Supplemental information to Schedule A-15 Data Book.pdf

August 26, 2020

Milliman Client Report

Data Support for MDOC Integrated Prisoner Healthcare Services RFP

State of Michigan

Department of Corrections

Prepared for:

Marti Kay Sherry Health Services Administrator Michigan Department of Corrections

Prepared by:

Jon M. Hendrickson, FSA, MAAA Principal & Consulting Actuary

Chris Lewis Actuarial Analyst

5415 E. High Street Suite 275 Phoenix, AZ 85054

USA

Tel +1 480 348 9020 Fax +1 480 348 9021 milliman.com

Michigan Department of Corrections Data Support for MDOC Integrated Prisoner Healthcare Services RFP

TABLE OF CONTENTS

I. BACKGROUND

II. ACTUARIAL COST MODELS

III. DATA PROCESSING

IV. DATA RELIANCE

V. LIMITATIONS AND QUALIFICATIONS

ATTACHMENTS

Attachment A – Historical Experience Cost Model Exhibits

Attachment B – (See attached Excel file)

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I. BACKGROUND

Milliman, Inc has been retained by the State of Michigan, Department of Corrections (MDOC) to provide actuarial and consulting services in support of the release of RFP No. 200000002287. Specifically, we were tasked with analyzing historical claims data and providing summaries that prospective responders to the RFP may wish to utilize.

This report provides documentation of the data processing and summarization of off-site prisoner healthcare related services.

Attachments A and B provide data that bidders may use in support of their responses to the RFP.

Attachment A provides actuarial cost models that summarize utilization, charges per service, and PPPM values. The cost models are discussed in more detail in Section II below.

Attachment B (provided in separate Excel file) provides detailed seriatim claim data.

This data was used to generate the cost models provided in Attachment A. Section III below describes the processing of the data and includes discussion of adjustments made to raw input claims files as provided by MDOC.

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II. ACTUARIAL COST MODELS

Actuarial cost models are a common tool used in examining the cost to deliver healthcare to a population. Actuarial cost models summarize data by service category as well as provide detail on utilization, charge per service and Per Prisoner Per Month (PPPM) values.

There are eight actuarial cost models provided in Attachment A. The data is split into eight cost models based on the incurral date of the claims and the MDOC contract year which runs from June to May as well as whether the claims were able to be repriced to Medicare allowed. The first four cost models (1-4) are provided for all available claims including just the charged amounts. The final four cost models (5-8) are provided only for services that were able to be repriced to Medicare allowed. The final four cost models include both the charge amount and the Medicare allowed amount.

The eight models reflect the following incurral dates:

Table 1 Model Incurral Dates

Model Incurral Date

Model 1 and 5 6/1/2016 – 5/31/2017

Model 2 and 6 6/1/2017 – 5/31/2018

Model 3 and 7 6/1/2018 – 5/31/2019

Model 4 and 8 6/1/2019 – 11/30/2019

The models provide summaries of historical healthcare utilization at off-site facilities.

No trend has been added to project these values to future time periods.

Service Category

The cost models summarize the seriatim claim data by grouping claims into a number of service categories. These categories are grouped by a major provider type: Hospital Inpatient, Hospital Outpatient, Professional, and Other. These groupings are done using Milliman’s proprietary grouping software. Within each major type of service category are more detailed sub categories. The following identifies the primary source of data for the Milliman groupings by major category of service:

Hospital Inpatient – Diagnostic Related Groups (DRGs) Hospital Outpatient – Revenue Code and procedure code Professional – Procedure code Other – HCPC code

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Units of Service during Incurral period Prisoner Months

X 12,000

Utilization

Utilization in an actuarial cost model is presented as annual utilization per 1,000 prisoners. This is determined by the following formula:

The units of service are counted differently for different service categories. The following describes the primary unit of service underlying the major categories of service:

Hospital Inpatient – both admits and days are counted and the resulting average length of stay is calculated

Hospital Outpatient – counted as visits

Professional – counted as visits or procedures

Other – counted as visits or procedures

Charge per Service

Charge per service simply defines the total charge for the service as defined by the unit of service. For example, for inpatient stays, the Charge per service represents the total charge per day. To assist bidders in constructing their bid, we have provided two ways of looking at the charge per service: (1) actual billed charges, and (2) Medicare allowed.

This allows bidders to construct bids based on either a discount off of billed charges or as a relativity to Medicare. Additional information is provided in the Data Processing section on the method used to assign Medicare allowed amounts.

Per Prisoner per Month

The PPPM is defined as the average dollar amount per prisoner per month. The cost models provide the PPPM on both a charge amount and a Medicare allowed amount.

Bidders will adjust these values depending on the structure of their contracts with providers.

Completion Factors

Completion factors are used when insufficient runout of claims data has occurred. The data provided by MDOC reflects claims incurred from 6/1/2016 – 11/30/2019 and paid through 12/31/2019. We did assume additional runout for claims in models 2-4 and 6-8 (incurral dates from 6/1/2017 – 11/30/2019). The seriatim claim data includes the fields necessary for each bidder to develop assumptions for claims runout. Table 2 below provides the assumed completion factors included in the models 2-4 and 6-8.

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Table 2 State of Michigan

Department of Corrections Cost Model Completion Factors

Period Inpatient Outpatient Physician Other

6/1/2017 to 5/31/2018 0.9995 1.0000 1.0000 1.0000

6/1/2018 to 5/31/2019 0.9410 0.9933 0.9986 0.9960

6/1/2019 to 11/30/2019 0.4356 0.8504 0.9318 0.8453

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III. DATA PROCESSING

Milliman received seriatim detailed claim data from MDOC. The data was processed and summarized by Milliman. We have made a number of adjustments to the data in order to be able to provide as much detailed information to bidders as possible. The following steps describe the adjustments made to the data:

1. De-identification – the prisoner ID has been de-identified. Unique prisoners are identified with masked prisoner ids.

2. Based on the entire claim id, only claims with a non-zero paid amount are included in the seriatim data.

3. Negative claim amounts reflect claim reversals and are kept in the data along with the originally submitted claim to be backed out.

4. Milliman developed IBNR factors for application to Models 2-4 and 6-8 as described in Section II. While the cost models in Attachment A have been adjusted to reflect these values, the detailed claims data has not. Bidders may develop independent completion factors in support of bids.

5. Milliman bucketed claims into categories for the purpose of creating Models 1-8.

The field in the claims data labeled “ServiceCategory” indicates which major service category the claim was bucketed in the models. IP is inpatient, OP is outpatient, and PHY is physician and other claims.

6. The "Repriced_ind" field contains a "1" for all claims that were repriced to 100% of Medicare. It is possible that Medicare bundles certain line items of a particular claim. This implies that a line with a "1" in the "Repriced_ind" field but a $0.00 in the repriced field was part of a bundled Medicare amount.

7. Prescription drug claims have been excluded from both the seriatim claims and the cost models. Information related to these services will be provided elsewhere in the RFP.

