Exhibit_36_MAPD_Detailed_Utilization_Reports.xlsx
XLSX spreadsheet 80 KB Posted
- Attached to
- OEIBA Program Commercial HMO, MSP, and MAPD Plans State and local contract opportunity
- Solicitation number
- EV00000681
- Issued by
- Oklahoma County, Hobart City, Oklahoma
About this file
This document is an Excel-based reporting template for a Medicare Advantage Prescription Drug (MAPD) Detailed Utilization Reports exhibit, prepared for the Oklahoma Office of Management and Enterprise Services (OMES). The file contains six detailed tabs (36a through 36f) that provide comprehensive healthcare utilization and cost reporting for a medical insurance program, with quarterly reports due 45 days following two months of run-off data (specific due dates are July 15, October 15, January 15, and April 15). The reports cover various medical and prescription drug service categories, tracking metrics such as paid amounts, per-member-per-month (PMPM) costs, service utilization, and trend analyses across different healthcare service types.
The reports provide granular insights into healthcare spending, including detailed breakdowns of medical services like facility inpatient/outpatient care, laboratory services, mental health services, physician services, and prescription drug expenditures. Key financial trends show an overall 6.8% increase in total medical and prescription drug costs from the previous year, with notable increases in specialty prescription drugs (25.4%), facility inpatient surgical services (15.8%), and professional office visits (21.6%). The total membership remained relatively stable at approximately 1,053,476 members, with reporting covering both medical and prescription drug utilization across various service categories and demographic segments.
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Report Cover
| Exhibit 36: MAPD Detailed Utilization Reports | ||
| [Supplier Name] | ||
| OEIBA Program | ||
| [Date] | ||
| Due | 45 days following two months of run-off data. | |
| Report | Report Title | Tab Name |
| 36a | MAPD High Cost Claimants YTD | High Cost Claimants YTD |
| 36b | MAPD Monthly Claims Exhibit | Monthly Claims Exhibit |
| 36c | MAPD High Level Summary YTD | High Level Summary YTD |
| 36d | MAPD High Level Summary (Rolling 12) | High Level Sum (Rolling 12) |
| 36e | MAPD All Plans YTD | All Plans YTD |
| 36f | MAPD All Plans (Rolling 12) | All Plans (Rolling 12) |
| Notes: | ||
| 1) Submit reports quarterly using this template. | ||
| 2) Completed template must be submitted electronically as an Excel file. | ||
| 3) Dates should be updated to reflect current reporting periods. Example: In tab '36b Monthly Claims Exhibit', months incurred reflect 2021 in column A but should be updated accordingly to reflect current information. | ||
| 4) Send via email by secure domain to: EGIDVendorReporting@omes.ok.gov | ||
| 5) Report is due 45 days following two months of run-off data. (Q1 due July 15; Q2 due October 15; Q3 due January 15; Q4 due April 15) |
36a High Cost Claimants YTD
| MAPD High Cost Claimants YTD |
| Plan Year [Year] |
| *Due 45 days following two months of run-off data. |
| Instructions on providing the experience segments: |
- Provide de-identified large claim data information requested below (dollars and diagnosis)
- Provide information for any claimant over $25,000 in aggregate claims (both medical and pharmacy)
- Data must be provided in the below worksheet - do not refer to a separate document
- Provide information for YTD ending September 2021 on an INCURRED basis
| Claimant | Primary Diagnosis | Status | Current Eligibility | Member Type | Medical | Pharmacy | Total | |
| Examples | Claimant 1 | Some Condition | Retiree | Termed | Dependent | $82,300 | $27,500 | $109,800 |
| 1. | Claimant 1 | alcohol dependency | Retiree | Active | Employee | $ 163,152 | $ 17,660 | $ 180,812 |
| 2. | Claimant 2 | Atherosclerotic heart disease w unstable angina | Retiree | Active | Spouse | $ 129,628 | $ 6,462 | $ 136,090 |
| 3. | Claimant 3 | malignant neoplasm of sigmoid colon | Retiree | Active | Dependent | $ 43,276 | $ 84,059 | $ 127,335 |
