2004 Yearly Operating Report Yearly Operating Report

Transcription

1 2004 Yearly Operating Report 2004 Yearly Operating Report

2 2004 Yearly Operating Report Enrollment Data

3 Total Enrollment By Calendar Year as of December 31, Chart 1

4 1,100 1, Policies In Force as of December 31, Total Enrollment , , , , ,532 Please Note: $2,500 & $5,000 PPO plan options were added in August of $500 Std. Plan $1,000 Std. Plan $1,500 Std. Plan Medicare $500 PPO Plan $1,000 PPO Plan $2,500 PPO Plan $5,000 PPO Plan Chart 2

5 2004 WSHIP & Market Statistics Jan-04 Feb-04 Mar-04 Apr-04 May-04 June-04 July-04 Aug-04 Sept-04 Oct-04 Nov-04 Dec-04 TOTAL Total Denied Total Screened HQ's Total Percent Denied 8.4% 6.8% 8.2% 9.6% 7.9% 7.9% 7.0% 7.8% 6.8% 6.2% 7.8% 10.2% 7.9% WSHIP Enrolled Plans 1 & % Enrolled by WSHIP 9.0% 9.7% 7.9% 10.7% 15.8% 13.9% 17.9% 12.9% 20.0% 14.1% 13.1% 8.5% 12.3% Plan Total Enrolled WSHIP Disenrolled Plans 1 & Plan Total Disenrolled WSHIP Total Enrollment Plans 1 & Plans TOTAL WSHIP Total Enrollment Jan-04 Feb-04 Mar-04 Apr-04 May-04 June-04 July-04 Aug-04 Sept-04 Oct-04 Nov-04 Dec-04 Chart 3

6 Terminations By Reason During 2004, 625 insureds terminated coverage for the following reasons: 3% 33% 35% 4% 8% 17% Non-Payment Death Other Coverage Residency Member Request Medicare * Non-payment may include those dropping coverage for other reasons Chart 4

7 900 Percent Change from 2003 to Band 18% Band 9% Band 24% Band 15% Band -17% 65 + Band 30% Band - 2% Change in Enrollment Since 2001 by Age Band Chart 5

8 2004 Age and Sex Distribution for all Plans Total Females 1,298 or 45% of the population. Total Males 1,591 or 55% of the population # of Insured's Female Male Chart 6

9 Average Time Enrolled in WSHIP 15 + Years Years 9-10 Years 8-9 Years 7-8 Years 6-7 Years 5-6 Years 4-5 Years 3-4 Years 2-3 Years 1-2 Years 0-1 Year # of Insured's Plan 1 Plan 2 Plan 3 Chart 7

10 Membership by Geography Chart 8

11 2004 Yearly Operating Report Claims Data

12 For the calendar year 2004, a total of $24,063,550 was paid in medical claims. $500 Std. Plan $1,000 Std. Plan $1,500 Std. Plan Medicare $500 PPO Plan $1,000 PPO Plan $ 5,407,067 $ 555,662 $ 2,988,985 $ 4,495,207 $ 8,417,660 $ 2,198,971 Medical Claims Paid by Plan $9,000,000 $8,000,000 $7,000,000 $6,000,000 $5,000,000 $4,000,000 $3,000,000 $2,000,000 $1,000,000 $- 500 Deductible 1000 Deductible 1500 Deductible Medicare 500 PPO 1000 PPO Medical Claims Paid by Plan Percentage Comparison Medical Claims Paid by Plan (PMPM Basis) $500 PPO Plan 36% $1,000 PPO Plan 9% Medicare 19% $500 Std. Plan 22% $1,000 Std. Plan 2% $1,500 Std. Plan 12% $1,000 $900 $800 $700 $600 $500 $400 $300 $200 $100 $- $ $ Plan 1 & 3 Plan 2 Chart 9

