DATA ANALYSIS & REPORTING SAMPLE REPORTS ......DATA ANALYSIS & REPORTING SAMPLE REPORTS CATALOG...

DATA ANALYSIS & REPORTING

SAMPLE REPORTS CATALOG

Integrated Charts and Graphing

Drill-Down to Individual Transaction/EOB

Benchmark Plan Performance

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Questions regarding this Sample Reports Catalog should be addressed to:

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Routine Menu ‐ Analysis and reporting routines are now l t d i d d t th l ft f th B

Function Icons – Icons located below the routine name d li k i di t i t th ti ff F11 33

Data Analysis and Reporting - Homepage

located in a drop‐down menu at the left of the screen. By clicking on each section, the similar routines within the section appear below and in the center section of the screen.

and link indicate various aspects the routine offers. For instance, if the report features trending, PBM detail or is downloadable to Microsoft Excel.

Routine Name and Description‐ A link to the analysis or reporting routine appears in the center of the screen with a description of the function at the right.

Quick Links – The most recent routines run by the user are listed under Quick Links. Below this section are the reference guides for analytics and planning functions.

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Sample Report Icon –By rolling the cursor over this icon ‐a sample of the report’s output will appear in a box beside the routine’s name/link.

Data Analysis and Reporting Functions

Standard Input Page

Most Data Analysis and Reporting applications have very similar data input page layouts. Important components of the data input page are:

Data Analysis and Reporting Functions

Report Scheduling

Many Data Analysis and Reporting applications can be schedule to run automatically and the output of the report can be electronically distributed to clients and broker/consultants. Below is a screen capture of report scheduling function:

Data Analysis and Reporting Applications

Executive Summary The Executive Summary provides an overview of plan activity and utilization. This robust solution can be easily configured to present a fixed number of standard reports detailing health plan utilization, trends, benchmarks and costs. The Executive Summary can present an overview for a brief period or annual plan information in one reporting function. Claim Analysis Overview Graphical summary of claim expenditures, network discounts and employee responsibility Normative Comparison Summary Summary-level view of enrollment, cost and utilization information Utilization Benchmark Summary Comparison of utilization patterns between plan and selected national normative values Shock Claim Summary Review high-claims members and the costs incurred Monthly Cost Summary Per-month summary of claim expenditures, network discounts and employee responsibility Dental Summary View service categories associated with your dental costs Cost Distribution Summary Number of members incurring 10%, 20%, 50% and 80% of the plan's claims Plan Experience Summary Eligibility and plan cost summary on a per-month basis Rank Order Analysis Create a summary of top Payees, Providers, Diagnoses, Procedures, Drugs, PPO or Benefit Code sorted by services and/or amounts Detailed Analysis Applications - Allow drill-down from plan level to individual EOBs

• Payee - Analyze and drill-down to specific claim information for payees used by members of your plan during a time specific timeframe

• Provider - Analyze and drill-down to specific claim information for healthcare providers used by members of your plan during a time specific timeframe

• Diagnosis - Analyze and drill-down to specified claim information for diagnoses of conditions experienced by members of your plan during a specific timeframe

• Procedure - Analyze and drill-down to specified claim information for procedures performed for members of your plan during a time specific timeframe

• Prescription - Analyze and drill-down to specified claim information related to prescription drug costs for members of your plan during a time specific timeframe

• Payment - Analyze and drill-down to create a list of individual claim payment details for a specified timeframe • Health Service - Review cost and utilization information associated with groups of services performed for

plan members during a specific Lag Matrix Generator Create a paid versus incurred lag matrix for specific time periods Turn Around Time Display claim counts, charges and payments associated with different payment turnaround periods Key Utilization Indicators Summary-level trend analysis of employee census and benefits utilization

Data Analysis and Reporting Applications

Large Claim Trend Analysis Trend analysis of large claimants comparing two timeframes Medical Cost Dist (Category) Trend analysis of benefits utilization across major diagnostic categories Medical Cost Dist (Diagnosis) Trend analysis of benefits utilization across individual diagnoses IBNR Estimate Create an estimate of claims dollars incurred but not yet received based on a weighted average of historical experience. Provider Cost Comparison Compare charges and payments for specified procedures and/or provider Prescription Drug Summary Prescription costs and dispensing information Prescription Utilization Summary Review prescription types, top 10 drugs by class and name for a specific timeframe Prescription Analysis Analyze and drill-down to specified claim information related to prescription drug costs Shock Claim Detail Detailed cost and procedure information for high-claims members and the costs incurred Preventable Conditions Displays conditions that might be prevented by behavior changes, and the group's cost associated with those conditions Stop Loss Trigger Report Provide diagnosis and procedure information for select key diagnoses Stop Loss Trigger Report (One Line per Member) Abbreviated trigger diagnosis listing containing one line per applicable member during a specific timeframe Cost by Age Group Review which age groups are incurring costs Cost Summary by Employee Per-employee/member breakdown of claim costs Eligibility Overview Provides a concise view of eligibility information Eligibility Analysis Eligibility details and claim cost with drill-down Eligibility by Tier Eligibility counts based on enrollment tier Flexible and Eligibility Claim Data Query Review plan's healthcare experience database for information related to costs or utilization. Specify a time period along with other data filtering criteria when using the query

Customizable Report Package

Change Title

Add or Change Logos

Add or Change Photos and Graphics

Additional customization:

C t i h d /f t• Customize headers/footers• Choose from a number of reports• Add or change content on each page• Add logos, photos, graphics to each page

Claim Analysis Overview

A1 Manufacturing - Group ID: DEMO3Output Generated: 5/6/2010Date Range: Check Date 1/1/2010 through 3/31/2010 Comparisons: None