| 4. | Claimant 4 | antineoplastic chemo | Retiree | Termed | Employee | $ 56,828 | $ 60,328 | $ 117,156 |
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36b Monthly Claims Exhibit
| MAPD Monthly Claims Exhibit | |||||||
| Plan Year [Year] | |||||||
| *Due 45 days following two months of run-off data. | |||||||
| MAPD | MAPD | ||||||
| Incurred Month | Paid Claims* | Premiums | CMS Revenue | Incurred Month | Paid Claims* | Premiums | CMS Revenue |
| 1/1/21 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) | 1/1/20 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) |
| 2/1/21 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) | 2/1/20 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) |
| 3/1/21 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) | 3/1/20 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) |
| 4/1/21 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) | 4/1/20 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) |
| 5/1/21 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) | 5/1/20 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) |
| 6/1/21 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) | 6/1/20 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) |
| 7/1/21 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) | 7/1/20 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) |
| 8/1/21 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) | 8/1/20 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) |
| 9/1/21 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) | 9/1/20 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) |
| 10/1/21 | 10/1/20 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) | |||
| 11/1/21 | 11/1/20 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) | |||
| 12/1/21 | 12/1/20 | $ 20,000,000 | $ (15,000,000) | $ (5,000,000) | |||
| Total | $ 180,000,000 | $ (135,000,000) | $ (45,000,000) | $ 240,000,000 | $ (180,000,000) | $ (60,000,000) |
| MAPD | MAPD | ||||||
| Incurred Month | Members | Subscribers | Dependents | Incurred Month | Members | Subscribers | Dependents |
| 1/1/21 | 1,900 | 1,300 | 600 | 1/1/20 | 1,300 | 1,100 | 200 |
| 2/1/21 | 1,900 | 1,300 | 600 | 2/1/20 | 1,300 | 1,000 | 300 |
| 3/1/21 | 1,900 | 1,300 | 600 | 3/1/20 | 1,300 | 1,000 | 300 |
| 4/1/21 | 1,900 | 1,300 | 600 | 4/1/20 | 1,300 | 1,000 | 300 |
| 5/1/21 | 1,900 | 1,300 | 600 | 5/1/20 | 1,300 | 1,000 | 300 |
| 6/1/21 | 1,900 | 1,300 | 600 | 6/1/20 | 1,300 | 1,000 | 300 |
| 7/1/21 | 1,900 | 1,300 | 600 | 7/1/20 | 1,300 | 1,000 | 300 |
| 8/1/21 | 1,900 | 1,300 | 600 | 8/1/20 | 1,300 | 1,000 | 300 |
| 9/1/21 | 1,900 | 1,300 | 600 | 9/1/20 | 1,300 | 1,000 | 300 |
| 10/1/21 | 10/1/20 | 1,300 | 1,000 | 300 | |||
| 11/1/21 | 11/1/20 | 1,300 | 1,000 | 300 | |||
| 12/1/21 | 12/1/20 | 1,300 | 1,000 | 300 |
| CMS Average Risk Score for Population 2024 | CMS Average Risk Score for Population 2023 |
| Notes: | |
| 1) This report should be completed for each individual month; however, only submit this report quarterly. | |
| 2) Member is the sum of subscribers and dependents. | |
| 3) Subscriber is the policy holder. | |
| 4) Dependents are all others in the policy. (i.e., spouse, child, etc.) |
36c High Level Summary YTD
| MAPD High Level Summary YTD | ||||||||||||
| Plan Year [Year] | ||||||||||||
| *Due 45 days following two months of run-off data. | ||||||||||||
| January - September 2021 | ||||||||||||
| 2021 over 2020 Membership Count Trend | Jan - Sep 2020 | Jan - Sep 2021 | 2021 vs. 2020 | Jan - Sep 2020 | Jan - Sep 2021 | 2021 vs. 2020 | Jan - Sep 2020 | Jan - Sep 2021 | 2021 vs. 2020 | Jan - Sep 2020 | Jan - Sep 2021 | 2021 vs. 2020 |
| Retirees | Members | Average Age | % Female | |||||||||
| MAPD | 10,000 | 12,000 | 20.0% | 20,000 | 24,000 | 20.0% | 35.00 | 36.00 | 2.9% | 35% | 36% | 2.9% |
| January - September | |||
| 2021 over 2020 Cost/Utilization Trend | Paid Cost Trend | Utilization Trend | Unit Cost Trend |
| Facility Inpatient | 8.5% | 0.6% | 7.8% |
| Facility Outpatient | 2.3% | -3.7% | 6.1% |