8. Pathology/Lab claims provided by Garcia Clincial Laboratory, Inc. were removed from the seriatim claims data and cost models as the detail necessary to bucket the claims and reprice to Medicare were not present. Information related to these services will be provided elsewhere in the RFP.

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IV. DATA RELIANCE

We have relied on the following information provided by MDOC to develop the actuarial cost models and the detailed claims data as described in Sections II, and III:

1. Detailed seriatim claims data incurred from 6/1/2016 – 11/30/2019 and paid through 12/31/2019

2. Monthly prisoner counts

We have relied upon MDOC for the accuracy of the information provided. We performed no independent audit of the data and information. The actuarial cost models and detailed claims data will change to the extent that there are material errors in the information that was provided.

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V. LIMITATIONS AND QUALIFICATIONS

The services provided for this project were performed under the signed contract between Milliman and the State of Michigan as amended June 30, 2015.

The information contained in this report, including the attachments, has been prepared for the State of Michigan, Michigan Department of Corrections and their consultants and advisors. It is our understanding that this report may be utilized in a public document. To the extent that the information contained in this report is provided to third parties, the report should be distributed in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the data presented.

Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for MDOC by Milliman that would result in the creation of any duty or liability under any theory of law by Milliman or its employees to third parties.

In performing this analysis, we relied on data and other information provided by MDOC and its vendors. We have not audited or verified this data and other information. If the underlying data or information is inaccurate or incomplete, the results of our analysis may likewise be inaccurate or incomplete.

Differences between our projections and actual amounts depend on the extent to which future experience conforms to the assumptions made for this analysis. It is certain that actual experience will not conform exactly to the assumptions used in this analysis.

Actual amounts will differ from projected amounts to the extent that actual experience deviates from expected experience.

We performed a limited review of the data used directly in our analysis for reasonableness and consistency and have not found material defects in the data. If there are material defects in the data, it is possible that they would be uncovered by a detailed, systematic review and comparison of the data to search for data values that are questionable or for relationships that are materially inconsistent. Such a review was beyond the scope of our assignment.

Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. Jon Hendrickson is a member of the American Academy of Actuaries, and meets the qualification standards for performing the analyses in this report.

Milliman Client Report Attachment A

Michigan Department of Corrections Attachment A

Attachment A

Historical Experience Cost Model Exhibits

2:48 PM

8/26/2020

Model #1 Michigan Department of Corrections - 2020 RFP Support

Timeframe: 201606-201705 Prison Resident Member Months: Medical - 497153

All Processed Claims Data

Annual Average Annual Average Total Admits Length Utilization Charge Charges

Benefit Per 1,000 of Stay Per 1,000 Per Service PPPM

Facility Inpatient Medical 0.7 3.57 2.6 days $5,951.78 $1.28 Other Newborn - 0.00 - days 0.00 0.00 Surgical 0.4 6.27 2.3 days 13,668.33 2.58 Psychiatric - Hospital - 0.00 - days 0.00 0.00 Psychiatric - Residential - 0.00 - days 0.00 0.00 Alcohol & Drug Abuse - Hospital - 0.00 - days 0.00 0.00 Alcohol & Drug Abuse - Residential - 0.00 - days 0.00 0.00 Mother - Normal Deliveries - 0.00 - days 0.00 0.00 Mother - Cesarean Deliveries - 0.00 - days 0.00 0.00 Well Newborn - 0.00 - days 0.00 0.00 Non-Deliveries - 0.00 - days 0.00 0.00 SNF - 1.00 - days 0.00 0.00 Subtotal 1.1 0.00 4.9 days $9,560.52 $3.87

Facility Outpatient Observation 9.4 visits $11,939.67 $9.37 Emergency Department 97.8 visits 3,643.36 29.69 Surgery 37.6 visits 10,274.03 32.16 Radiology - Therapeutic 2.3 visits 22,556.62 4.31 Radiology - Diagnostic 29.9 visits 607.54 1.51 Radiology - CT/MRI/PET 31.4 visits 3,125.83 8.18 Pathology/Lab 32.6 visits 382.82 1.04 Pharmacy 56.3 visits 2,332.53 10.94 Cardiovascular 11.0 visits 972.53 0.89 PT/OT/ST 2.6 visits 469.49 0.10 Psychiatric 0.4 visits 850.67 0.03 Alcohol & Drug Abuse - visits 0.00 0.00 Preventive 5.2 visits 1,842.85 0.80 Other Outpatient Facility 86.1 visits 983.08 7.06 Subtotal $106.08

Professional Inpatient Surgeon 22.4 proced $922.24 $1.73 Inpatient Anesthesia 12.8 proced 873.90 0.94 Maternity - Physician 0.1 proced 107.00 0.00 Maternity - Anesthesia 0.0 proced 507.50 0.00 Outpatient Facility Surgery 62.4 proced 950.52 4.94 Outpatient Office Surgery 18.2 proced 382.10 0.58 Outpatient Anesthesia 38.1 proced 901.65 2.86 Inpatient Visits 10.5 visits 734.41 0.65 Office/Home Visits - PCP 25.4 visits 210.89 0.45 Office/Home Visits - Specialist 85.5 visits 851.27 6.07 Urgent Care Visits - visits 0.00 0.00 Office Administered Drugs 6.0 proced 344.30 0.17 Allergy Testing 0.0 proced 696.00 0.00 Allergy Immunotherapy - visits 0.00 0.00 Miscellaneous Medical 51.2 proced 217.33 0.93 Preventive Immunizations - proced 0.00 0.00 Preventive Well Baby Exams - visits 0.00 0.00 Preventive Physical Exams 0.0 visits 178.00 0.00 Other Preventive 11.3 proced 465.18 0.44 ED Visits and Observation 110.5 visits 576.30 5.30 Vision Exams 14.2 visits 400.47 0.47 Hearing and Speech Exams 0.9 visits 218.85 0.02 Physical Therapy 0.1 visits 86.75 0.00 Cardiovascular 68.7 proced 69.08 0.40 Radiology Inpatient 66.8 proced 189.95 1.06 Radiology OP - Therapeutic 9.7 proced 601.72 0.49 Radiology OP - Diagnostic 87.1 proced 62.64 0.45 Radiology OP - CT/MRI/PET 79.0 proced 251.76 1.66 Radiology Office - Therapeutic 1.5 proced 586.54 0.07

P58d, P58f Radiology Office - Diagnostic 16.9 proced 841.88 1.19 Radiology Office - CT/MRI/PET 0.4 proced 47.56 0.00 Pathology/Lab - Inpatient & Outpatient 34.9 proced 212.94 0.62 Pathology/Lab - Office 32.8 proced 98.37 0.27 Chiropractor 0.1 visits 55.00 0.00 Outpatient Psychiatric 0.4 units 165.54 0.01 Outpatient Alcohol & Drug Abuse 0.1 units 65.41 0.00 Subtotal $31.76

Other Prescription Drugs: Medical and Non-Medical Covered 2 - scripts $0.00 $0.00 Home Health Care 0.2 visits 625.42 0.01 Ambulance 111.9 proced 637.28 5.94 DME and Supplies 22.9 proced 428.29 0.82 Prosthetics 7.9 proced 1,202.41 0.79 Subtotal $7.55

