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Spending and Utilization in Medical Services – Dashboard Menu Data Parameters in Spending and Utilization for Medical Services CY 2012 Medical Spending vs. All Other Service Spending (Total: $6,091,240,210) CY 2013 Medical Spending vs. All Other Service Spending (Total: $6,335,428,003) Medical Spending: All Members, Child, Adult Member Months (MMs): All Members, Child, Adult Medical Spending: Per Member Per Month (PMPM) Cost -All Members, Child, Adult Quarterly Growth Trend for Medical Services: MMs vs. PMPM – All Members Quarterly Growth Trend for Medical Services: MMs vs. PMPM – Child Quarterly Growth Trend for Medical Services: MMs vs. PMPM – Adult Average Members in CT Medical Assistance Program Annually: All Members, Child, Adult Per Capita for Medical Only: All Members, Child, Adult Distinct Members Received Medical Services: All Members, Child, Adult Cost per Distinct Member Who Received Medical Services Medical Spending by HUSKY Program Distinct Members Who Received Services by HUSKY Program Per Member Per Month (PMPM) Cost by HUSKY Program Medical Spending by Category of Service PMPM Costs by Category Of Service Distinct Members by Category of Service Utilization Per 1000 Member Months by Category of Service CY 2012 - Spending Distribution by Category of Service CY 2013 - Spending Distribution by Category of Service Overall CY 2012 – 2013 Cost Variance by Category, Unit Cost and Utilization Impact

Source: Connecticut Department of Social Services.

Data Parameters in Spending and Utilization for Medical Services

• CY 2012 data represents claims of date of service 1/1/2012 – 12/31/2012 with Paid Run-Out of 22 months

• CY 2013 data represents claims of date of service 1/1/2013 – 12/31/2013 with Paid

Run-Out of 10 months • All data for CY 2012 & CY 2013 include claims Paid Through 10/31/2014 • All HUSKY Health, Charter Oak members, Limited Benefit members except Dual

members (i.e., members who are eligible for both Medicare and Medicaid) are included. Data does not contain a factor for Incurred But Not Reported (IBNR)

• Children defined as Age 0 to 20 • Adult defined as Age 21 and above


CY 2012 Medical Spending vs. All Other Service Spending (Total: $6,091,240,210)

MEDICAL SERVICES, $1,880,044,385

(31%)

ALL OTHER SERVICES,

$4,211,195,825 (69%)


CY 2013 Medical Spending vs. All Other Service Spending (Total: $6,335,428,003)

MEDICAL SERVICES, $2,033,514,311

(32%)

ALL OTHER SERVICES, $4,301,913,692

(68%)


Medical Spending: All Members, Child, Adult

$1,880,044,385

$510,282,590

$1,369,761,795

$2,033,514,311

$569,504,356

$1,464,009,955

All Members Child Adult

CY 2012 CY 2013


Member Months (MMS): All Members, Child, Adult (*Member Months defined as cumulative members in a year counting each member enrolled in each month)

7,877,907

3,546,989

4,330,918

8,153,146

3,739,251

4,413,895

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000


CY 2012 CY 2013


Medical Spending: Per Member Per Month Cost – All, Child, Adult (*Per Member Per Month (PMPM) = Total Cost divided by Total Member Months)

$239

$144

$316

$249

$152

$332

All PMPM Child PMPM Adult PMPM

CY 2012 CY 2013


Quarterly Growth Trend for Medical Services: MMS vs. PMPM – All Members (*Member Months defined as cumulative members in a year counting each member enrolled in each month) (*PMPM = Total Cost divided by Total Member Months)

Note:- Member months increased by 6% from Q1 2012 to Q4 2013 while Per Member Per month Cost increased by 4% from Q1 2012 to Q4 2013.