| Laboratory Outpatient | 16.4% | 6.1% | 9.6% |
| MHSA | 9.8% | 7.2% | 2.4% |
| Other Professional Services | 8.6% | 6.4% | 2.1% |
| Physician Inpatient | 2.7% | 1.2% | 1.4% |
| Physician Outpatient | -0.2% | -1.8% | 1.6% |
| Radiology Outpatient | 2.5% | -7.5% | 10.8% |
| Total Medical | 4.8% | 1.9% | 2.9% |
| Prescription Drugs Mail Order | 0.8% | 0.3% | 0.5% |
| Prescription Drugs Retail | 5.8% | 2.7% | 3.0% |
| Prescription Specialty Drugs | 25.4% | 16.2% | 7.9% |
| Total Rx | 12.0% | 2.8% | 9.0% |
| Total (Medical + Rx) | 6.8% | 2.1% | 3.6% |
36d High Level Sum (Rolling 12)
| MAPD High Level Summary (Rolling 12) | ||||||||||||
| Plan Year [Year] | ||||||||||||
| *Due 45 days following two months of run-off data. | ||||||||||||
| Rolling 12 Months | ||||||||||||
| 2021 over 2020 Membership Count Trend | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 | 2021 vs. 2020 | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 | 2021 vs. 2020 | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 | 2021 vs. 2020 | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 | 2021 vs. 2020 |
| Retirees | Members | Average Age | % Female | |||||||||
| MAPD | 10,000 | 12,000 | 20.0% | 20,000 | 24,000 | 20.0% | 35.00 | 36.00 | 2.9% | 35% | 36% | 2.9% |
| Jan - Dec | |||
| 2021 over 2020 Cost/Utilization Trend | Paid Cost Trend | Utilization Trend | Unit Cost Trend |
| Facility Inpatient | 8.5% | 0.6% | 7.8% |
| Facility Outpatient | 2.3% | -3.7% | 6.1% |
| Laboratory Outpatient | 16.4% | 6.1% | 9.6% |
| MHSA | 9.8% | 7.2% | 2.4% |
| Other Professional Services | 8.6% | 6.4% | 2.1% |
| Physician Inpatient | 2.7% | 1.2% | 1.4% |
| Physician Outpatient | -0.2% | -1.8% | 1.6% |
| Radiology Outpatient | 2.5% | -7.5% | 10.8% |
| Total Medical | 4.8% | 1.9% | 2.9% |
| Prescription Drugs Mail Order | 0.8% | 0.3% | 0.5% |
| Prescription Drugs Retail | 5.8% | 2.7% | 3.0% |
| Prescription Specialty Drugs | 25.4% | 16.2% | 7.9% |
| Total Rx | 12.0% | 2.8% | 9.0% |
| Total (Medical + Rx) | 6.8% | 2.1% | 3.6% |
36e All Plans YTD
| MAPD All Plans YTD | ||
| Plan Year [Year] | ||
| *Due 45 days following two months of run-off data. | ||
| MAPD | Jan - Sep 2020 | Jan - Sep 2021 |
| Total Members | 1,052,838 | 1,053,476 |
| Medical | Jan - Sep 2020 | Jan - Sep 2021 | Jan - Sep 2020 | Jan - Sep 2021 | 2021/2020 | Jan - Sep 2021 | Jan - Sep 2020 | Jan - Sep 2021 | Jan - Sep 2020 | Jan - Sep 2021 | 2021/2020 | Jan - Sep 2021 | 2021/2020 |
| Paid Amount | Paid PMPM | Paid Trend | Book of Business Paid PMPM | Service | Service/1000 Members | Service Trend | Book of Business Service/1000 | Unit Cost Trend | |||||
| Facility Inpatient | $71,741,344 | $77,880,350 | $68 | $74 | 8.5% | 211,869 | 213,344 | 201 | 203 | 0.6% | 7.8% | ||
| Facility Inpatient Long Term Care | $639,694 | $524,038 | $1 | $0 | -18.1% | 3,131 | 2,421 | 3 | 2 | -22.7% | 5.9% | ||
| Facility Inpatient Maternity | $8,657,570 | $8,749,775 | $8 | $8 | 1.0% | 45,716 | 43,162 | 43 | 41 | -5.6% | 7.0% | ||
| Facility Inpatient Medical | $24,208,572 | $24,364,834 | $23 | $23 | 0.6% | 87,108 | 88,151 | 83 | 84 | 1.1% | -0.5% | ||
| Facility Inpatient Non Acute | $250,223 | $229,746 | $0 | $0 | -8.2% | 733 | 1,065 | 1 | 1 | 45.2% | -36.8% | ||
| Facility Inpatient Surgical | $37,985,284 | $44,011,958 | $36 | $42 | 15.8% | 75,181 | 78,545 | 71 | 75 | 4.4% | 10.9% | ||
| Facility Outpatient | $112,077,447 | $114,678,642 | $106 | $109 | 2.3% | 518,358 | 499,697 | 492 | 474 | -3.7% | 6.1% | ||
| Facility Outpatient DME | $44,018 | $47,467 | $0 | $0 | 7.8% | 70 | 61 | 0 | 0 | -12.9% | 23.7% | ||
| Facility Outpatient Diagnostic Services | $6,190,460 | $6,687,980 | $6 | $6 | 8.0% | 10,531 | 11,074 | 10 | 11 | 5.1% | 2.7% | ||
| Facility Outpatient Dialysis | $2,580,556 | $2,980,201 | $2 | $3 | 15.4% | 5,402 | 6,353 | 5 | 6 | 17.5% | -1.8% | ||
| Facility Outpatient ER | $22,005,531 | $22,378,164 | $21 | $21 | 1.6% | 153,869 | 151,088 | 146 | 143 | -1.9% | 3.6% | ||
| Facility Outpatient Home Health | $320,361 | $341,257 | $0 | $0 | 6.5% | 3,741 | 3,285 | 4 | 3 | -12.2% | 21.3% | ||