13 For the calendar year 2004, a total of $23, was paid in pharmacy claims. $500 Std. Plan $1,000 Std. Plan $1,500 Std. Plan Medicare $500 PPO Plan $1,000 PPO Plan $ 2,399,289 $ 271,869 $ 1,137,374 $ 12,444,372 $ 6,720,354 $ 850,337 Pharmacy Claims Paid by Plan $14,000,000 $12,000,000 $10,000,000 $8,000,000 $6,000,000 $4,000,000 $2,000,000 $- $500 Std. Plan $1,000 Std. Plan $1,500 Std. Plan Medicare $500 PPO Plan $1,000 PPO Plan Pharmacy Claims Paid by Plan Percentage Comparison Pharmacy Claims Paid by Plan (PMPM Basis) $500 PPO Plan 28% $500 Std. Plan $1,000 PPO 10% Plan 4% $1,000 Std. Plan 1% $1,200 $1,000 $800 $600 $ $1, $400 Medicare 52% $1,500 Std. Plan 5% $200 $- Plan 1 & 3 Plan 2 Chart 10

14 For the calendar year 2004, a total of $47,887,146 was paid in both pharmacy and medical claims. $500 Std. Plan $1,000 Std. Plan $1,500 Std. Plan Medicare $500 PPO Plan $1,000 PPO Plan Medical $ 5,407,067 $ 555,662 $ 2,988,985 $ 4,495,207 $ 8,417,660 $ 2,198,971 Pharmacy $ 2,399,289 $ 271,869 $ 1,137,374 $ 12,444,372 $ 6,720,354 $ 850,337 Total $ 7,806,357 $ 827,530 $ 4,126,359 $ 16,939,579 $ 15,138,014 $ 3,049,308 Medical and Pharmacy Claims Paid by Plan $20,000,000 $15,000,000 $10,000,000 $5,000,000 $- $500 Std. Plan $1,000 Std. Plan $1,500 Std. Plan Medicare $500 PPO Plan $1,000 PPO Plan Pharmacy Medical Medical and Pharmacy Claims Paid by Plan Percentage Comparison Medical and Pharmacy Claims Paid by Plan (PMPM Basis) $1,000 PPO Plan 6% $500 PPO Plan 32% $500 Std. Plan 16% Medicare 35% $1,000 Std. Plan 2% $1,500 Std. Plan 9% $1,550 $1,500 $1,450 $1,400 $1,350 $1,300 $1,501 $1,370 Plan 1 & 3 Plan 2 Chart 11

15 Average Claims Per Member Per Month The average number of medical claims PMPM increased 15% over The average number of pharmacy claims PMPM increased 7% over Medical Pharmacy Chart 12

16 Average Claim Cost Per Member Per Member Per Month The average cost of medical claims PMPM increased 40% over The average cost of pharmacy claims PMPM increased 29% over $800 $730 $722 $700 $600 $567 $426 $523 $562 $500 $400 $300 $200 $100 $ Medical Pharmacy Chart 13

17 Washington State Health Insurance Pool Yearly Operating Report March 10, Distribution of Claim Payments by Provider Type 8% 37% 50% 5% Physician Hospital Other Pharmacy Chart 14

18 Washington State Health Insurance Pool Yearly Operating Report March 10, 2005 PPO Savings (PMPM Basis) The percent increase in PPO savings for Plan 1 on a PMPM basis from 2003 to2004 was 60%. The percent increase in PPO savings for Plan 3 on a PMPM basis from 2003 to2004 was 48%. $1,200 $1,000 $976 $800 $811 $600 $579 $489 $400 $200 $202 $323 $174 $258 $- Claims Paid Plan 1 Discounts Plan 1 Claims Paid Plan 3 Discounts Plan Chart 15

19 Washington State Health Insurance Pool 2004 Yearly Operating Report March 10, 2004 Inpatient, Outpatient & Other Charges for all Plans (PMPM Basis) $250 $200 $170 $202 $195 $183 $187 $185 $165 $150 $131 $149 $100 $50 $- Inpatient Outpatient Other Chart 16