Total% of Total

ChargesEmployee %

Employee% of Total

ChargesDependent %

Dependent% of Total

ChargesTotal Number of Claims Processed 1,735 678 1,057

Total Number of Services 3,940 1,501 2,439 Total Charges $731,858.71 $297,902.19 40.70% $433,956.52 59.30% Total Provider Reductions $340,700.93 46.55% $121,052.42 35.53% 40.63% $219,648.51 64.47% 50.62%Total Employee Responsibility $52,923.89 7.23% $16,665.23 31.49% 5.59% $36,258.66 68.51% 8.36%

Total Exclusions $0.00 0.00% $0.00 N/A 0.00% $0.00 N/A 0.00%Total Other Insurance $6,594.07 0.90% $632.80 9.60% 0.21% $5,961.27 90.40% 1.37%Total Plan Payment $331,639.82 45.31% $159,551.74 48.11% 53.56% $172,088.08 51.89% 39.66%

This report provides an overview of claim expenditures, provider reductions and employee responsibility. These costs are broken out by employee and dependent for further analysis.

Normative Comparison Summary A1 Manufacturing - Group ID: DEMO3Output Generated: 5/6/2010Date Range: Check Date 4/1/2009 through 3/31/2010 Comparisons: None

Enrollments, Payments & SavingsTotal Health Plan Contracts 236

Total Health Plan Members 576

Members per Contract 2.44Average Member Age 39.49Average Employee Age 51.47

Inpatient Facility $228,218.78Outpatient Facility $434,813.77Inpatient Professional $4,456.83Outpatient Professional $574,442.98Dental $156,277.06Total Plan Payment $1,398,209.42

Total Charges $3,238,398.11Total Plan Payment $1,398,209.42Employee Responsibility $212,965.81Other Insurance COB $18,834.20Not Covered $849,237.51Overall N/W Savings Amount $759,151.17

Overall N/W Savings Percent 23.44%

* Derived from: Employer Health Benefits 2009 Annual Survey (#7936), The Henry J. Kaiser Family Foundation and HRET, September 2009, This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible analysis and information on health issues.

Utilization Statistics Claim Type

Statistics

Group

Norm

% Difference

Norm Category

All Medical Claims

Services/1000 Members 20,113

Plan Payment/Member $2,156.13

Plan Payment/Contract $5,262.43 $8,932.81 -41.09% National, Overall*

Plan Payment/Contract $5,262.43 $9,113.36 -42.26% 200 or More EEs*

Plan Payment/Contract $5,262.43 $8,996.68 -41.51% Midwest Region*

Plan Payment/Contract $5,262.43 $8,184.88 -35.71% Agriculture/Mining/Construction*

Inpatient Facility


Plan Payment/Member $396.21

Plan Payment/Contract $967.03

Admissions/1000 Members 85

Average Length of Stay (Days) 1.3

Days/1000 Members 115

Outpatient Facility



Plan Payment/Contract $1,842.43

Inpatient Professional

Services/1000 Members 30


Plan Payment/Contract $18.88

Outpatient Professional



Plan Payment/Contract $2,434.08

Per-Network SavingsPPO Charges Exclusions Discount

Amount%

SavingsABCPPO $2,336,475.63 $0.00 $745,345.50 31.90%DEFPPO $41,824.33 $0.00 $189.19 0.45%Other $860,098.15 $0.00 $13,616.48 27.99%Total $3,238,398.11 $0.00 $759,151.17 23.44%

In-Network StatisticsNumber of Services 10425 (70.97%)Plan Payment $878,777.00 (62.85%)

Claim Type % Services Plan PaymentInpatientFacility 11.72% 24.35%Outpatient Facility 38.91% 40.41%Inpatient Professional 0.15% 0.46%Outpatient Professional 49.16% 34.55%

Top Five Payees by Plan Payment

Payee % of Payments PaymentsASSOCIATED ASSOC 26.85% $375,396.60

ASSISTANCE INC 14.82% $207,226.07

ASSOCIATED HOSPITAL 6.96% $97,321.46

ENDOCR ASSOC 3.31% $46,286.50

ASSISTANCE MEDICAL CENTER 3.18% $44,478.70

All Other Payees 44.88% $627,500.09

Utilization Benchmark Summary

This application displays a summary of your group's utilization versus selected benchmark values. The benchmark values were derived from information supplied through the United States Department of Health and Human Services, Centers for Disease Control and Prevention. Note that if a particular service is not available through your plan, this application will show little or no utilization for that service category.


Benchmark TypeValue For

Group

National Benchmark

Value

Percent Variance

from Benchmark

Medical Encounters % persons having at least one office visit, home visit or ER visit 31.9444% 12.8548% 149%ER Services % persons under 18 who had at least one ER visit 2.2727% 2.8603% -21% % persons under 6 who had at least one ER visit N/A N/A N/A % persons between 6 and 17 who had at least one ER visit 2.2727% 2.5479% -11% % persons between 18 and 64 who had at least one ER visit 2.0225% 2.8438% -29% % persons 65 and older who had at least one ER visit 0.0000% 3.8959% -100%Dental Services % persons under 18 who had at least one dental visit 50.0000% 12.5260% 299% % persons between 18 and 64 who had at least one dental visit 25.1685% 10.4384% 141%Mammography Services % women age 40 and over who received a mammogram 8.6331% 5.4904% 57% % women age 40 to 49 who received a mammogram 10.2564% 5.2192% 97% % women age 50 to 64 who received a mammogram 9.3023% 5.9014% 58% % women age 65 and over who received a mammogram 0.0000% 5.2438% -100%