1,940,519

1,956,984

1,979,191

2,001,213

2,011,713

2,032,389

2,049,345 2,059,699

$241 $237 $241

$236

$245 $250 $252 $250

$-

$50

$100

$150

$200

$250

$300

$350

$400

Q1.12 Q2.12 Q3.12 Q4.12 Q1.13 Q2.13 Q3.13 Q4.13 1,880,000

1,900,000

1,920,000

1,940,000

1,960,000

1,980,000

2,000,000

2,020,000

2,040,000

2,060,000

2,080,000

PMPM

MMS

MMS PMPM


Quarterly Growth Trend for Medical: MMS vs. PMPM – Child

(*Member Months defined as cumulative members in a year counting each member enrolled in each month) (*PMPM = Total Cost divided by Total Member Months)

Note:- Member months increased by 10% from Q1 2012 to Q4 2013 while Per Member Per month increased by 7% from Q1 2012 to Q4 2013.

865,931

877,850

893,620

909,588

918,494

929,445

941,588

949,724

$145

$140

$146 $143 $150 $151 $153 $155

$-

$20

$40

$60

$80

$100

$120

$140

$160

$180

$200

Q1.12 Q2.12 Q3.12 Q4.12 Q1.13 Q2.13 Q3.13 Q4.13 820,000

840,000

860,000

880,000

900,000

920,000

940,000

960,000

PMPM

MMS

MMS PMPM


Quarterly Growth Trend for Medical: MMS vs. PMPM – Adult

(*Member Months defined as cumulative members in a year counting each member enrolled in each month) (*PMPM = Total Cost divided by Total Member Months)

Note:- Member months increased by 3% from Q1 2012 to Q4 2013 while Per Member Per month increased by 5% from Q1 2012 to Q4 2013.

1,074,588 1,079,134

1,085,571

1,091,625 1,093,219

1,102,944

1,107,757

1,109,975 $316 $313 $320 $313

$324 $332 $336

$332

$-

$50

$100

$150

$200

$250

$300

$350

$400

Q1.12 Q2.12 Q3.12 Q4.12 Q1.13 Q2.13 Q3.13 Q4.13 1,050,000

1,060,000

1,070,000

1,080,000

1,090,000

1,100,000

1,110,000

1,120,000

PMPM

MMS

MMS PMPM


Average Members in CT Medical Assistance Program -All Members, Child, Adult

656,492

295,582

360,910

679,429

311,604

367,825

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000


CY 2012 CY 2013


Per Capita for Medical Only– All Members, Child, Adult (* Per Capita means cost per person in a year. [Per Capita = Total Cost divided by Total number of members])

$2,864

$1,726

$3,795

$2,993

$1,828

$3,980


CY 2012 CY 2013


Distinct Members Received Medical Services: All Members, Child, Adult

637,163

292,697 344,466

658,021

308,914 349,107


CY 2012 CY 2013


Cost per Distinct Member Received Medical Services: All Members, Child, Adult

$2,951

$1,743

$3,976

$3,090

$1,844

$4,194


CY 2012 CY 2013


Medical Spending by HUSKY Program

$957,862,674

$13,542,923

$469,017,377

$411,001,938

$575,129 $23,079,787

$4,964,558

$1,037,015,781

$14,622,548

$481,947,689 $476,056,957

$1,230,454 $19,721,577 $2,919,306 $-

$200,000,000

$400,000,000

$600,000,000

$800,000,000

$1,000,000,000

$1,200,000,000

HUSKY A HUSKY B HUSKY C HUSKY D LIMITED BENEFIT CHARTER OAK OTHER

CY 2012

CY 2013


Distinct Members Who Received Medical Services by HUSKY Program

437,488

17,287

80,956 103,968

2,426 7,632

449,644

16,216

81,052

114,660

4,056 5,613 0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

HUSKY A HUSKY B HUSKY C HUSKY D LIMITED BENEFIT CHARTER OAK

CY 2012 CY 2013


Per Member Per Month (PMPM) Medical Cost by HUSKY Program

$181

$79

$384 $370

$58

$297

$191

$90

$393 $384

$35

$359

HUSKY A HUSKY B HUSKY C HUSKY D LIMITED BENEFIT (FP& TB)