Additional Benefits Glasses/Contacts - visits $0.00 $0.00 Additional Benefits Other 18.3 proced 247.29 0.38 Subtotal $0.38

Total Medical Cost $149.63

Model #2 Michigan Department of Corrections - 2020 RFP Support

Timeframe: 201706-201805 Prison Resident Member Months: Medical - 478148

All Processed Claims Data

Annual Average Annual Average Total Admits Length Utilization Charge Charges

Benefit Per 1,000 of Stay Per 1,000 Per Service PPPM

Facility Inpatient Medical 1.0 5.84 5.6 days $6,325.40 $2.94 Other Newborn - 0.00 - days 0.00 0.00 Surgical 0.4 5.79 2.0 days 11,869.25 2.01 Psychiatric - Hospital - 0.00 - days 0.00 0.00 Psychiatric - Residential - 0.00 - days 0.00 0.00 Alcohol & Drug Abuse - Hospital - 0.00 - days 0.00 0.00 Alcohol & Drug Abuse - Residential - 0.00 - days 0.00 0.00 Mother - Normal Deliveries 0.0 3.00 0.1 days 3,057.14 0.02 Mother - Cesarean Deliveries - 0.00 - days 0.00 0.00 Well Newborn - 0.00 - days 0.00 0.00 Non-Deliveries - 0.00 - days 0.00 0.00 SNF - 1.00 - days 0.00 0.00 Subtotal 1.3 0.00 7.7 days $7,760.85 $4.97

Facility Outpatient Observation 10.8 visits $12,803.98 $11.49 Emergency Department 109.8 visits 3,926.42 35.92 Surgery 45.7 visits 9,447.47 36.00 Radiology - Therapeutic 16.8 visits 4,080.18 5.73 Radiology - Diagnostic 32.9 visits 596.72 1.64 Radiology - CT/MRI/PET 49.4 visits 2,703.03 11.14 Pathology/Lab 42.0 visits 288.89 1.01 Pharmacy 61.9 visits 2,046.87 10.55 Cardiovascular 12.5 visits 1,238.66 1.29 PT/OT/ST 2.8 visits 305.59 0.07 Psychiatric 0.7 visits 870.12 0.05 Alcohol & Drug Abuse - visits 0.00 0.00 Preventive 5.4 visits 1,745.78 0.78 Other Outpatient Facility 95.4 visits 942.22 7.49 Subtotal $123.15

Professional Inpatient Surgeon 1.2 proced $1,290.17 $0.12 Inpatient Anesthesia 1.1 proced 1,193.19 0.11 Maternity - Physician 0.2 proced 382.17 0.00 Maternity - Anesthesia - proced 0.00 0.00 Outpatient Facility Surgery 79.9 proced 921.05 6.13 Outpatient Office Surgery 21.2 proced 443.91 0.79 Outpatient Anesthesia 59.4 proced 963.32 4.77 Inpatient Visits 13.2 visits 713.59 0.78 Office/Home Visits - PCP 56.3 visits 226.99 1.07 Office/Home Visits - Specialist 86.5 visits 888.84 6.41 Urgent Care Visits - visits 0.00 0.00 Office Administered Drugs 6.7 proced 291.56 0.16 Allergy Testing 0.1 proced 447.33 0.00 Allergy Immunotherapy - visits 0.00 0.00 Miscellaneous Medical 57.6 proced 192.20 0.92 Preventive Immunizations 0.1 proced 30.00 0.00 Preventive Well Baby Exams - visits 0.00 0.00 Preventive Physical Exams 0.0 visits 190.00 0.00 Other Preventive 9.1 proced 417.79 0.32 ED Visits and Observation 122.8 visits 605.64 6.20 Vision Exams 9.9 visits 193.96 0.16 Hearing and Speech Exams 0.9 visits 220.91 0.02 Physical Therapy 0.2 visits 94.73 0.00 Cardiovascular 87.0 proced 71.27 0.52 Radiology Inpatient 2.0 proced 183.18 0.03 Radiology OP - Therapeutic 16.3 proced 500.54 0.68 Radiology OP - Diagnostic 119.9 proced 61.94 0.62 Radiology OP - CT/MRI/PET 124.6 proced 253.27 2.63 Radiology Office - Therapeutic 1.7 proced 940.36 0.13

P58d, P58f Radiology Office - Diagnostic 20.0 proced 1,001.07 1.67 Radiology Office - CT/MRI/PET 0.9 proced 413.03 0.03 Pathology/Lab - Inpatient & Outpatient 30.6 proced 243.58 0.62 Pathology/Lab - Office 24.9 proced 129.65 0.27 Chiropractor - visits 0.00 0.00 Outpatient Psychiatric 0.3 units 270.54 0.01 Outpatient Alcohol & Drug Abuse 0.1 units 52.81 0.00 Subtotal $35.16

Other Prescription Drugs: Medical and Non-Medical Covered 2 - scripts $0.00 $0.00 Home Health Care 0.2 visits 569.58 0.01 Ambulance 140.2 proced 608.68 7.11 DME and Supplies 31.3 proced 370.77 0.97 Prosthetics 9.3 proced 1,204.09 0.93 Subtotal $9.02

Additional Benefits Glasses/Contacts 0.1 visits $450.50 $0.00 Additional Benefits Other 17.0 proced 195.47 0.28 Subtotal $0.28

Total Medical Cost $172.58

Model #3 Michigan Department of Corrections - 2020 RFP Support

Timeframe: 201806-201905 Prison Resident Member Months: Medical - 464388

All Processed Claims Data

Annual Average Annual Average Total Admits Length Utilization Charge Charges

Benefit Per 1,000 of Stay Per 1,000 Per Service PPPM

Facility Inpatient Medical 1.4 5.20 7.1 days $7,955.44 $4.73 Other Newborn - 0.00 - days 0.00 0.00 Surgical 1.0 7.11 6.8 days 12,959.96 7.38 Psychiatric - Hospital - 0.00 - days 0.00 0.00 Psychiatric - Residential - 0.00 - days 0.00 0.00 Alcohol & Drug Abuse - Hospital - 0.00 - days 0.00 0.00 Alcohol & Drug Abuse - Residential - 0.00 - days 0.00 0.00 Mother - Normal Deliveries - 0.00 - days 0.00 0.00 Mother - Cesarean Deliveries - 0.00 - days 0.00 0.00 Well Newborn - 0.00 - days 0.00 0.00 Non-Deliveries - 0.00 - days 0.00 0.00 SNF - 1.00 - days 0.00 0.00 Subtotal 2.3 0.00 14.0 days $10,403.62 $12.12

