 48.9 58.3 19.3% 225.6 274.2 21.5% $23,415 $27,632 18.0%

Inpatient Maternity

Base

Current

Norm

Current Period reflects claims incurred between Jan. 2023 and Dec. 2023, paid through Feb. 2024 Base Period reflects claims incurred between Jan. 2022 and Dec. 2022, paid through Feb. 2023

Vaginal Cesarean Other

4.8 4.8 0.0

4.1 4.1 0.0

5.4 3.2 0.8

$20,000

$15,000

$10,000

$5,000

$0

Base

Current

Norm

Vaginal Cesarean Other

$8,007 $14,223 $0

$9,737 $13,185 $0

$10,711 $16,608 $16,150

Maternity admits utilization per 1,000

Average payment per maternity admit

3.32

2.49

1.66

0.83

0.00

Base

Current

Norm

Normal Premature

Full…