| Facility Outpatient Other | $2,538,270 | $2,443,957 | $2 | $2 | -3.8% | 16,397 | 17,436 | 16 | 17 | 6.3% | -9.5% | ||
| Facility Outpatient PT, OT, Speech Therapy | $3,374,915 | $3,644,473 | $3 | $3 | 7.9% | 27,247 | 28,013 | 26 | 27 | 2.7% | 5.0% | ||
| Facility Outpatient Pharmacy | $2,611,813 | $2,743,727 | $2 | $3 | 5.0% | 44,990 | 45,061 | 43 | 43 | 0.1% | 4.9% | ||
| Facility Outpatient Specialty Drugs | $17,172,999 | $15,842,706 | $16 | $15 | -7.8% | 12,954 | 15,132 | 12 | 14 | 16.7% | -21.0% | ||
| Facility Outpatient Supplies and Devices | $408,555 | $454,068 | $0 | $0 | 11.1% | 15,489 | 13,213 | 15 | 13 | -14.7% | 30.3% | ||
| Facility Outpatient Surgery | $54,748,534 | $57,045,381 | $52 | $54 | 4.1% | 227,599 | 208,909 | 216 | 198 | -8.3% | 13.5% | ||
| Facility Outpatient Transportation | $81,434 | $69,260 | $0 | $0 | -15.0% | 69 | 72 | 0 | 0 | 4.3% | -18.5% | ||
| Laboratory Outpatient | $11,478,788 | $13,367,896 | $11 | $13 | 16.4% | 635,722 | 675,224 | 604 | 641 | 6.1% | 9.6% | ||
| Laboratory Outpatient Chemistry Tests | $4,355,850 | $5,760,903 | $4 | $5 | 32.2% | 322,414 | 320,776 | 306 | 304 | -0.6% | 32.9% | ||
| Laboratory Outpatient Other | $3,517,695 | $4,192,719 | $3 | $4 | 19.1% | 263,267 | 306,536 | 250 | 291 | 16.4% | 2.4% | ||
| Laboratory Outpatient Pathology | $3,605,244 | $3,414,273 | $3 | $3 | -5.4% | 50,041 | 47,912 | 48 | 45 | -4.3% | -1.1% | ||
| MHSA | $9,301,038 | $10,216,660 | $9 | $10 | 9.8% | 99,079 | 106,269 | 94 | 101 | 7.2% | 2.4% | ||
| Mental Health Inpatient | $2,048,423 | $2,152,147 | $2 | $2 | 5.0% | 6,114 | 6,407 | 6 | 6 | 4.7% | 0.3% | ||
| Mental Health Office Visits | $1,515,818 | $1,612,451 | $1 | $2 | 6.3% | 19,965 | 20,992 | 19 | 20 | 5.1% | 1.2% | ||
| Mental Health Other Outpatient | $3,950,025 | $4,602,485 | $4 | $4 | 16.4% | 53,735 | 63,748 | 51 | 61 | 18.6% | -1.8% | ||
| Substance Abuse Inpatient | $780,330 | $781,567 | $1 | $1 | 0.1% | 2,156 | 2,160 | 2 | 2 | 0.1% | -0.0% | ||
| Substance Abuse Office Visits | $38,719 | $35,663 | $0 | $0 | -7.9% | 526 | 477 | 0 | 0 | -9.4% | 1.6% | ||
| Substance Abuse Other Outpatient | $967,723 | $1,032,346 | $1 | $1 | 6.6% | 16,583 | 12,485 | 16 | 12 | -24.8% | 41.7% | ||
| Other Professional Services | $42,056,724 | $45,697,286 | $40 | $43 | 8.6% | 722,710 | 769,240 | 686 | 730 | 6.4% | 2.1% | ||
| Professional Chiropractic Services | $2,240,756 | $2,267,902 | $2 | $2 | 1.2% | 73,960 | 74,967 | 70 | 71 | 1.3% | -0.1% | ||
| Professional DME | $2,043,006 | $2,012,996 | $2 | $2 | -1.5% | 19,634 | 21,338 | 19 | 20 | 8.6% | -9.3% | ||
| Professional Diagnostic Services | $3,326,851 | $3,382,138 | $3 | $3 | 1.6% | 54,352 | 56,050 | 52 | 53 | 3.1% | -1.4% | ||
| Professional Dialysis | $75,728 | $86,397 | $0 | $0 | 14.0% | 377 | 319 | 0 | 0 | -15.4% | 34.8% | ||
| Professional Home Health | $516,858 | $528,703 | $0 | $1 | 2.2% | 6,004 | 6,111 | 6 | 6 | 1.7% | 0.5% | ||
| Professional Injections | $3,140,603 | $3,176,079 | $3 | $3 | 1.1% | 115,382 | 124,926 | 110 | 119 | 8.2% | -6.6% | ||
| Professional Office Visits | $8,627,551 | $10,501,417 | $8 | $10 | 21.6% | 124,604 | 150,291 | 118 | 143 | 20.5% | 0.9% | ||
| Professional PT, OT, Speech Therapy | $4,818,655 | $4,858,685 | $5 | $5 | 0.8% | 190,456 | 188,123 | 181 | 179 | -1.3% | 2.1% | ||
| Professional Services Other | $5,087,740 | $5,667,151 | $5 | $5 | 11.3% | 83,170 | 83,028 | 79 | 79 | -0.2% | 11.6% | ||
| Professional Specialty Drugs | $6,963,689 | $8,020,896 | $7 | $8 | 15.1% | 6,149 | 6,586 | 6 | 6 | 7.0% | 7.5% | ||
| Professional Supplies and Devices | $2,457,710 | $2,785,060 | $2 | $3 | 13.3% | 44,943 | 53,558 | 43 | 51 | 19.1% | -4.9% | ||
| Professional Transportation | $2,757,577 | $2,409,860 | $3 | $2 | -12.7% | 3,679 | 3,943 | 3 | 4 | 7.1% | -18.5% | ||
| Physician Inpatient | $10,020,457 | $10,293,091 | $10 | $10 | 2.7% | 41,893 | 42,432 | 40 | 40 | 1.2% | 1.4% | ||
| Physician Non-Specialty Inpatient | $3,629,661 | $3,601,679 | $3 | $3 | -0.8% | 13,855 | 13,742 | 13 | 13 | -0.9% | 0.0% | ||
| Physician Specialty Inpatient | $6,390,796 | $6,691,411 | $6 | $6 | 4.6% | 28,038 | 28,690 | 27 | 27 | 2.3% | 2.3% | ||