Facility Outpatient Observation 7.9 visits $12,330.27 $8.13 Emergency Department 106.8 visits 4,218.30 37.53 Surgery 47.2 visits 10,167.04 39.96 Radiology - Therapeutic 23.1 visits 3,018.56 5.82 Radiology - Diagnostic 42.9 visits 586.16 2.09 Radiology - CT/MRI/PET 55.9 visits 2,919.11 13.59 Pathology/Lab 47.2 visits 326.61 1.28 Pharmacy 62.4 visits 2,462.84 12.80 Cardiovascular 13.1 visits 1,320.35 1.44 PT/OT/ST 3.7 visits 344.54 0.11 Psychiatric 0.8 visits 896.50 0.06 Alcohol & Drug Abuse - visits 0.00 0.00 Preventive 3.3 visits 2,157.45 0.58 Other Outpatient Facility 99.4 visits 1,065.84 8.83 Subtotal $132.22

Professional Inpatient Surgeon 4.1 proced $1,296.71 $0.44 Inpatient Anesthesia 1.9 proced 1,289.19 0.21 Maternity - Physician 0.1 proced 273.00 0.00 Maternity - Anesthesia 0.1 proced 660.00 0.00 Outpatient Facility Surgery 88.5 proced 1,017.02 7.50 Outpatient Office Surgery 28.7 proced 731.94 1.75 Outpatient Anesthesia 69.6 proced 985.80 5.72 Inpatient Visits 21.6 visits 751.26 1.35 Office/Home Visits - PCP 75.9 visits 237.60 1.50 Office/Home Visits - Specialist 93.0 visits 892.32 6.92 Urgent Care Visits - visits 0.00 0.00 Office Administered Drugs 7.0 proced 379.54 0.22 Allergy Testing 0.0 proced 660.00 0.00 Allergy Immunotherapy - visits 0.00 0.00 Miscellaneous Medical 65.3 proced 213.16 1.16 Preventive Immunizations - proced 0.00 0.00 Preventive Well Baby Exams - visits 0.00 0.00 Preventive Physical Exams - visits 0.00 0.00 Other Preventive 8.7 proced 277.77 0.20 ED Visits and Observation 120.6 visits 699.87 7.03 Vision Exams 14.6 visits 198.65 0.24 Hearing and Speech Exams 1.6 visits 181.90 0.02 Physical Therapy 0.2 visits 100.25 0.00 Cardiovascular 100.9 proced 65.88 0.55 Radiology Inpatient 5.6 proced 120.33 0.06 Radiology OP - Therapeutic 2.5 proced 605.38 0.13 Radiology OP - Diagnostic 133.0 proced 66.44 0.74 Radiology OP - CT/MRI/PET 129.1 proced 281.25 3.02 Radiology Office - Therapeutic 9.5 proced 831.94 0.66

P58d, P58f Radiology Office - Diagnostic 22.2 proced 1,135.78 2.10 Radiology Office - CT/MRI/PET 4.3 proced 350.05 0.13 Pathology/Lab - Inpatient & Outpatient 31.3 proced 323.39 0.84 Pathology/Lab - Office 15.8 proced 205.13 0.27 Chiropractor - visits 0.00 0.00 Outpatient Psychiatric 0.2 units 290.00 0.00 Outpatient Alcohol & Drug Abuse - units 0.00 0.00 Subtotal $42.78

Other Prescription Drugs: Medical and Non-Medical Covered 2 - scripts $0.00 $0.00 Home Health Care - visits 0.00 0.00 Ambulance 157.4 proced 611.31 8.02 DME and Supplies 14.9 proced 435.82 0.54 Prosthetics 8.0 proced 1,062.32 0.71 Subtotal $9.27

Additional Benefits Glasses/Contacts - visits $0.00 $0.00 Additional Benefits Other 20.9 proced 168.10 0.29 Subtotal $0.29

Total Medical Cost $196.68

Model #4 Michigan Department of Corrections - 2020 RFP Support

Timeframe: 201906-201911 Prison Resident Member Months: Medical - 229136

All Processed Claims Data

Annual Average Annual Average Total Admits Length Utilization Charge Charges

Benefit Per 1,000 of Stay Per 1,000 Per Service PPPM

Facility Inpatient Medical 1.6 6.00 9.4 days $6,139.13 $4.80 Other Newborn - 0.00 - days 0.00 0.00 Surgical 0.7 4.33 3.1 days 9,311.43 2.43 Psychiatric - Hospital - 0.00 - days 0.00 0.00 Psychiatric - Residential - 0.00 - days 0.00 0.00 Alcohol & Drug Abuse - Hospital - 0.00 - days 0.00 0.00 Alcohol & Drug Abuse - Residential - 0.00 - days 0.00 0.00 Mother - Normal Deliveries - 0.00 - days 0.00 0.00 Mother - Cesarean Deliveries - 0.00 - days 0.00 0.00 Well Newborn - 0.00 - days 0.00 0.00 Non-Deliveries - 0.00 - days 0.00 0.00 SNF - 1.00 - days 0.00 0.00 Subtotal 2.3 0.00 12.5 days $6,932.20 $7.22

Facility Outpatient Observation 9.9 visits $13,347.50 $10.96 Emergency Department 113.9 visits 4,373.59 41.50 Surgery 51.0 visits 11,484.33 48.80 Radiology - Therapeutic 17.5 visits 3,105.59 4.53 Radiology - Diagnostic 46.7 visits 689.45 2.69 Radiology - CT/MRI/PET 56.3 visits 2,970.24 13.95 Pathology/Lab 52.4 visits 322.09 1.41 Pharmacy 64.4 visits 3,201.09 17.18 Cardiovascular 17.9 visits 1,224.55 1.82 PT/OT/ST 4.9 visits 519.89 0.21 Psychiatric 0.5 visits 940.25 0.04 Alcohol & Drug Abuse - visits 0.00 0.00 Preventive 4.0 visits 1,137.91 0.38 Other Outpatient Facility 95.9 visits 1,132.21 9.05 Subtotal $152.50

Professional Inpatient Surgeon 1.7 proced $676.25 $0.10 Inpatient Anesthesia 0.4 proced 743.57 0.02 Maternity - Physician 0.1 proced 718.00 0.00 Maternity - Anesthesia 0.1 proced 1,232.00 0.01 Outpatient Facility Surgery 94.6 proced 1,038.87 8.19 Outpatient Office Surgery 37.4 proced 828.01 2.58 Outpatient Anesthesia 68.2 proced 1,021.56 5.80 Inpatient Visits 17.3 visits 758.43 1.09 Office/Home Visits - PCP 102.9 visits 268.15 2.30 Office/Home Visits - Specialist 88.2 visits 928.19 6.82 Urgent Care Visits - visits 0.00 0.00 Office Administered Drugs 8.5 proced 1,006.09 0.72 Allergy Testing 0.1 proced 42.00 0.00 Allergy Immunotherapy - visits 0.00 0.00 Miscellaneous Medical 71.2 proced 201.94 1.20 Preventive Immunizations 0.2 proced 48.00 0.00 Preventive Well Baby Exams - visits 0.00 0.00 Preventive Physical Exams - visits 0.00 0.00 Other Preventive 7.9 proced 239.57 0.16 ED Visits and Observation 134.4 visits 759.38 8.50 Vision Exams 17.8 visits 202.73 0.30 Hearing and Speech Exams 2.5 visits 210.57 0.04 Physical Therapy 0.1 visits 48.00 0.00 Cardiovascular 96.0 proced 78.36 0.63 Radiology Inpatient 2.9 proced 129.47 0.03 Radiology OP - Therapeutic 10.4 proced 595.98 0.52 Radiology OP - Diagnostic 139.6 proced 74.51 0.87 Radiology OP - CT/MRI/PET 143.3 proced 274.15 3.27 Radiology Office - Therapeutic 2.5 proced 1,379.90 0.29