Infectious Diseases % persons presenting Hepatitis cases 0.1736% 0.0005% 31,807% % persons presenting Tuberculosis cases 0.0000% 0.0008% -100% % persons presenting STD cases (Syphilis, Chlamydia, Gonorrhea) 0.0000% 0.0755% -100% % persons presenting Symptomatic HIV cases 0.1736% 0.0023% 7,537%

Cancers % persons presenting Cancer cases (All Types) 0.5208% 0.0734% 609% % persons presenting Lung Cancer cases 0.0000% 0.0091% -100% % persons presenting Colon and Rectum Cancer cases 0.0000% 0.0078% -100% % persons presenting Prostate Cancer cases 0.1736% 0.0262% 563% % persons presenting Breast Cancer cases 0.1736% 0.0199% 773% % persons presenting Leukemia cases 0.0000% 0.0020% -100%Diabetes % persons having services associated with physician-diagnosed, non-pregnancy diabetes 2.0833% 1.2000% 74%

Shock Claim Summary

Excluded Prescription Details from PBM Included Prescription Payments from Adjudication System Shock Claim Threshold: $15,000.00


# of members with claims above threshold: 7Total Plan Payment in claims above threshold: $53,130.47Total Plan Payment for claimants with claims above threshold: $158,130.47Total Plan Payment in claims: $745,126.43

Member SSNTotal Plan

PaymentMost Expensive

Primary DiagnosisTotal

ChargePlan

Payment Provider

1. FOWPAQIQ, WILLIAM 991143626 $30,463.97 722.10 - LUMBAR DISC DISPLACEMENT $11,823.22 $10,050.59 ASSOCIATED MEDICAL CENTER

722 - INTERVERTEBRAL DISC DISORDERS

$11,201.00 $9,362.28 ASSOCIATED ASSOC

V76.51 - SCREEN MALIG NEOP-COLON $2,476.73 $2,352.89 GREEN PHYSICIANS

2. JPQGEGCACTKA, ROB

997682358 $26,020.52 198 - SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES

$10,446.00 $7,932.30 ASSOCIATED LAB

185 - MALIGN NEOPL PROSTATE $6,810.74 $6,180.71 ASSOCIATED ASSOC

185 - MALIGN NEOPL PROSTATE $4,445.00 $3,478.00 ASSOCIATED LAB

3. GEGXQCOAR, KAYTIE 998311426 $25,320.30 558 - OTHER NONINFECTIVE GASTROENTERITIS AND COLITIS

$24,504.78 $11,923.53 ASSISTANCE MEDICAL CENTER

558 - OTHER NONINFECTIVE GASTROENTERITIS AND COLITIS

$4,489.75 $3,421.00 PARTNERS SPECIALIST

787 - SYMPTOMS INVOLVING DIGESTIVE SYSTEM

$5,942.04 $2,009.71 ASSOCIATED ASSOC

4. JOQIVR, DAWN 994438551 $23,249.19 727.64 - RUPT FLEXOR TENDON HAND $9,428.40 $4,947.78 ASSOCIATED ASSOC

789.09 - ABDMNAL PAIN OTH SPCF ST $7,221.00 $4,838.03 ASSOCIATED MEDICAL CENTER

753.10 - CYSTIC KIDNEY DISEAS NOS $5,928.50 $3,972.08 ASSOCIATED ASSOC

5. GTAG, FRANK 995385415 $22,050.00 726.0 - ADHESIVE CAPSULIT SHLDER $20,093.00 $18,065.00 ASSOCIATED ASSOC

727 - OTHER DISORDERS OF SYNOVIUM, TENDON, AND BURSA

$6,993.00 $2,596.00 ASSOCIATED BONE & JOINT

726 - PERIPHERAL ENTHESOPATHIES AND ALLIED SYNDROMES

$1,116.00 $718.00 ASSOCIATED BONE & JOINT

6. FAANW, STEVE 995811557 $15,682.88 723 - OTHER DISORDERS OF CERVICAL REGION

$18,540.00 $5,600.00 ASSOCIATED MED CTR

721 - SPONDYLOSIS AND ALLIED DISORDERS

$4,283.00 $3,426.40 ASSOCIATED HOSPITAL

723 - OTHER DISORDERS OF CERVICAL REGION

$1,520.00 $1,232.00 ENDOCR ASSOC

7. PADJOQXE, WILLIAM 997822358 $15,343.61 296.80 - BIPOLAR DISORDER NOS $11,286.18 $7,964.64 ASSOCIATED ASSOC

296.89 - BIPOLAR DISORDER NEC $4,229.25 $2,520.00 ASSOCIATED HOSPITAL

296.89 - BIPOLAR DISORDER NEC $2,746.32 $2,246.32 ASSOCIATED LAB

This report lists those claimants whose total paid claims during the period specified were greater than or equal to the amount shown. Entries are shown in descending order of total dollars paid. Amounts shown may not reflect adjustments or reversals made outside the specified time period shown on this report.

Monthly Cost Summary


Date Range 10/1/2009 10/31/2009

11/1/2009 11/30/2009

12/1/2009 12/31/2009

1/1/2010 1/31/2010

2/1/2010 2/28/2010

3/1/2010 3/31/2010

Average/Total

Employees 236 236 236 236 236 236 236

Members 576 576 576 576 576 576 576

Medical Plan Payment $67,982.48 $115,900.27 $125,330.69 $88,692.21 $76,831.06 $70,634.39 $545,371.10

Dental Plan Payment $17,216.90 $12,562.10 $14,012.40 $9,851.20 $12,344.70 $14,495.00 $80,482.30

Other Plan Payment $25,045.18 $18,771.73 $16,664.86 $20,812.59 $17,658.09 $20,320.58 $119,273.03

Total Plan Payment $110,244.56 $147,234.10 $156,007.95 $119,356.00 $106,833.85 $105,449.97 $745,126.43

Dental Service Summary

This report indicates the types of services your dental dollars have provided.