20 TOP ICD-9 sorted by Claim Frequency ICD 9 Code Number of Claims Claim Totals Human immunodeficiency virus (HIV) disease 4500 $ 931, Chronic renal failure 3680 $ 1,336, Asymptomatic human immunodeficiency virus (HIV) infection status 1138 $ 132, Diabetes mellitus 998 $ 41, Organ or tissue replacement by transplant - Kidney 940 $ 53, Chest pain 816 $ 104, Hypersomnia with sleep apnea 779 $ 85, Other and unspecified disorder of back - Lumbago 728 $ 53, Essential hypertension - Benign 628 $ 20, Other symptoms involving abdomen and pelvis 624 $ 75, Multiple sclerosis 533 $ 90, Chronic airway obstruction, not elsewhere classified 510 $ 42, Malignant neoplasm of female breast - Breast (female), unspecified 486 $ 315, Nonallopathic lesions, not elsewhere classified - Cervical region 485 $ 16, Special screening for malignant neoplasm - Other screening mammogram 481 $ 14, Cardiac dysrhythmias - Atrial fibrillation 459 $ 20, Heart failure 452 $ 120, Encounter for unspecified procedures and aftercare - Long-term (current) use of anticoagulants 437 $ 6, Other and unspecified hyperlipidemia 421 $ 17, Pneumonia, organism unspecified 410 $ 465, Diabetes mellitus without mention of complication 401 $ 11, Other disorders of cervical region - Cervicalgia 399 $ 26, Major depressive disorder, recurrent episode 397 $ 25, Other forms of chronic ischemic heart disease 392 $ 206, Encounter for other and unspecified procedures and aftercare - Long-term (current) use of other medicat 392 $ 12, Chart 17

21 TOP ICD-9 sorted by Dollars ICD 9 Code Number of Claims Claim Totals Chronic renal failure 3680 $ 1,336, Human immunodeficiency virus (HIV) disease 4500 $ 931, Chemotherapy 138 $ 529, Pneumonia, organism unspecified 410 $ 465, Malignant neoplasm of female breast - Breast (female), unspecified 486 $ 315, Other primary cardiomyopathy 165 $ 263, Myeloid leukemia - Chronic 171 $ 232, Malignant neoplasm of colon - Ascending colon 138 $ 213, Other forms of chronic ischemic heart disease 392 $ 206, Coagulation defects - Congenital factor IX disorder 17 $ 193, Malignant neoplasm of ovary and other uterine adnexa 365 $ 191, Disorders of function of stomach - Gastroparesis 73 $ 188, Infection and inflammatory reaction due to internal prosthetic device, implant, and graft 86 $ 181, Intraspinal abscess 16 $ 174, Neoplasm of uncertain behavior of other and unspecified sites and tissues 98 $ 169, Other and unspecified disorders of metabolism - With pulmonary manifestation 24 $ 161, Hypertensive heart disease - With heart failure 5 $ 151, Care involving use of rehabilitation procedures - Other 43 $ 151, Traumatic pneumothorax and hemothorax 3 $ 148, Malignant melanoma of skin 90 $ 144, Asymptomatic human immunodeficiency virus (HIV) infection status 1138 $ 132, Mitral valve insufficiency and aortic valve insufficiency 3 $ 130, Malignant neoplasm of pancreas 8 $ 127, Lymphoid leukemia - Chronic 170 $ 121, Heart failure 452 $ 120, Chart 18

22 Top 25 Facilities by Revenue The top 25 providers account for 55% of all medical claims paid. Provider Name Paid Amount Number of Claims SWEDISH HEALTH SERVICES $ 1,593, UNIVERSITY OF WASHINGTON MEDICAL $ 1,426, HARBORVIEW MEDICAL CENTER $ 920, VIRGINIA MASON MEDICAL CENTER $ 896, SACRED HEART MEDICAL CENTER $ 751, S C C A $ 428, APRIA HEALTHCARE $ 396, TOTAL RENAL CARE INC $ 377, NORTHWEST KIDNEY CENTERS $ 296, ASSOCIATION OF UNIVERSITY PHYSICIANS $ 296, TACOMA GENERAL-ALLENMORE $ 283, PROVIDENCE HOME INFUSION $ 280, PUGET SOUND BLOOD CENTER $ 217, SW WA MEDICAL CTR $ 185, VMMC DBA BAILEY-BOUSHAY HOUSE $ 181, OPTION CARE EVERETT $ 177, WASHINGTON CANCER CENTERS $ 176, ST JOSEPH - TACOMA $ 176, ROCKWOOD CLINIC, P.S. $ 175, VIRGINIA MASON CLINIC $ 171, CHILDRENS HOSPITAL & REGIONAL $ 166, PROVIDENCE ST PETER HOSPITAL $ 166, NORTHWEST MEDICAL SPECIALTIES, $ 154, PROVIDENCE EVERETT MEDICAL CENTER $ 137, Chart 19