CHARTER OAK

CY 2012 CY 2013


Medical Spending by Category of Service

$108,351,783

$63,668,651

$1,083,197

$25,586,670 $15,130,022

$283,455,735

$26,144,872

$95,028,230

$22,809,654

$141,902,693

$3,756,155

$338,061,376

$11,560,515

$173,938,070

$569,566,761

$1,880,044,385

$108,818,577

$62,402,755

$1,215,319 $34,875,529

$21,658,693

$344,220,085

$29,553,164

$94,616,488

$25,421,478

$142,938,325

$3,827,047

$387,405,903

$10,650,660

$198,259,320

$567,650,969

$2,033,514,311

All Other

Durable Medical Equipment

Independent Radiology

Independent Laboratory

Other Practitioner

Physician Services – All

Vision

FQHC – Medical

Clinical Services

Home Health Services

Hospice

Hospital Outpatient – All Other

Hospital Outpatient - Non Emergent

Hospital Outpatient – Emergency

Hospital Inpatient

Total

CY 2013

CY 2012


PMPM Costs by Category of Service

$13.75

$8.08

$0.14

$3.25

$1.92

$35.98

$3.32

$12.06

$2.90

$18.01

$0.48

$42.91

$1.47

$22.08

$72.30

$13.35

$7.65

$0.15

$4.28

$2.66

$42.22

$3.62

$11.60

$3.12

$17.53

$0.47

$47.52

$1.31

$24.32

$69.62

All Other




Other Practitioner


Vision

FQHC – Medical

Clinical Services


Hospice




Hospital Inpatient

CY 2013 CY 2012


Distinct Members by Category of Service

58,969

77,744

3,944

212,912

84,605

476,791

151,902

169,715

50,514

23,616

452

259,819

100,296

216,377

64,506

62,120

81,708

4,828

226,138

104,913

490,416

162,119

175,528

55,516

24,196

490

266,673

91,620

224,853

64,592

All Other




Other Practitioner


Vision

FQHC – Medical

Clinical Services


Hospice




Hospital InpatientCY 2013 CY 2012


Medical Utilization Per 1000 Member Month by Category of Service

210

528

12

964

335

4,582

361

972

211

554

2

1,501

222

647

129

227

530

14

1,069

412

4,570

381

954

229

574

2

1,448

192

652

125

All Other




Other Practitioner


Vision

FQHC – Medical

Clinical Services


Hospice




Hospital Inpatient

CY 2013 CY 2012


CY 2012 - Medical Spending Distribution by Category of Service

22

30%

28% 1%

16%

8%

1% 5%

0% 2% 0%

6% 3% Hospital InPatient

Hospital OutPatient

IndependentLaboratoryPhysician+OtherPractHome Health

Clinic Servicses

FQHC Medical

IndependentRadiologyVision

Hospice

All Other

Durable MedicalEquipment


CY 2013 - Medical Spending Distribution by Category of Service

28%

29%

2%

18%

7%

1% 5%

0% 1% 0%

5% 3% Hospital InPatient

Hospital OutPatient

Independent Laboraroty

Physician+Other Pract

Home Health

Clinic Servicses

FQHC Medical


Vision

Hospice

All Other

Durable MedicalEquipment


Medical CY 2012 – 2013 Cost Variance by Category, Unit Cost and Utilization Impact

-50

-40

-30

-20

-10

0

10

20

30

40

50

60

70

80

90

100

110

120

130

140

150

160

170

-20

-10

0

10

20

30

40

50

60

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erv.

FQH

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DM

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Inde

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2012-13 Variance Unit Cost Impact Utilization ImpactTotal 2012-13 Variance Total Unit Cost Impact Total Utilization Impact


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Spending and Utilization in Medical Services – Dashboard ... · Spending and Utilization in Medical Services – Dashboard Menu. Data Parameters in Spending and Utilization for