# of Services

Total Charges

(Discount Amount)

Eligible Charges

Patient Responsibility

Plan Payment Other Discount

AmountDiagnostic Services 630 $24,187.00 $58.00 $24,129.00 $944.00 $19,049.90 $4,135.10 0.29%

Preventive Dental Services 504 $26,706.00 $28.00 $26,678.00 $0.00 $21,301.50 $5,376.50 0.13%

Restorative Dental Services 247 $53,456.00 $232.00 $53,224.00 $16,534.05 $24,339.20 $12,350.75 0.56%

Endodontics 14 $7,185.00 $0.00 $7,185.00 $1,227.28 $4,609.10 $1,348.62 0.00%Periodontics 50 $5,818.00 $0.00 $5,818.00 $1,360.10 $3,365.00 $1,092.90 0.00%Removable Prosthodontics 7 $5,915.00 $0.00 $5,915.00 $1,900.50 $1,850.50 $2,164.00 0.00%

Fixed Prosthodontics 17 $10,453.00 $0.00 $10,453.00 $3,049.50 $2,918.50 $4,485.00 0.00%

Oral and Maxillofacial Surgery

64 $11,330.00 $72.00 $11,258.00 $1,866.40 $3,770.10 $5,621.50 1.26%

Other Dental Procedures 39 $3,973.00 $0.00 $3,973.00 $557.00 $283.00 $3,133.00 0.00%

Total 1,572 $149,023.00 $390.00 $148,633.00 $27,438.83 $81,486.80 $39,707.37 0.36%

Cost Distribution Summary

Total Plan Payment: $745,126.43 Total Employees with Claims: 243


# of Employees % of EmployeesWith Claims $ Claims Cost

Employees Representing 10% of Cost 1 0.41% $119,273.03Employees Representing 20% of Cost 2 0.82% $150,798.59Employees Representing 50% of Cost 15 6.17% $378,764.93Employees Representing 80% of Cost 62 25.51% $597,729.88

Top 10 Primary Diagnosis by Plan Payment Amount


Primary DiagnosisNumber

of Services

Total Charge Amount

Discount Amount

Employee Responsibility

AmountOther

AmountPlan Payment

Amount

780 - GENERAL SYMPTOMS 87 $128,292.93 $2,264.69 $666.70 $0.00 $124,043.64Not Specified 1,608 $145,868.97 $447.18 $20,207.00 $1,099.00 $83,757.84722 - INTERVERTEBRAL DISC DISORDERS 110 $104,031.40 $50,248.90 $2,062.02 $0.00 $19,588.08726.0 - ADHESIVE CAPSULIT SHLDER 9 $20,093.00 $149.00 $1,759.00 $0.00 $18,065.00558 - OTHER NONINFECTIVE GASTROENTERITIS AND COLITIS 41 $29,722.53 $11.70 $328.86 $0.00 $15,391.83

474.10 - HYPERTROPHY T AND A 44 $30,309.19 $4,782.91 $1,738.96 $0.00 $14,286.52722.10 - LUMBAR DISC DISPLACEMENT 17 $20,502.38 $1,228.38 $807.17 $0.00 $14,229.10185 - MALIGN NEOPL PROSTATE 78 $14,259.13 $1,648.09 $244.15 $0.00 $11,996.89786 - SYMPTOMS INVOLVING RESPIRATORY SYSTEM AND OTHER CHEST SYMPTOMS 67 $27,131.10 $4,488.00 $1,486.81 $0.00 $11,883.39

250 - DIABETES MELLITUS 102 $16,520.07 $4,883.98 $574.01 $0.00 $9,944.68Total in Top 10 2,163 $536,730.70 $70,152.83 $29,874.68 $1,099.00 $323,186.97 All Other 5,935 $1,197,831.12 $305,127.35 $86,942.24 $6,420.84 $421,939.46Grand Total 8,098 $1,734,561.82 $375,280.18 $116,816.92 $7,519.84 $745,126.43

Top 25 Drug Names by Plan Payment Amount


Drug NameNumber

of Services

Total Charge Amount

Discount Amount

Employee Responsibility

AmountOther

AmountPlan Payment

Amount

LIPITOR TABLETS 96 $13,905.67 $1,727.16 $3,750.00 $0.00 $8,428.51AVONEX ADMIN PACK 30MCG S 2 $9,772.88 $3,447.26 $120.00 $0.00 $6,205.62NEXIUM CAPSULES DELAYED RELEASED 44 $8,455.92 $1,637.63 $1,350.00 $0.00 $5,468.29PREVACID CAPSULES DELAYED RELEASE 26 $4,556.25 $596.10 $870.00 $0.00 $3,090.15ACIPHEX TABLETS 11 $2,820.27 $144.38 $450.00 $0.00 $2,225.89RYTHMOL SR 425MG CAPSULE 3 $2,525.35 $274.57 $150.00 $0.00 $2,100.78ZYRTEC TABLETS 45 $4,307.17 $732.86 $1,620.00 $0.00 $1,954.31ZOLOFT TABLETS 37 $3,578.78 $524.14 $1,123.58 $0.00 $1,931.06BEXTRA TABLETS 17 $2,740.11 $346.63 $600.00 $0.00 $1,793.48HUMALOG INJECTION 26 $3,159.56 $641.39 $780.00 $0.00 $1,738.17CELEBREX CAPSULES 21 $2,520.36 $202.66 $690.00 $0.00 $1,627.70PRAVACHOL TABLETS 14 $2,334.48 $286.67 $540.00 $0.00 $1,507.81GEODON CAPSULES 4 $1,753.73 $194.00 $150.00 $0.00 $1,409.73ALLEGRA TABLETS 26 $2,727.75 $438.79 $900.00 $0.00 $1,388.96PENTASA CAPSULES CONTROLLED RELEASE 7 $2,286.83 $852.12 $150.00 $0.00 $1,284.71OXYCONTIN TABLETS CONTROLLED RELEASE 5 $1,647.50 $308.97 $150.00 $0.00 $1,188.53ZOCOR TABLETS 11 $1,761.42 $240.82 $390.00 $0.00 $1,130.60ONE TOUCH ULTRA TEST STRI 7 $1,592.77 $164.93 $300.00 $0.00 $1,127.84LEXAPRO TABLETS 32 $2,683.15 $457.83 $1,110.00 $0.00 $1,115.32NORVASC TABLETS 37 $2,760.59 $416.07 $1,260.00 $0.00 $1,084.52CONCERTA METHYLPHENIDATE HCL EXTENDED RELEASE TABL 16 $2,033.33 $564.81 $420.00 $0.00 $1,048.52