| Physician Outpatient | $47,425,621 | $47,379,308 | $45 | $45 | -0.2% | 467,140 | 459,147 | 444 | 436 | -1.8% | 1.6% | ||
| Physician Non-Specialty ER | $131,037 | $124,918 | $0 | $0 | -4.7% | 582 | 488 | 1 | 0 | -16.2% | 13.7% | ||
| Physician Non-Specialty Office Visits | $19,087,948 | $18,977,554 | $18 | $18 | -0.6% | 244,611 | 243,202 | 232 | 231 | -0.6% | -0.0% | ||
| Physician Non-Specialty Outpatient Other | $1,077,780 | $1,063,177 | $1 | $1 | -1.4% | 34,911 | 32,004 | 33 | 30 | -8.4% | 7.6% | ||
| Physician Non-Specialty Outpatient Surgery | $1,636,112 | $1,655,190 | $2 | $2 | 1.1% | 3,949 | 3,666 | 4 | 3 | -7.2% | 9.0% | ||
| Physician Specialty ER | $1,905,433 | $1,903,573 | $2 | $2 | -0.2% | 8,931 | 8,933 | 8 | 8 | -0.0% | -0.1% | ||
| Physician Specialty Office Visits | $9,224,107 | $9,346,014 | $9 | $9 | 1.3% | 103,602 | 102,534 | 98 | 97 | -1.1% | 2.4% | ||
| Physician Specialty Outpatient Other | $3,369,762 | $3,398,210 | $3 | $3 | 0.8% | 42,490 | 40,528 | 40 | 38 | -4.7% | 5.7% | ||
| Physician Specialty Outpatient Surgery | $10,993,442 | $10,910,672 | $10 | $10 | -0.8% | 28,064 | 27,792 | 27 | 26 | -1.0% | 0.2% | ||
| Radiology Outpatient | $29,153,284 | $29,904,301 | $28 | $28 | 2.5% | 180,884 | 167,424 | 172 | 159 | -7.5% | 10.8% | ||
| Radiology Outpatient CT Scans | $4,283,033 | $4,129,768 | $4 | $4 | -3.6% | 14,612 | 15,190 | 14 | 14 | 3.9% | -7.2% | ||
| Radiology Outpatient MRIs | $4,445,877 | $4,412,861 | $4 | $4 | -0.8% | 9,710 | 9,405 | 9 | 9 | -3.2% | 2.5% | ||
| Radiology Outpatient Mammograms | $2,907,052 | $3,230,808 | $3 | $3 | 11.1% | 45,081 | 32,062 | 43 | 30 | -28.9% | 56.3% | ||
| Radiology Outpatient Nuclear Medicine | $3,221,936 | $2,996,850 | $3 | $3 | -7.0% | 6,169 | 5,709 | 6 | 5 | -7.5% | 0.5% | ||
| Radiology Outpatient Other | $937,887 | $988,613 | $1 | $1 | 5.3% | 4,600 | 4,615 | 4 | 4 | 0.3% | 5.1% | ||
| Radiology Outpatient Therapeutic Radiology | $4,385,553 | $5,379,736 | $4 | $5 | 22.6% | 10,017 | 9,301 | 10 | 9 | -7.2% | 32.1% | ||
| Radiology Outpatient Ultrasounds | $4,509,739 | $4,185,021 | $4 | $4 | -7.3% | 25,952 | 24,711 | 25 | 23 | -4.8% | -2.5% | ||
| Radiology Outpatient X-Rays | $4,462,208 | $4,580,643 | $4 | $4 | 2.6% | 64,743 | 66,431 | 61 | 63 | 2.5% | 0.0% | ||
| Total Medical | $333,254,702 | $349,417,533 | $317 | $332 | 4.8% | 2,877,655 | 2,932,777 | 2,733 | 2,784 | 1.9% | 2.9% |
| Prescription Drugs | Jan - Sep 2020 | Jan - Sep 2021 | Jan - Sep 2020 | Jan - Sep 2021 | 2021/2020 | Jan - Sep 2021 | Jan - Sep 2020 | Jan - Sep 2021 | Jan - Sep 2020 | Jan - Sep 2021 | 2021/2020 | Jan - Sep 2021 | 2021/2020 |
| Paid Amount | Paid PMPM | Paid Trend | Book of Business Paid PMPM | Scripts | Scripts/1000 Members | Scripts Trend | Book of Business scripts/1000 | Unit Cost Trend | |||||
| Prescription Drugs Mail Order | $3,881,907 | $3,915,468 | $3.7 | $3.7 | 0.8% | 27,274 | 27,374 | 25.9 | 26.0 | 0.3% | 0.5% | ||
| Generic | $1,501,389 | $1,507,657 | $1.4 | $1.4 | 0.4% | 23,722 | 24,019 | 22.5 | 22.8 | 1.2% | -0.8% | ||
| Brand Preferred | $2,172,475 | $2,213,676 | $2.1 | $2.1 | 1.8% | 2,938 | 2,719 | 2.8 | 2.6 | -7.5% | 10.1% | ||
| Brand None Preferred | $102,295 | $116,684 | $0.1 | $0.1 | 14.0% | 136 | 150 | 0.1 | 0.1 | 10.2% | 3.4% | ||
| OTC | $57,782 | $13,018 | $0.1 | $0.0 | -77.5% | 198 | 95 | 0.2 | 0.1 | -52.0% | -53.0% | ||
| Missing | $47,964 | $64,433 | $0.0 | $0.1 | 34.3% | 280 | 391 | 0.3 | 0.4 | 39.6% | -3.8% | ||
| Prescription Drugs Retail | $82,362,028 | $87,193,968 | $78.2 | $82.8 | 5.8% | 1,443,476 | 1,483,536 | 1,371.0 | 1,408.2 | 2.7% | 3.0% | ||
| Generic | $32,109,767 | $35,246,837 | $30.5 | $33.5 | 9.7% | 1,285,531 | 1,326,838 | 1,221.0 | 1,259.5 | 3.2% | 6.4% | ||
| Brand Preferred | $43,841,478 | $44,824,134 | $41.6 | $42.5 | 2.2% | 139,110 | 133,831 | 132.1 | 127.0 | -3.9% | 6.3% | ||
| Brand None Preferred | $5,845,828 | $6,170,639 | $5.6 | $5.9 | 5.5% | 12,713 | 11,443 | 12.1 | 10.9 | -10.0% | 17.3% | ||
| OTC | $409,678 | $287,216 | $0.4 | $0.3 | -29.9% | 4,029 | 5,389 | 3.8 | 5.1 | 33.7% | -47.6% | ||