P58d, P58f Radiology Office - Diagnostic 27.7 proced 1,060.67 2.45 Radiology Office - CT/MRI/PET 1.6 proced 357.79 0.05 Pathology/Lab - Inpatient & Outpatient 33.7 proced 333.97 0.94 Pathology/Lab - Office 16.0 proced 591.01 0.79 Chiropractor - visits 0.00 0.00 Outpatient Psychiatric 0.3 units 290.00 0.01 Outpatient Alcohol & Drug Abuse - units 0.00 0.00 Subtotal $47.68

Other Prescription Drugs: Medical and Non-Medical Covered 2 - scripts $0.00 $0.00 Home Health Care 2.9 visits 9,430.48 2.29 Ambulance 148.7 proced 599.92 7.43 DME and Supplies 13.1 proced 338.13 0.37 Prosthetics 9.2 proced 1,231.50 0.94 Subtotal $11.03

Additional Benefits Glasses/Contacts - visits $0.00 $0.00 Additional Benefits Other 15.8 proced 189.87 0.25 Subtotal $0.25

Total Medical Cost $218.69

Model #5 Michigan Department of Corrections - 2020 RFP Support

Timeframe: 201606-201705 Prison Resident Member Months: Medical - 497153

Repriced Data Only

Annual Average Annual Average Total Average Medicare Admits Length Utilization Charge Charges Medicare Allowed Allowed

Benefit Per 1,000 of Stay Per 1,000 Per Service PPPM Per Service PPPM

Facility Inpatient Medical 0.7 3.30 2.4 days $6,109.22 $1.22 $2,378.24 $0.47 Other Newborn - 0.00 - days 0.00 0.00 0.00 0.00 Surgical 0.3 6.36 2.1 days 13,321.18 2.38 2,892.88 0.52 Psychiatric - Hospital - 0.00 - days 0.00 0.00 0.00 0.00 Psychiatric - Residential - 0.00 - days 0.00 0.00 0.00 0.00 Alcohol & Drug Abuse - Hospital - 0.00 - days 0.00 0.00 0.00 0.00 Alcohol & Drug Abuse - Residential - 0.00 - days 0.00 0.00 0.00 0.00 Mother - Normal Deliveries - 0.00 - days 0.00 0.00 0.00 0.00 Mother - Cesarean Deliveries - 0.00 - days 0.00 0.00 0.00 0.00 Well Newborn - 0.00 - days 0.00 0.00 0.00 0.00 Non-Deliveries - 0.00 - days 0.00 0.00 0.00 0.00 SNF - 1.00 - days 0.00 0.00 0.00 0.00 Subtotal 1.1 0.00 4.5 days $9,523.39 $3.60 $2,621.87 $0.99

Facility Outpatient Observation 9.3 visits $12,091.68 $9.36 $1,519.81 $1.18 Emergency Department 97.8 visits 3,644.18 29.69 604.54 4.93 Surgery 37.5 visits 10,299.77 32.22 2,393.02 7.48 Radiology - Therapeutic 2.3 visits 22,556.62 4.31 4,404.40 0.84 Radiology - Diagnostic 26.8 visits 617.50 1.38 183.97 0.41 Radiology - CT/MRI/PET 30.8 visits 3,140.50 8.07 402.46 1.03 Pathology/Lab 24.0 visits 316.84 0.63 42.89 0.09 Pharmacy 16.4 visits 7,113.90 9.70 260.82 0.36 Cardiovascular 7.0 visits 1,365.04 0.79 366.50 0.21 PT/OT/ST 2.6 visits 473.92 0.10 114.80 0.02 Psychiatric 0.3 visits 900.00 0.02 427.87 0.01 Alcohol & Drug Abuse - visits 0.00 0.00 0.00 0.00 Preventive 4.1 visits 2,241.97 0.76 581.76 0.20 Other Outpatient Facility 43.3 visits 525.21 1.89 221.45 0.80 Subtotal $98.94 $17.56

Professional Inpatient Surgeon 22.4 proced $917.04 $1.71 $378.42 $0.71 Inpatient Anesthesia 0.0 proced 53.50 0.00 12.32 0.00 Maternity - Physician 0.1 proced 107.00 0.00 36.60 0.00 Maternity - Anesthesia - proced 0.00 0.00 0.00 0.00 Outpatient Facility Surgery 62.3 proced 948.79 4.92 259.18 1.34 Outpatient Office Surgery 18.2 proced 382.10 0.58 152.85 0.23 Outpatient Anesthesia 0.9 proced 87.67 0.01 15.40 0.00 Inpatient Visits 10.5 visits 734.41 0.65 210.74 0.19 Office/Home Visits - PCP 25.4 visits 211.05 0.45 98.33 0.21 Office/Home Visits - Specialist 72.0 visits 989.77 5.93 107.88 0.65 Urgent Care Visits - visits 0.00 0.00 0.00 0.00 Office Administered Drugs 5.4 proced 368.76 0.16 71.14 0.03 Allergy Testing 0.0 proced 696.00 0.00 6.30 0.00 Allergy Immunotherapy - visits 0.00 0.00 0.00 0.00 Miscellaneous Medical 50.9 proced 218.39 0.93 59.34 0.25 Preventive Immunizations - proced 0.00 0.00 0.00 0.00 Preventive Well Baby Exams - visits 0.00 0.00 0.00 0.00 Preventive Physical Exams 0.0 visits 178.00 0.00 115.21 0.00 Other Preventive 6.4 proced 434.72 0.23 143.93 0.08 ED Visits and Observation 110.4 visits 576.32 5.30 134.40 1.24 Vision Exams 14.2 visits 400.47 0.47 114.87 0.14 Hearing and Speech Exams 0.9 visits 218.85 0.02 50.48 0.00 Physical Therapy 0.1 visits 86.75 0.00 50.39 0.00 Cardiovascular 68.7 proced 69.09 0.40 22.27 0.13 Radiology Inpatient 64.5 proced 172.63 0.93 44.33 0.24 Radiology OP - Therapeutic 9.7 proced 601.72 0.49 116.74 0.09 Radiology OP - Diagnostic 87.0 proced 62.64 0.45 17.57 0.13 Radiology OP - CT/MRI/PET 79.0 proced 251.76 1.66 65.72 0.43 Radiology Office - Therapeutic 0.6 proced 521.39 0.02 90.73 0.00