LAMISIL TABLETS 4 $1,280.46 $201.34 $120.00 $0.00 $959.12ADVAIR DISKUS INH PWR 6 $1,228.36 $140.49 $210.00 $0.00 $877.87CARTIA XT CAPSULES 18 $1,031.12 ($5.95) $180.00 $0.00 $857.07DIOVAN HCT TABLETS 19 $1,907.24 $337.71 $720.00 $0.00 $849.53Total in Top 25 534 $85,371.05 $14,873.38 $18,103.58 $0.00 $52,394.09 All Other 10,061 $1,856,960.82 $398,908.07 $155,332.57 $7,519.84 $805,381.89Grand Total 10,595 $1,942,331.87 $413,781.45 $173,436.15 $7,519.84 $857,775.98

Detailed Analysis Applications – Allow drill-down from plan level to individual EOBs Analysis Applications Include: • Payee - Analyze and drill-down to specific claim information for payees used by members of your plan during a time

specific timeframe • Provider - Analyze and drill-down to specific claim information for healthcare providers used by members of your

plan during a time specific timeframe • Diagnosis - Analyze and drill-down to specified claim information for diagnoses of conditions experienced by

members of your plan during a specific timeframe • Procedure - Analyze and drill-down to specified claim information for procedures performed for members of your

plan during a time specific timeframe • Prescription - Analyze and drill-down to specified claim information related to prescription drug costs for members

of your plan during a time specific timeframe • Payment - Analyze and drill-down to create a list of individual claim payment details for a specified timeframe • Health Service - Review cost and utilization information associated with groups of services performed for plan

members during a specific timeframe

Sample: Payee Analysis Output

Sample System-Generated EOB

Lag Matrix

Output Generated: 5/6/2010 Vertical Date: Service Through Date 1/1/2010 through 4/30/2010 Horizontal Date: Check Date 1/1/2010 through 4/30/2010 (Paid Data) Comparisons: None

A1 Manufacturing - Group ID: DEMO3

Service Through DateCheck Date 1/2010 2/2010 3/2010 4/2010 Totals

Prior $88,277.40 $13,116.83 $6,652.24 $5,959.63 $114,006.101/2010 $31,078.60 $55,515.09 $24,471.61 $27,049.53 $138,114.832/2010 $0.00 $38,201.93 $36,996.05 $13,235.56 $88,433.543/2010 $0.00 $0.00 $37,330.07 $37,174.01 $74,504.084/2010 $0.00 $0.00 $0.00 $25,526.64 $25,526.64

Specified Range Totals $31,078.60 $93,717.02 $98,797.73 $102,985.74 $326,579.09Overall Totals $119,356.00 $106,833.85 $105,449.97 $108,945.37 $440,585.19

This report provides a matrix display of when your benefit costs were incurred versus when they were paid. Payment lag is a function of both provider billing and administrator payment processing.

Turn Around Time Summary A1 Manufacturing - Group ID: DEMO3Output Generated: 5/6/2010Date Range: Check Date 1/1/2010 through 4/30/2010 (Paid Data)Comparisons: None Turn Around

Days# Claims Cumulative

% of TotalTotal Charges Cumulative

%of TotalPlan Payments Cumulative

% of Total0 15 0.65% $3,404.00 0.36% $893.00 0.20%1 422 19.02% $234,215.56 24.84% $116,063.78 26.54%2 224 28.77% $91,834.19 34.44% $51,586.58 38.25%3 7 29.07% $2,182.28 34.67% $0.00 38.25%4 99 33.38% $76,290.70 42.64% $39,146.87 47.14%5 558 57.67% $245,031.82 68.25% $101,553.91 70.19%6 630 85.10% $203,489.35 89.52% $107,616.73 94.62%7 52 87.36% $14,942.58 91.08% $6,215.82 96.03%8 2 87.45% ($15,308.00) 89.48% ($14,663.25) 92.70%9 39 89.15% $13,530.04 90.89% $7,558.01 94.42%

10 101 93.55% $33,809.32 94.42% $14,708.89 97.76%11-15 137 99.51% $56,259.69 100.30% $12,697.50 100.64%16-20 3 99.64% $583.47 100.36% $114.00 100.67%21-25 1 99.68% $52.00 100.37% $41.60 100.68%26-30 2 99.77% ($3,540.00) 100.00% ($110.00) 100.66%

31 or greater 5 99.99% $96.00 100.01% ($2,838.25) 100.02%Total 2,297 $956,873.00 $440,585.19