23 2004 Yearly Operating Report Enrollment and Claims Summary Detail for Advocate Groups

24 Advocate Group Members Plan & Age Distribution Summary as of December 31, 2004 Standard Plan Medicare Plan PPO Plan Age $500 $1,000 $1,500 Age Age $500 $1,000 $2,500* $5,000* Total Total 229 Total TOTAL ENROLLMENT: $500 Std. Plan $1000 Std. Plan $1500 Std. Plan Medicare $500 PPO Plan $1000 PPO Plan $2500 PPO Plan $5000 PPO Plan * Began enrolling on August 1, 2004 Chart 20

25 Advocate Group Members 2004 Age and Sex Distribution Total Females 104 or 15% of the population. Total Males 597 or 85% of the population # of Insured's Female Male Chart 21

26 For the calendar year 2004, a total of $3,990,982 was paid in medical claims for advocate group members which is 17% of the total medical claims paid by WSHIP for all members. Medical Claims Paid by Plan (PMPM Basis): WSHIP vs. Total Advocate Groups $1,000 $949 $800 $600 $400 $500 $423 $364 $200 $- Total Advocate WSHIP Plan 1 & 3 Plan 2 Medical Claims Paid by Plan (PMPM Basis): WSHIP vs. Advocate Groups Breakdown $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $- $5,009 $424 $887 $339 $534 $949 $364 $89 AIDS Kidney DSHS WSHIP Plan 1 & 3 Plan 2 Chart 22

27 For the calendar year 2004, a total of $8,340,996 was paid in pharmacy claims for advocate group members which is 35% of the total pharmacy claims paid by WSHIP for all members. Pharmacy Claims Paid by Plan (PMPM Basis): WSHIP vs. Total Advocate Groups $1,400 $1,200 $1,000 $800 $600 $400 $200 $- $1,236 $882 $1,006 $552 Total Advocate WSHIP Plan 1 & 3 Plan 2 Pharmacy Claims Paid by Plan (PMPM Basis): WSHIP vs. Advocate Groups Breakdown $2,000 $1,727 $1,500 $1,000 $500 $882 $1,228 $1,301 $612 $552 $510 $1,006 $- AIDS Kidney DSHS WSHIP Plan 1 & 3 Plan 2 Chart 23

28 For the calendar year 2004, a total of $12,331,948 was paid in both medical and pharmacy claims for advocate group members which is 26% of the total medical and pharmacy claims paid by WSHIP for all members. Total Medical & Pharmacy Claims Paid by Plan (PMPM Basis): WSHIP vs. Total Advocate Groups $2,000 $1,500 $1,000 $500 $882 $1,727 $1,228 $1,301 $612 $552 $510 $1,006 $- AIDS Kidney DSHS WSHIP Plan 1 & 3 Plan 2 Total Medical & Pharmacy Loss Ratio: WSHIP vs. Advocate Groups Breakdown 650% 600% 550% 500% 450% 400% 350% 300% 597% 495% 435% 347% AIDS Kidney DSHS WSHIP Chart 24

29 2004 Yearly Operating Report Web Site Activity

30 Interesting Facts 30,432 Total daily number of unique visitors 110 Average daily number of unique visitors 7,492 Number of times that WSHIP users logged onto the secure side of the web site 68% Of all visitors view the site between the hours of 8 AM - 5 PM PST. 20% from 5 PM - 12 AM PST. Top 10 Downloads Number of Times Downloaded Form Name/Content 4,141 SHQ (10/8/03 version) 2,807 SHQ Scoring Form 1,540 Agent Directory 901 Plan 1 & Plan 3 Summary of Coverage (6-page document) 886 SHQ (9/9/04 version) 736 Plan 1 & Plan 3 Application 634 SHQ - Conditions not on the SHQ form 622 SHQ - Conditions on the Questionaire sorted alphabetically 572 SHQ - Carrier Instructions 495 Plan 2 Summary of Coverage (6-page document) How long are people visiting the site? Statistics April 1, December 31, 2004 Length of Visit 30+ min min 3-10 min 1-3 min sec sec 0-10 sec 0 2,000 4,000 6,000 8,000 10,000 12,000 # of Unique Visitors Chart 25