P58d, P58f Radiology Office - Diagnostic 15.9 proced 297.11 0.39 33.01 0.04 Radiology Office - CT/MRI/PET 0.4 proced 327.12 0.01 77.79 0.00 Pathology/Lab - Inpatient & Outpatient 34.9 proced 213.00 0.62 35.40 0.10 Pathology/Lab - Office 32.7 proced 92.36 0.25 16.46 0.04 Chiropractor 0.1 visits 55.00 0.00 46.21 0.00 Outpatient Psychiatric 0.4 units 165.54 0.01 99.07 0.00 Outpatient Alcohol & Drug Abuse 0.1 units 65.41 0.00 44.03 0.00 Subtotal $26.60 $6.29

Other Prescription Drugs: Medical and Non-Medical Covered 2 - scripts $0.00 $0.00 $0.00 $0.00 Home Health Care - visits 0.00 0.00 0.00 0.00 Ambulance 111.6 proced 637.79 5.93 224.12 2.08 DME and Supplies 20.5 proced 458.14 0.78 203.76 0.35 Prosthetics 7.9 proced 1,202.41 0.79 713.24 0.47 Subtotal $7.50 $2.90

Additional Benefits Glasses/Contacts - visits $0.00 $0.00 $0.00 $0.00 Additional Benefits Other - proced 0.00 0.00 0.00 0.00 Subtotal $0.00 $0.00

Total Medical Cost $136.63 $27.74

Model #6 Michigan Department of Corrections - 2020 RFP Support

Timeframe: 201706-201805 Prison Resident Member Months: Medical - 478148

Repriced Data Only

Annual Average Annual Average Total Average Medicare Admits Length Utilization Charge Charges Medicare Allowed Allowed

Benefit Per 1,000 of Stay Per 1,000 Per Service PPPM Per Service PPPM

Facility Inpatient Medical 0.9 5.72 5.2 days $6,553.55 $2.82 $1,547.82 $0.67 Other Newborn - 0.00 - days 0.00 0.00 0.00 0.00 Surgical 0.4 5.07 1.8 days 14,858.40 2.21 3,586.19 0.53 Psychiatric - Hospital - 0.00 - days 0.00 0.00 0.00 0.00 Psychiatric - Residential - 0.00 - days 0.00 0.00 0.00 0.00 Alcohol & Drug Abuse - Hospital - 0.00 - days 0.00 0.00 0.00 0.00 Alcohol & Drug Abuse - Residential - 0.00 - days 0.00 0.00 0.00 0.00 Mother - Normal Deliveries 0.0 3.00 0.1 days 3,057.14 0.02 1,994.86 0.01 Mother - Cesarean Deliveries - 0.00 - days 0.00 0.00 0.00 0.00 Well Newborn - 0.00 - days 0.00 0.00 0.00 0.00 Non-Deliveries - 0.00 - days 0.00 0.00 0.00 0.00 SNF - 1.00 - days 0.00 0.00 0.00 0.00 Subtotal 1.3 0.00 7.0 days $8,621.96 $5.05 $2,069.48 $1.21

Facility Outpatient Observation 10.7 visits $12,893.11 $11.49 $1,587.52 $1.41 Emergency Department 109.8 visits 3,926.42 35.92 655.73 6.00 Surgery 45.7 visits 9,466.88 36.07 2,110.17 8.04 Radiology - Therapeutic 16.8 visits 4,080.18 5.73 805.25 1.13 Radiology - Diagnostic 27.8 visits 621.75 1.44 197.02 0.46 Radiology - CT/MRI/PET 39.1 visits 3,171.58 10.32 360.28 1.17 Pathology/Lab 24.1 visits 295.64 0.59 43.70 0.09 Pharmacy 21.8 visits 5,090.76 9.24 242.92 0.44 Cardiovascular 8.3 visits 1,618.70 1.11 494.18 0.34 PT/OT/ST 2.4 visits 340.02 0.07 90.94 0.02 Psychiatric 0.4 visits 868.71 0.03 413.41 0.01 Alcohol & Drug Abuse - visits 0.00 0.00 0.00 0.00 Preventive 4.3 visits 2,117.22 0.76 623.35 0.22 Other Outpatient Facility 61.9 visits 521.92 2.69 210.71 1.09 Subtotal $115.47 $20.43

Professional Inpatient Surgeon 1.2 proced $1,290.17 $0.12 $338.55 $0.03 Inpatient Anesthesia 0.1 proced 59.00 0.00 11.79 0.00 Maternity - Physician 0.2 proced 382.17 0.00 179.67 0.00 Maternity - Anesthesia - proced 0.00 0.00 0.00 0.00 Outpatient Facility Surgery 79.8 proced 919.53 6.11 266.54 1.77 Outpatient Office Surgery 21.2 proced 443.91 0.79 165.68 0.29 Outpatient Anesthesia 3.1 proced 65.83 0.02 12.52 0.00 Inpatient Visits 13.2 visits 713.59 0.78 204.78 0.22 Office/Home Visits - PCP 55.8 visits 228.69 1.06 90.14 0.42 Office/Home Visits - Specialist 73.0 visits 1,043.03 6.34 106.02 0.64 Urgent Care Visits - visits 0.00 0.00 0.00 0.00 Office Administered Drugs 6.1 proced 308.50 0.16 90.07 0.05 Allergy Testing 0.1 proced 447.33 0.00 6.33 0.00 Allergy Immunotherapy - visits 0.00 0.00 0.00 0.00 Miscellaneous Medical 57.5 proced 192.28 0.92 58.93 0.28 Preventive Immunizations 0.1 proced 30.00 0.00 22.91 0.00 Preventive Well Baby Exams - visits 0.00 0.00 0.00 0.00 Preventive Physical Exams 0.0 visits 190.00 0.00 133.97 0.00 Other Preventive 4.4 proced 437.79 0.16 131.38 0.05 ED Visits and Observation 122.7 visits 605.69 6.20 134.30 1.37 Vision Exams 9.9 visits 193.96 0.16 118.03 0.10 Hearing and Speech Exams 0.9 visits 220.91 0.02 52.31 0.00 Physical Therapy 0.2 visits 94.73 0.00 47.35 0.00 Cardiovascular 86.9 proced 71.25 0.52 21.77 0.16 Radiology Inpatient 2.0 proced 183.18 0.03 47.03 0.01 Radiology OP - Therapeutic 16.3 proced 500.54 0.68 115.28 0.16 Radiology OP - Diagnostic 119.8 proced 61.90 0.62 17.83 0.18 Radiology OP - CT/MRI/PET 124.6 proced 253.27 2.63 66.68 0.69 Radiology Office - Therapeutic 1.1 proced 779.43 0.07 181.19 0.02

P58d, P58f Radiology Office - Diagnostic 19.7 proced 465.61 0.76 34.76 0.06 Radiology Office - CT/MRI/PET 0.9 proced 413.03 0.03 124.01 0.01 Pathology/Lab - Inpatient & Outpatient 30.6 proced 243.73 0.62 36.64 0.09 Pathology/Lab - Office 24.8 proced 121.07 0.25 18.52 0.04 Chiropractor - visits 0.00 0.00 0.00 0.00 Outpatient Psychiatric 0.3 units 245.64 0.01 127.24 0.00 Outpatient Alcohol & Drug Abuse 0.1 units 52.81 0.00 25.18 0.00 Subtotal $29.07 $6.66