Key Utilization Indicators

Date Range 1: Check Date 1/1/2009 through 4/30/2009 (120 days) Date Range 2: Check Date 1/1/2010 through 4/30/2010 (120 days) Comparisons: None


Check Date 1/1/2009 - 4/30/2009

Check Date 1/1/2010 - 4/30/2010 % Difference

Enrollment Average Member Age 39.24 40.24 2.55%Average Employee Age 51.22 52.22 1.95%Number of Enrollment Contracts 236.00 236.00 0.00%Total Members 576.00 576.00 0.00%Members per Contract 2.44 2.44 0.00%Payments Inpatient Facility $8,745.02 $71,549.86 718.18%Outpatient Facility $68,244.87 $143,098.31 109.68%Inpatient Professional $36,788.54 $0.00 -100.00%Outpatient Professional $251,881.11 $175,365.72 -30.38%Dental $52,925.67 $50,571.30 -4.45%Total Payments $418,585.21 $440,585.19 5.26%Unit Cost Payment per Enrollment Contract $1,773.67 $1,866.89 5.26%Payment per Member $726.71 $764.90 5.26%Inpatient Facility Admissions/1000 Members 19.10 31.25 63.64%Average Length of Stay(Days) 2.09 1.44 -30.92%Days/1000 Members 39.93 45.14 13.04%Services/1000 Members 71.18 1,194.44 1,578.05%Payment/Service $213.29 $104.00 -51.24%Payment/Member $15.18 $124.22 718.18%Payment/Contract $37.06 $303.18 718.18%Outpatient Facility Services/1000 Members 795.14 2,687.50 237.99%Payment/Service $149.01 $92.44 -37.96%Payment/Member $118.48 $248.43 109.68%Payment/Contract $289.17 $606.35 109.68%Inpatient Professional Services/1000 Members 192.71 0.00 -100.00%Payment/Service $331.43 $0.00 -100.00%Payment/Member $63.87 $0.00 -100.00%Payment/Contract $155.88 $0.00 -100.00%Outpatient Professional Services/1000 Members 4,397.57 3,366.32 -23.45%Payment/Service $99.44 $90.44 -9.05%Payment/Member $437.29 $304.45 -30.38%Payment/Contract $1,067.29 $743.08 -30.38%This report provides an overview of your group’s medical cost and utilization. Key indicators can help identify both where positive changes have occurred and where potential problems exist.

Large Claim Trend

Output Generated: 5/6/2010 Date Range 1: Check Date 9/1/2009 through 12/31/2009 Threshold 1: $10,000.00 Date Range 2: Check Date 1/1/2010 through 4/30/2010 Threshold 2: $10,000.00 Comparisons: None


9/1/2009 - 12/31/2009 1/1/2010 - 4/30/2010


# of Employees

% of Employees With Claims

Employees Representing 10% of Cost 1 0.42%





# of Employees

% of Employees With Claims





Large Claimants

ClaimantDate Range

1 Cost

Date Range 1 Diagnoses

Date Range 2

CostDate Range 2

Diagnoses

WILLIAM FOWPAQIQ (991143626)

$24,806.71 722.10 - LUMBAR DISC DISPLACEMENT 722 - INTERVERTEBRAL DISC DISORDERS

$5,672.26 Not over Threshold V76.51 - SCREEN MALIG NEOP-COLON 569.89 - INTESTINAL DISORDERS NEC V72.83 - OTH SPCF PREOP EXAM

FRANK GTAG (995385415)

$22,050.00 726.0 - ADHESIVE CAPSULIT SHLDER727 - OTHER DISORDERS OF

$0.00 Not over Threshold

Medical Benefits Category Distribution

Date Range 1: Check Date 1/1/2009 through 4/30/2009 Date Range 2: Check Date 1/1/2010 through 4/30/2010 Number of Days in Date Range 1: 120 Number of Days in Date Range 2: 120 Grouping Type: Standard AMA Grouping Comparisons: None


Date Range 1 (Check Date 1/1/2009 through 4/30/2009)

Date Range 2 (Check Date 1/1/2010 through 4/30/2010 ) % Changes

Diagnosis Category# of

Services (1)

Total Charges (1)

Payment Amount (1)

# of Admits

(1)

Avg Length

of Stay (1)

# of Services

(2)Total

Charges (2)Payment

Amount (2)# of

Admits (2)

Avg Length

of Stay (2)

# of Services

Total Charges

Payment Amount

Infectious, Parasitic 43 $2,792.85 $1,332.96 0 0.00 49 $4,532.27 $2,254.78 0 0.00 13.95 62.28 69.16Neoplasms 147 $80,276.57 $41,604.75 0 0.00 164 $42,505.70 $21,106.49 0 0.00 11.56 -47.05 -49.27Endocrine, Nutritional/Metabolic/Immunity 182 $20,897.46 $6,479.72 1 1.00 362 $38,122.23 $19,322.53 2 1.00 98.90 82.43 198.20

Blood, Blood-Forming Organs 22 $1,616.00 $220.00 0 0.00 26 $1,541.40 $647.85 0 0.00 18.18 -4.62 194.48Mental 69 $14,823.81 $3,491.62 0 0.00 178 $43,917.38 $28,218.02 3 3.33 157.97 196.26 708.16Nervous System, Sense Organs 141 $35,871.84 $19,394.59 0 0.00 157 $31,308.46 $13,552.02 0 0.00 11.35 -12.72 -30.12