| Missing | $155,277 | $664,218 | $0.1 | $0.6 | 327.5% | 2,093 | 6,033 | 2.0 | 5.7 | 188.1% | 48.4% | ||
| Prescription Specialty Drugs | $41,679,172 | $52,300,875 | $39.6 | $49.6 | 25.4% | 10,827 | 12,588 | 10.3 | 11.9 | 16.2% | 7.9% | ||
| Generic | $2,072,927 | $2,707,317 | $2.0 | $2.6 | 30.5% | 2,426 | 2,828 | 2.3 | 2.7 | 16.5% | 12.0% | ||
| Brand Preferred | $26,723,291 | $34,360,271 | $25.4 | $32.6 | 28.5% | 6,233 | 7,448 | 5.9 | 7.1 | 19.4% | 7.6% | ||
| Brand None Preferred | $12,882,954 | $15,233,287 | $12.2 | $14.5 | 18.2% | 2,168 | 2,312 | 2.1 | 2.2 | 6.6% | 10.9% | ||
| OTC | $0 | $0 | $0.0 | $0.0 | N/A | 0 | 0 | 0.0 | 0.0 | N/A | N/A | ||
| Missing | $0 | $0 | $0.0 | $0.0 | N/A | 0 | 0 | 0.0 | 0.0 | N/A | N/A | ||
| Total Rx | $127,923,107 | $143,410,312 | $121.50 | $136.13 | 12.0% | 1,481,577 | 1,523,498 | 1,407 | 1,446 | 2.8% | 9.0% |
Total (Medical + Rx) $461,177,809 $492,827,845 $438 $468 6.8% 4,359,232 4,456,275 4,140 4,230 2.2% 4.5%
36f All Plans (Rolling 12)
| MAPD All Plans (Rolling 12) | ||
| Plan Year [Year] | ||
| *Due 45 days following two months of run-off data. | ||
| MAPD | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 |
| Total Members | 1,052,838 | 1,053,476 |
| Medical | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 | 2021/2020 | Oct 2020 - Sep 2021 | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 | 2021/2020 | Oct 2020 - Sep 2021 | 2021/2020 |
| Paid Amount | Paid PMPM | Paid Trend | Book of Business Paid PMPM | Service | Service/1000 Members | Service Trend | Book of Business service/1000 | Unit Cost Trend | |||||
| Facility Inpatient | $71,741,344 | $77,880,350 | $68 | $74 | 8.5% | 211,869 | 213,344 | 201 | 203 | 0.6% | 7.8% | ||
| Facility Inpatient Long Term Care | $639,694 | $524,038 | $1 | $0 | -18.1% | 3,131 | 2,421 | 3 | 2 | -22.7% | 5.9% | ||
| Facility Inpatient Maternity | $8,657,570 | $8,749,775 | $8 | $8 | 1.0% | 45,716 | 43,162 | 43 | 41 | -5.6% | 7.0% | ||
| Facility Inpatient Medical | $24,208,572 | $24,364,834 | $23 | $23 | 0.6% | 87,108 | 88,151 | 83 | 84 | 1.1% | -0.5% | ||
| Facility Inpatient Non Acute | $250,223 | $229,746 | $0 | $0 | -8.2% | 733 | 1,065 | 1 | 1 | 45.2% | -36.8% | ||
| Facility Inpatient Surgical | $37,985,284 | $44,011,958 | $36 | $42 | 15.8% | 75,181 | 78,545 | 71 | 75 | 4.4% | 10.9% | ||
| Facility Outpatient | $112,077,447 | $114,678,642 | $106 | $109 | 2.3% | 518,358 | 499,697 | 492 | 474 | -3.7% | 6.1% | ||
| Facility Outpatient DME | $44,018 | $47,467 | $0 | $0 | 7.8% | 70 | 61 | 0 | 0 | -12.9% | 23.7% | ||
| Facility Outpatient Diagnostic Services | $6,190,460 | $6,687,980 | $6 | $6 | 8.0% | 10,531 | 11,074 | 10 | 11 | 5.1% | 2.7% | ||
| Facility Outpatient Dialysis | $2,580,556 | $2,980,201 | $2 | $3 | 15.4% | 5,402 | 6,353 | 5 | 6 | 17.5% | -1.8% | ||
| Facility Outpatient ER | $22,005,531 | $22,378,164 | $21 | $21 | 1.6% | 153,869 | 151,088 | 146 | 143 | -1.9% | 3.6% | ||
| Facility Outpatient Home Health | $320,361 | $341,257 | $0 | $0 | 6.5% | 3,741 | 3,285 | 4 | 3 | -12.2% | 21.3% | ||
| Facility Outpatient Other | $2,538,270 | $2,443,957 | $2 | $2 | -3.8% | 16,397 | 17,436 | 16 | 17 | 6.3% | -9.5% | ||
| Facility Outpatient PT, OT, Speech Therapy | $3,374,915 | $3,644,473 | $3 | $3 | 7.9% | 27,247 | 28,013 | 26 | 27 | 2.7% | 5.0% | ||
| Facility Outpatient Pharmacy | $2,611,813 | $2,743,727 | $2 | $3 | 5.0% | 44,990 | 45,061 | 43 | 43 | 0.1% | 4.9% | ||
| Facility Outpatient Specialty Drugs | $17,172,999 | $15,842,706 | $16 | $15 | -7.8% | 12,954 | 15,132 | 12 | 14 | 16.7% | -21.0% | ||
| Facility Outpatient Supplies and Devices | $408,555 | $454,068 | $0 | $0 | 11.1% | 15,489 | 13,213 | 15 | 13 | -14.7% | 30.3% | ||
| Facility Outpatient Surgery | $54,748,534 | $57,045,381 | $52 | $54 | 4.1% | 227,599 | 208,909 | 216 | 198 | -8.3% | 13.5% | ||
| Facility Outpatient Transportation | $81,434 | $69,260 | $0 | $0 | -15.0% | 69 | 72 | 0 | 0 | 4.3% | -18.5% | ||
| Laboratory Outpatient | $11,478,788 | $13,367,896 | $11 | $13 | 16.4% | 635,722 | 675,224 | 604 | 641 | 6.1% | 9.6% | ||