Other Prescription Drugs: Medical and Non-Medical Covered 2 - scripts $0.00 $0.00 $0.00 $0.00 Home Health Care 0.0 visits 1,968.40 0.00 256.77 0.00 Ambulance 139.9 proced 608.78 7.10 222.02 2.59 DME and Supplies 28.8 proced 384.40 0.92 149.59 0.36 Prosthetics 9.3 proced 1,206.05 0.93 735.92 0.57 Subtotal $8.96 $3.52

Additional Benefits Glasses/Contacts 0.1 visits $450.50 $0.00 $319.07 $0.00 Additional Benefits Other - proced 0.00 0.00 0.00 0.00

Total Medical Cost $158.55 $31.81

Model #7 Michigan Department of Corrections - 2020 RFP Support

Timeframe: 201806-201905 Prison Resident Member Months: Medical - 464388

Repriced Data Only

Annual Average Annual Average Total Average Medicare Admits Length Utilization Charge Charges Medicare Allowed Allowed

Benefit Per 1,000 of Stay Per 1,000 Per Service PPPM Per Service PPPM

Facility Inpatient Medical 1.3 4.35 5.8 days $9,497.35 $4.63 $2,146.71 $1.05 Other Newborn - 0.00 - days 0.00 0.00 0.00 0.00 Surgical 1.0 5.03 4.8 days 16,236.82 6.54 3,916.83 1.58 Psychiatric - Hospital - 0.00 - days 0.00 0.00 0.00 0.00 Psychiatric - Residential - 0.00 - days 0.00 0.00 0.00 0.00 Alcohol & Drug Abuse - Hospital - 0.00 - days 0.00 0.00 0.00 0.00 Alcohol & Drug Abuse - Residential - 0.00 - days 0.00 0.00 0.00 0.00 Mother - Normal Deliveries - 0.00 - days 0.00 0.00 0.00 0.00 Mother - Cesarean Deliveries - 0.00 - days 0.00 0.00 0.00 0.00 Well Newborn - 0.00 - days 0.00 0.00 0.00 0.00 Non-Deliveries - 0.00 - days 0.00 0.00 0.00 0.00 SNF - 1.00 - days 0.00 0.00 0.00 0.00 Subtotal 2.3 0.00 10.7 days $12,546.57 $11.17 $2,947.59 $2.62

Facility Outpatient Observation 7.6 visits $12,728.93 $8.11 $1,612.81 $1.03 Emergency Department 106.8 visits 4,222.90 37.58 696.27 6.20 Surgery 47.2 visits 10,179.13 40.03 2,251.12 8.85 Radiology - Therapeutic 23.1 visits 3,018.56 5.82 631.65 1.22 Radiology - Diagnostic 34.8 visits 612.64 1.78 174.63 0.51 Radiology - CT/MRI/PET 50.4 visits 3,136.69 13.17 333.24 1.40 Pathology/Lab 24.3 visits 371.36 0.75 46.86 0.10 Pharmacy 21.6 visits 6,011.33 10.83 238.82 0.43 Cardiovascular 9.7 visits 1,552.38 1.26 558.86 0.45 PT/OT/ST 3.2 visits 389.45 0.10 108.26 0.03 Psychiatric 0.7 visits 994.00 0.05 455.06 0.02 Alcohol & Drug Abuse - visits 0.00 0.00 0.00 0.00 Preventive 3.1 visits 2,255.18 0.58 549.93 0.14 Other Outpatient Facility 72.4 visits 618.02 3.73 206.59 1.25 Subtotal $123.79 $21.62

Professional Inpatient Surgeon 4.1 proced $1,296.71 $0.44 $304.00 $0.10 Inpatient Anesthesia 0.1 proced 49.00 0.00 12.39 0.00 Maternity - Physician 0.1 proced 273.00 0.00 126.03 0.00 Maternity - Anesthesia - proced 0.00 0.00 0.00 0.00 Outpatient Facility Surgery 87.8 proced 1,021.13 7.47 270.32 1.98 Outpatient Office Surgery 28.4 proced 736.48 1.75 186.07 0.44 Outpatient Anesthesia 3.9 proced 80.76 0.03 14.96 0.00 Inpatient Visits 21.6 visits 751.26 1.35 212.25 0.38 Office/Home Visits - PCP 75.8 visits 237.94 1.50 95.80 0.60 Office/Home Visits - Specialist 78.0 visits 1,051.82 6.83 105.04 0.68 Urgent Care Visits - visits 0.00 0.00 0.00 0.00 Office Administered Drugs 6.4 proced 400.36 0.21 136.65 0.07 Allergy Testing 0.0 proced 660.00 0.00 5.03 0.00 Allergy Immunotherapy - visits 0.00 0.00 0.00 0.00 Miscellaneous Medical 65.1 proced 213.78 1.16 60.01 0.33 Preventive Immunizations - proced 0.00 0.00 0.00 0.00 Preventive Well Baby Exams - visits 0.00 0.00 0.00 0.00 Preventive Physical Exams - visits 0.00 0.00 0.00 0.00 Other Preventive 4.5 proced 356.72 0.13 108.09 0.04 ED Visits and Observation 120.6 visits 699.87 7.03 140.54 1.41 Vision Exams 14.6 visits 198.78 0.24 120.86 0.15 Hearing and Speech Exams 1.5 visits 182.61 0.02 49.50 0.01 Physical Therapy 0.2 visits 100.25 0.00 58.15 0.00 Cardiovascular 100.8 proced 64.94 0.55 20.37 0.17 Radiology Inpatient 5.6 proced 120.33 0.06 27.38 0.01 Radiology OP - Therapeutic 2.4 proced 622.48 0.12 128.78 0.03 Radiology OP - Diagnostic 132.9 proced 66.38 0.74 17.05 0.19 Radiology OP - CT/MRI/PET 129.1 proced 281.25 3.02 70.41 0.76 Radiology Office - Therapeutic 5.7 proced 771.79 0.36 181.39 0.09

P58d, P58f Radiology Office - Diagnostic 21.8 proced 588.76 1.07 36.16 0.07 Radiology Office - CT/MRI/PET 4.3 proced 350.05 0.13 119.14 0.04 Pathology/Lab - Inpatient & Outpatient 31.3 proced 323.39 0.84 36.48 0.10 Pathology/Lab - Office 15.8 proced 205.13 0.27 19.21 0.03 Chiropractor - visits 0.00 0.00 0.00 0.00 Outpatient Psychiatric 0.2 units 290.00 0.00 142.73 0.00 Outpatient Alcohol & Drug Abuse - units 0.00 0.00 0.00 0.00 Subtotal $35.35 $7.68

Other Prescription Drugs: Medical and Non-Medical Covered 2 - scripts $0.00 $0.00 $0.00 $0.00 Home Health Care - visits 0.00 0.00 0.00 0.00 Ambulance 156.8 proced 611.79 7.99 217.47 2.84 DME and Supplies 14.0 proced 418.97 0.49 225.53 0.26 Prosthetics 7.9 proced 1,065.61 0.70 655.05 0.43 Subtotal $9.19 $3.54