Circulatory System 144 $59,015.54 $35,249.33 2 1.00 163 $15,196.20 $5,779.19 0 0.00 13.19 -74.25 -83.60Respiratory System 256 $26,044.30 $14,267.08 0 0.00 219 $49,366.04 $26,499.14 1 2.00 -14.45 89.55 85.74Digestive System 122 $51,764.24 $38,109.94 0 0.00 207 $65,679.79 $16,729.95 2 1.00 69.67 26.88 -56.10Genitourinary System 113 $34,131.25 $10,565.18 1 1.00 109 $16,066.27 $8,380.03 0 0.00 -3.54 -52.93 -20.68Pregnancy, Childbirth, Puerperium 58 $27,204.76 $13,274.96 2 4.00 56 $44,532.31 $21,914.76 4 1.00 -3.45 63.69 65.08

Skin, Subcutaneous Tissue 56 $6,291.35 $3,117.95 0 0.00 76 $8,606.05 $4,644.53 0 0.00 35.71 36.79 48.96Musculoskeletal System, Connective Tissue 553 $111,465.81 $43,633.76 1 1.00 677 $118,948.22 $31,815.94 1 1.00 22.42 6.71 -27.08

Congenital Anomalies 16 $3,581.33 $1,991.73 0 0.00 7 $6,245.50 $4,187.08 0 0.00 -56.25 74.39 110.22Certain Conditions Originating in the Perinatal Period 1 $338.00 $193.50 0 0.00 0 $0.00 $0.00 0 0.00 0.00 0.00 0.00

Ill-Defined Conditions 344 $106,586.47 $81,126.43 0 0.00 456 $163,645.96 $114,827.56 0 0.00 32.56 53.53 41.54Injury, Poisoning 285 $46,219.79 $24,128.57 0 0.00 391 $104,233.33 $18,624.75 0 0.00 37.19 125.52 -22.81External Causes of Injury, Poisoning 0 $0.00 $0.00 0 0.00 0 $0.00 $0.00 0 0.00 0.00 0.00 0.00

Factors Influencing Health Status, Contact with Health Services

568 $59,265.58 $26,202.47 4 2.50 855 $93,349.89 $50,991.47 5 1.00 50.53 57.51 94.61

Other Categories 1,154 $123,179.35 $54,200.67 0 0.00 1,016 $109,076.00 $51,089.10 0 0.00 -11.96 -11.45 -5.74Total Diagnoses: 6,822 4,274 $811,366.30 $418,585.21 11 2.09 5,168 $956,873.00 $440,585.19 18 1.44

This table displays data by diagnosis category for the selected reporting periods. Because pharmacy drug claims are submitted without a diagnosis, they will fall into the `Other` category unless they are excluded from this report using comparison fields. Information on high cost diagnostic categories can be used to assess benefits plan design and to promote employee awareness. It is useful to review changes in medically diagnosed illnesses or injuries (diagnostic categories) to understand shifts in the mix of services and length of stay for your group.

Medical Benefits Distribution Comparison

This table displays data by diagnosis code for the selected reporting periods. Because pharmacy drug claims are submitted without a diagnosis, they will fall into the `Other` category unless they are excluded from this report using comparison fields. Information on high cost diagnostic categories can be used to assess benefits plan design and to promote employee awareness. It is useful to review changes in medically diagnosed illnesses or injuries (diagnostic categories) to understand shifts in the mix of services and length of stay for your group.

A1 Manufacturing - Group ID: DEMO3Output Generated: 5/6/2010Date Range 1: Check Date 1/1/2009 through 4/30/2009 (120 days)Date Range 2: Check Date 1/1/2010 through 4/30/2010 (120 days)Comparisons: None (If grid is empty click here to refresh.) Page 1 of 31 Table Usage Hints<< < > >>

Total Diagnoses: 753 4,274 $811,366.30 $418,585.21 11 2.09 5,168 $956,873.00 $440,585.19 18 1.44

Diagnosis Code # of ... Total Charges (1) Payment Amo... ... Avg ... # of ... Total Charges (2) Payment Amoun... ... Avg ... % Chang... % C