| Laboratory Outpatient Chemistry Tests | $4,355,850 | $5,760,903 | $4 | $5 | 32.2% | 322,414 | 320,776 | 306 | 304 | -0.6% | 32.9% | ||
| Laboratory Outpatient Other | $3,517,695 | $4,192,719 | $3 | $4 | 19.1% | 263,267 | 306,536 | 250 | 291 | 16.4% | 2.4% | ||
| Laboratory Outpatient Pathology | $3,605,244 | $3,414,273 | $3 | $3 | -5.4% | 50,041 | 47,912 | 48 | 45 | -4.3% | -1.1% | ||
| MHSA | $9,301,038 | $10,216,660 | $9 | $10 | 9.8% | 99,079 | 106,269 | 94 | 101 | 7.2% | 2.4% | ||
| Mental Health Inpatient | $2,048,423 | $2,152,147 | $2 | $2 | 5.0% | 6,114 | 6,407 | 6 | 6 | 4.7% | 0.3% | ||
| Mental Health Office Visits | $1,515,818 | $1,612,451 | $1 | $2 | 6.3% | 19,965 | 20,992 | 19 | 20 | 5.1% | 1.2% | ||
| Mental Health Other Outpatient | $3,950,025 | $4,602,485 | $4 | $4 | 16.4% | 53,735 | 63,748 | 51 | 61 | 18.6% | -1.8% | ||
| Substance Abuse Inpatient | $780,330 | $781,567 | $1 | $1 | 0.1% | 2,156 | 2,160 | 2 | 2 | 0.1% | -0.0% | ||
| Substance Abuse Office Visits | $38,719 | $35,663 | $0 | $0 | -7.9% | 526 | 477 | 0 | 0 | -9.4% | 1.6% | ||
| Substance Abuse Other Outpatient | $967,723 | $1,032,346 | $1 | $1 | 6.6% | 16,583 | 12,485 | 16 | 12 | -24.8% | 41.7% | ||
| Other Professional Services | $42,056,724 | $45,697,286 | $40 | $43 | 8.6% | 722,710 | 769,240 | 686 | 730 | 6.4% | 2.1% | ||
| Professional Chiropractic Services | $2,240,756 | $2,267,902 | $2 | $2 | 1.2% | 73,960 | 74,967 | 70 | 71 | 1.3% | -0.1% | ||
| Professional DME | $2,043,006 | $2,012,996 | $2 | $2 | -1.5% | 19,634 | 21,338 | 19 | 20 | 8.6% | -9.3% | ||
| Professional Diagnostic Services | $3,326,851 | $3,382,138 | $3 | $3 | 1.6% | 54,352 | 56,050 | 52 | 53 | 3.1% | -1.4% | ||
| Professional Dialysis | $75,728 | $86,397 | $0 | $0 | 14.0% | 377 | 319 | 0 | 0 | -15.4% | 34.8% | ||
| Professional Home Health | $516,858 | $528,703 | $0 | $1 | 2.2% | 6,004 | 6,111 | 6 | 6 | 1.7% | 0.5% | ||
| Professional Injections | $3,140,603 | $3,176,079 | $3 | $3 | 1.1% | 115,382 | 124,926 | 110 | 119 | 8.2% | -6.6% | ||
| Professional Office Visits | $8,627,551 | $10,501,417 | $8 | $10 | 21.6% | 124,604 | 150,291 | 118 | 143 | 20.5% | 0.9% | ||
| Professional PT, OT, Speech Therapy | $4,818,655 | $4,858,685 | $5 | $5 | 0.8% | 190,456 | 188,123 | 181 | 179 | -1.3% | 2.1% | ||
| Professional Services Other | $5,087,740 | $5,667,151 | $5 | $5 | 11.3% | 83,170 | 83,028 | 79 | 79 | -0.2% | 11.6% | ||
| Professional Specialty Drugs | $6,963,689 | $8,020,896 | $7 | $8 | 15.1% | 6,149 | 6,586 | 6 | 6 | 7.0% | 7.5% | ||
| Professional Supplies and Devices | $2,457,710 | $2,785,060 | $2 | $3 | 13.3% | 44,943 | 53,558 | 43 | 51 | 19.1% | -4.9% | ||
| Professional Transportation | $2,757,577 | $2,409,860 | $3 | $2 | -12.7% | 3,679 | 3,943 | 3 | 4 | 7.1% | -18.5% | ||
| Physician Inpatient | $10,020,457 | $10,293,091 | $10 | $10 | 2.7% | 41,893 | 42,432 | 40 | 40 | 1.2% | 1.4% | ||
| Physician Non-Specialty Inpatient | $3,629,661 | $3,601,679 | $3 | $3 | -0.8% | 13,855 | 13,742 | 13 | 13 | -0.9% | 0.0% | ||
| Physician Specialty Inpatient | $6,390,796 | $6,691,411 | $6 | $6 | 4.6% | 28,038 | 28,690 | 27 | 27 | 2.3% | 2.3% | ||
| Physician Outpatient | $47,425,621 | $47,379,308 | $45 | $45 | -0.2% | 467,140 | 459,147 | 444 | 436 | -1.8% | 1.6% | ||
| Physician Non-Specialty ER | $131,037 | $124,918 | $0 | $0 | -4.7% | 582 | 488 | 1 | 0 | -16.2% | 13.7% | ||
| Physician Non-Specialty Office Visits | $19,087,948 | $18,977,554 | $18 | $18 | -0.6% | 244,611 | 243,202 | 232 | 231 | -0.6% | -0.0% | ||
| Physician Non-Specialty Outpatient Other | $1,077,780 | $1,063,177 | $1 | $1 | -1.4% | 34,911 | 32,004 | 33 | 30 | -8.4% | 7.6% | ||
| Physician Non-Specialty Outpatient Surgery | $1,636,112 | $1,655,190 | $2 | $2 | 1.1% | 3,949 | 3,666 | 4 | 3 | -7.2% | 9.0% | ||
| Physician Specialty ER | $1,905,433 | $1,903,573 | $2 | $2 | -0.2% | 8,931 | 8,933 | 8 | 8 | -0.0% | -0.1% | ||
| Physician Specialty Office Visits | $9,224,107 | $9,346,014 | $9 | $9 | 1.3% | 103,602 | 102,534 | 98 | 97 | -1.1% | 2.4% | ||
| Physician Specialty Outpatient Other | $3,369,762 | $3,398,210 | $3 | $3 | 0.8% | 42,490 | 40,528 | 40 | 38 | -4.7% | 5.7% | ||