Additional Benefits Glasses/Contacts - visits $0.00 $0.00 $0.00 $0.00 Additional Benefits Other - proced 0.00 0.00 0.00 0.00

Total Medical Cost $179.50 $35.45

Model #8 Michigan Department of Corrections - 2020 RFP Support

Timeframe: 201906-201911 Prison Resident Member Months: Medical - 229136

Repriced Data Only

Annual Average Annual Average Total Average Medicare Admits Length Utilization Charge Charges Medicare Allowed Allowed

Benefit Per 1,000 of Stay Per 1,000 Per Service PPPM Per Service PPPM

Facility Inpatient Medical 1.6 6.00 9.4 days $5,990.49 $4.68 $1,421.14 $1.11 Other Newborn - 0.00 - days 0.00 0.00 0.00 0.00 Surgical 0.7 4.33 3.1 days 9,311.43 2.43 3,975.77 1.04 Psychiatric - Hospital - 0.00 - days 0.00 0.00 0.00 0.00 Psychiatric - Residential - 0.00 - days 0.00 0.00 0.00 0.00 Alcohol & Drug Abuse - Hospital - 0.00 - days 0.00 0.00 0.00 0.00 Alcohol & Drug Abuse - Residential - 0.00 - days 0.00 0.00 0.00 0.00 Mother - Normal Deliveries - 0.00 - days 0.00 0.00 0.00 0.00 Mother - Cesarean Deliveries - 0.00 - days 0.00 0.00 0.00 0.00 Well Newborn - 0.00 - days 0.00 0.00 0.00 0.00 Non-Deliveries - 0.00 - days 0.00 0.00 0.00 0.00 SNF - 1.00 - days 0.00 0.00 0.00 0.00 Subtotal 2.3 0.00 12.5 days $6,820.72 $7.11 $2,059.79 $2.15

Facility Outpatient Observation 9.7 visits $13,513.87 $10.96 $1,772.91 $1.44 Emergency Department 113.9 visits 4,373.59 41.50 716.54 6.80 Surgery 51.0 visits 11,484.33 48.80 2,463.20 10.47 Radiology - Therapeutic 17.5 visits 3,105.59 4.53 746.29 1.09 Radiology - Diagnostic 39.3 visits 718.59 2.35 201.02 0.66 Radiology - CT/MRI/PET 56.3 visits 2,970.80 13.93 303.62 1.42 Pathology/Lab 28.2 visits 407.75 0.96 47.37 0.11 Pharmacy 21.2 visits 8,959.90 15.86 212.29 0.38 Cardiovascular 13.6 visits 1,408.13 1.60 386.34 0.44 PT/OT/ST 4.5 visits 558.06 0.21 141.56 0.05 Psychiatric 0.5 visits 940.25 0.04 414.23 0.02 Alcohol & Drug Abuse - visits 0.00 0.00 0.00 0.00 Preventive 3.8 visits 1,194.93 0.37 193.66 0.06 Other Outpatient Facility 84.2 visits 625.28 4.39 200.37 1.41 Subtotal $145.50 $24.33

Professional Inpatient Surgeon 1.7 proced $676.25 $0.10 $235.36 $0.03 Inpatient Anesthesia 0.1 proced 52.50 0.00 11.18 0.00 Maternity - Physician 0.1 proced 718.00 0.00 364.29 0.00 Maternity - Anesthesia - proced 0.00 0.00 0.00 0.00 Outpatient Facility Surgery 92.4 proced 1,045.45 8.05 276.88 2.13 Outpatient Office Surgery 35.6 proced 857.05 2.55 155.62 0.46 Outpatient Anesthesia 4.2 proced 75.97 0.03 12.43 0.00 Inpatient Visits 17.3 visits 758.43 1.09 199.15 0.29 Office/Home Visits - PCP 102.8 visits 268.26 2.30 99.51 0.85 Office/Home Visits - Specialist 74.9 visits 1,057.89 6.60 102.26 0.64 Urgent Care Visits - visits 0.00 0.00 0.00 0.00 Office Administered Drugs 7.6 proced 1,035.11 0.66 334.93 0.21 Allergy Testing 0.1 proced 42.00 0.00 4.04 0.00 Allergy Immunotherapy - visits 0.00 0.00 0.00 0.00 Miscellaneous Medical 71.0 proced 202.39 1.20 56.79 0.34 Preventive Immunizations 0.2 proced 48.00 0.00 17.57 0.00 Preventive Well Baby Exams - visits 0.00 0.00 0.00 0.00 Preventive Physical Exams - visits 0.00 0.00 0.00 0.00 Other Preventive 4.7 proced 322.37 0.13 86.56 0.03 ED Visits and Observation 134.4 visits 759.38 8.50 139.96 1.57 Vision Exams 17.8 visits 202.73 0.30 121.94 0.18 Hearing and Speech Exams 2.5 visits 210.57 0.04 53.49 0.01 Physical Therapy 0.1 visits 48.00 0.00 30.93 0.00 Cardiovascular 96.0 proced 78.36 0.63 24.38 0.20 Radiology Inpatient 2.9 proced 129.47 0.03 28.09 0.01 Radiology OP - Therapeutic 10.4 proced 595.98 0.52 126.98 0.11 Radiology OP - Diagnostic 139.5 proced 74.35 0.86 18.47 0.21 Radiology OP - CT/MRI/PET 143.3 proced 274.04 3.27 69.22 0.83 Radiology Office - Therapeutic 1.3 proced 907.35 0.10 177.90 0.02

P58d, P58f Radiology Office - Diagnostic 27.4 proced 558.07 1.27 37.17 0.08 Radiology Office - CT/MRI/PET 1.6 proced 357.79 0.05 124.69 0.02 Pathology/Lab - Inpatient & Outpatient 33.7 proced 333.97 0.94 35.51 0.10 Pathology/Lab - Office 16.0 proced 591.01 0.79 59.25 0.08 Chiropractor - visits 0.00 0.00 0.00 0.00 Outpatient Psychiatric 0.3 units 290.00 0.01 142.87 0.00 Outpatient Alcohol & Drug Abuse - units 0.00 0.00 0.00 0.00 Subtotal $40.01 $8.41

Other Prescription Drugs: Medical and Non-Medical Covered 2 - scripts $0.00 $0.00 $0.00 $0.00 Home Health Care 0.6 visits 957.42 0.04 13.43 0.00 Ambulance 148.3 proced 600.66 7.42 219.31 2.71 DME and Supplies 12.3 proced 341.86 0.35 178.87 0.18 Prosthetics 9.1 proced 1,236.48 0.94 829.03 0.63 Subtotal $8.75 $3.52

Additional Benefits Glasses/Contacts - visits $0.00 $0.00 $0.00 $0.00 Additional Benefits Other - proced 0.00 0.00 0.00 0.00

Total Medical Cost $201.37 $38.41