| Physician Specialty Outpatient Surgery | $10,993,442 | $10,910,672 | $10 | $10 | -0.8% | 28,064 | 27,792 | 27 | 26 | -1.0% | 0.2% | ||
| Radiology Outpatient | $29,153,284 | $29,904,301 | $28 | $28 | 2.5% | 180,884 | 167,424 | 172 | 159 | -7.5% | 10.8% | ||
| Radiology Outpatient CT Scans | $4,283,033 | $4,129,768 | $4 | $4 | -3.6% | 14,612 | 15,190 | 14 | 14 | 3.9% | -7.2% | ||
| Radiology Outpatient MRIs | $4,445,877 | $4,412,861 | $4 | $4 | -0.8% | 9,710 | 9,405 | 9 | 9 | -3.2% | 2.5% | ||
| Radiology Outpatient Mammograms | $2,907,052 | $3,230,808 | $3 | $3 | 11.1% | 45,081 | 32,062 | 43 | 30 | -28.9% | 56.3% | ||
| Radiology Outpatient Nuclear Medicine | $3,221,936 | $2,996,850 | $3 | $3 | -7.0% | 6,169 | 5,709 | 6 | 5 | -7.5% | 0.5% | ||
| Radiology Outpatient Other | $937,887 | $988,613 | $1 | $1 | 5.3% | 4,600 | 4,615 | 4 | 4 | 0.3% | 5.1% | ||
| Radiology Outpatient Therapeutic Radiology | $4,385,553 | $5,379,736 | $4 | $5 | 22.6% | 10,017 | 9,301 | 10 | 9 | -7.2% | 32.1% | ||
| Radiology Outpatient Ultrasounds | $4,509,739 | $4,185,021 | $4 | $4 | -7.3% | 25,952 | 24,711 | 25 | 23 | -4.8% | -2.5% | ||
| Radiology Outpatient X-Rays | $4,462,208 | $4,580,643 | $4 | $4 | 2.6% | 64,743 | 66,431 | 61 | 63 | 2.5% | 0.0% | ||
| Total Medical | $333,254,702 | $349,417,533 | $317 | $332 | 4.8% | 2,877,655 | 2,932,777 | 2,733 | 2,784 | 1.9% | 2.9% |
| Prescription Drugs | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 | 2021/2020 | Oct 2020 - Sep 2021 | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 | Oct 2019 - Sep 2020 | Oct 2020 - Sep 2021 | 2021/2020 | Oct 2020 - Sep 2021 | 2021/2020 |
| Paid Amount | Paid PMPM | Paid Trend | Book of Business Paid PMPM | Scripts | Scripts/1000 Members | Scripts Trend | Book of Business scripts/1000 | Unit Cost Trend | |||||
| Prescription Drugs Mail Order | $3,881,907 | $3,915,468 | $3.7 | $3.7 | 0.8% | 27,274 | 27,374 | 25.9 | 26.0 | 0.3% | 0.5% | ||
| Generic | $1,501,389 | $1,507,657 | $1.4 | $1.4 | 0.4% | 23,722 | 24,019 | 22.5 | 22.8 | 1.2% | -0.8% | ||
| Brand Preferred | $2,172,475 | $2,213,676 | $2.1 | $2.1 | 1.8% | 2,938 | 2,719 | 2.8 | 2.6 | -7.5% | 10.1% | ||
| Brand None Preferred | $102,295 | $116,684 | $0.1 | $0.1 | 14.0% | 136 | 150 | 0.1 | 0.1 | 10.2% | 3.4% | ||
| OTC | $57,782 | $13,018 | $0.1 | $0.0 | -77.5% | 198 | 95 | 0.2 | 0.1 | -52.0% | -53.0% | ||
| Missing | $47,964 | $64,433 | $0.0 | $0.1 | 34.3% | 280 | 391 | 0.3 | 0.4 | 39.6% | -3.8% | ||
| Prescription Drugs Retail | $82,362,028 | $87,193,968 | $78.2 | $82.8 | 5.8% | 1,443,476 | 1,483,536 | 1,371.0 | 1,408.2 | 2.7% | 3.0% | ||
| Generic | $32,109,767 | $35,246,837 | $30.5 | $33.5 | 9.7% | 1,285,531 | 1,326,838 | 1,221.0 | 1,259.5 | 3.2% | 6.4% | ||
| Brand Preferred | $43,841,478 | $44,824,134 | $41.6 | $42.5 | 2.2% | 139,110 | 133,831 | 132.1 | 127.0 | -3.9% | 6.3% | ||
| Brand None Preferred | $5,845,828 | $6,170,639 | $5.6 | $5.9 | 5.5% | 12,713 | 11,443 | 12.1 | 10.9 | -10.0% | 17.3% | ||
| OTC | $409,678 | $287,216 | $0.4 | $0.3 | -29.9% | 4,029 | 5,389 | 3.8 | 5.1 | 33.7% | -47.6% | ||
| Missing | $155,277 | $664,218 | $0.1 | $0.6 | 327.5% | 2,093 | 6,033 | 2.0 | 5.7 | 188.1% | 48.4% | ||
| Prescription Specialty Drugs | $41,679,172 | $52,300,875 | $39.6 | $49.6 | 25.4% | 10,827 | 12,588 | 10.3 | 11.9 | 16.2% | 7.9% | ||
| Generic | $2,072,927 | $2,707,317 | $2.0 | $2.6 | 30.5% | 2,426 | 2,828 | 2.3 | 2.7 | 16.5% | 12.0% | ||
| Brand Preferred | $26,723,291 | $34,360,271 | $25.4 | $32.6 | 28.5% | 6,233 | 7,448 | 5.9 | 7.1 | 19.4% | 7.6% | ||
| Brand None Preferred | $12,882,954 | $15,233,287 | $12.2 | $14.5 | 18.2% | 2,168 | 2,312 | 2.1 | 2.2 | 6.6% | 10.9% | ||
| OTC | $0 | $0 | $0.0 | $0.0 | N/A | 0 | 0 | 0.0 | 0.0 | N/A | N/A | ||
| Missing | $0 | $0 | $0.0 | $0.0 | N/A | 0 | 0 | 0.0 | 0.0 | N/A | N/A | ||
| Total Rx | $127,923,107 | $143,410,312 | $121.50 | $136.13 | 12.0% | 1,481,577 | 1,523,498 | 1,407 | 1,446 | 2.8% | 9.0% |
Total (Medical + Rx) $461,177,809 $492,827,845 $438 $468 6.8% 4,681,646 4,777,051 4,447 4,535 2.0% 4.7%
File details come from the government source that posted it. Updated .