1 Other 1154 $123,179.35 $54,200.67 ... 0.00 1016 $109,076.00 $51,089.10 ... 0.00 -11.962 034 - STREPTOCOCCAL SORE THROAT AND ... 4 $209.00 $18.00 ... 0.00 0 $0.00 $0.00 ... 0.00 0.003 034.0 - STREP SORE THROAT 2 $120.00 $87.00 ... 0.00 2 $178.00 $113.00 ... 0.00 0.004 054 - HERPES SIMPLEX 0 $0.00 $0.00 ... 0.00 4 $156.00 $72.00 ... 0.00 0.005 057 - OTHER VIRAL EXANTHEMATA 1 $198.00 $0.00 ... 0.00 0 $0.00 $0.00 ... 0.00 0.006 057.9 - VIRAL EXANTHEMATA NOS 0 $0.00 $0.00 ... 0.00 1 $85.00 $34.00 ... 0.00 0.007 070 - VIRAL HEPATITIS 12 $370.00 $192.00 ... 0.00 6 $578.33 $283.00 ... 0.00 -50.008 074.0 - HERPANGINA 0 $0.00 $0.00 ... 0.00 3 $205.00 $88.00 ... 0.00 0.009 074.3 - HAND FOOT & MOUTH DIS 0 $0.00 $0.00 ... 0.00 1 $84.00 $46.00 ... 0.00 0.0010 078 - OTHER DISEASES DUE TO VIRUSES AN... 2 $107.00 $56.80 ... 0.00 5 $521.00 $290.00 ... 0.00 150.0011 078.10 - VIRAL WARTS NOS 3 $315.00 $221.00 ... 0.00 7 $695.44 $374.00 ... 0.00 133.3312 078.19 - OTH SPECFD VIRAL WARTS 2 $168.00 $113.00 ... 0.00 3 $283.00 $154.00 ... 0.00 50.0013 079 - VIRAL INFECTION IN CONDITIONS CLA... 2 $220.00 $61.00 ... 0.00 1 $182.60 $131.47 ... 0.00 -50.0014 079.99 - VIRAL INFECTION NOS 5 $256.00 $138.90 ... 0.00 2 $427.90 $83.09 ... 0.00 -60.0015 110 - DERMATOPHYTOSIS 3 $118.65 $43.00 ... 0.00 7 $665.00 $387.22 ... 0.00 133.3316 110.1 - DERMATOPHYTOSIS OF NAIL 1 $65.00 $42.00 ... 0.00 0 $0.00 $0.00 ... 0.00 0.0017 110.4 - DERMATOPHYTOSIS OF FOOT 0 $0.00 $0.00 ... 0.00 1 $145.00 $87.00 ... 0.00 0.0018 110.5 - DERMATOPHYTOSIS OF BODY 0 $0.00 $0.00 ... 0.00 1 $121.00 $0.00 ... 0.00 0.0019 111 - DERMATOMYCOSIS OTHER AND UNS... 1 $75.00 $25.00 ... 0.00 0 $0.00 $0.00 ... 0.00 0.0020 111.0 - PITYRIASIS VERSICOLOR 1 $75.00 $42.00 ... 0.00 0 $0.00 $0.00 ... 0.00 0.0021 112 - CANDIDIASIS 3 $296.20 $206.86 ... 0.00 0 $0.00 $0.00 ... 0.00 0.0022 112.0 - THRUSH 1 $200.00 $86.40 ... 0.00 0 $0.00 $0.00 ... 0.00 0.0023 112.1 - CANDIDAL VULVOVAGINITIS 0 $0.00 $0.00 ... 0.00 1 $55.00 $6.00 ... 0.00 0.0024 117 - OTHER MYCOSES 0 $0.00 $0.00 ... 0.00 4 $150.00 $106.00 ... 0.00 0.0025 157 - MALIGNANT NEOPLASM OF PANCREAS 10 $16,429.00 $6,337.00 ... 0.00 0 $0.00 $0.00 ... 0.00 0.00

IBNR Estimate


Month Monthly Claim Dollars

One Day Avg Paid

Avg Days Lag for Month

One Day Weighted Avg Paid

Weighted Avg Days Lag for Month

April 2009 $72,598.53 $3,830.71 18.95 $4,082.88 17.78May 2009 $130,274.00 $3,830.71 34.01 $4,082.88 31.91June 2009 $79,428.32 $3,830.71 20.73 $4,082.88 19.45July 2009 $176,931.81 $3,830.71 46.19 $4,082.88 43.34August 2009 $73,859.58 $3,830.71 19.28 $4,082.88 18.09September 2009 $119,990.75 $3,830.71 31.32 $4,082.88 29.39

October 2009 $110,244.56 $3,830.71 28.78 $4,082.88 27.00November 2009 $147,234.10 $3,830.71 38.44 $4,082.88 36.06

December 2009 $125,922.46 $3,830.71 32.87 $4,082.88 30.84

January 2010 $149,441.49 $3,830.71 39.01 $4,082.88 36.60February 2010 $106,833.85 $3,830.71 27.89 $4,082.88 26.17

March 2010 $105,449.97 $3,830.71 27.53 $4,082.88 25.83Totals $1,398,209.42 365.00 342.466 Month Totals $1,490,252.86

One day average dollar paid $1,398,209.42 / 365 = $3,830.71One day weighted average dollar paid $1,490,252.86 / 365 = $4,082.88Average days lag for the year 365.00 / 12 = 30.42Weighted average days lag for the year 342.46 / 12 = 28.54Estimate of incurred but not reported claims 30.42 x $3,830.71 = $116,530.20Weighted est of incurred but not reported claims 28.54 x $4,082.88 = $116,525.40

This report provides an IBNR estimate based on historical utilization patterns.

Provider Cost Comparison

Prescription Drug Summary

* Discount % equals Discount Amount divided by Total Charges ** Prescriptions labeled as Unclassifiable include drugs whose dispensing details were not available from the provider. These often include drugs administered in a clinical setting. This report answers the following questions: (1) What percent off of Total Charges are pharmacy networks saving my health benefit plan? (2) What is the distribution of generic and brand name prescriptions (both by number and cost) in my benefit plan? (3) How often are employees getting a brand name prescription when a generic is available? (4) How often are employees getting a brand name prescription due to it being prescribed "dispense as written"?


COST SHARE ANALYSIS # of ALL RX

Total Charges

(Discount Amount)

= EligibleCharges

Patient Responsibility

Plan Payment

DiscountPercent

*GENERIC 574 $18,820.31 $3,138.56 $15,681.75 $5,971.53 $9,710.22 16.68%BRAND 679 $86,189.29 $16,827.30 $69,361.99 $22,331.39 $47,030.60 19.52%BRAND - DAW 1 (DR. REQUEST) 23 $3,095.91 $402.12 $2,693.79 $783.60 $1,910.19 12.99%

UNCLASSIFIABLE 2 $204.09 $9.57 $194.52 $54.27 $140.25 4.69%TOTAL 1278 $108,309.60 $20,377.55 $87,932.05 $29,140.79 $58,791.26 18.81%

SOURCE ANALYSIS % of ALL

RX% of Total Charges

% of Eligible Charges

% of Plan Payment

GENERIC 44.91% 17.38% 17.83% 16.52%BRAND 53.13% 79.58% 78.88% 80.00%BRAND - DAW 1 (DR. REQUEST) 1.80% 2.86% 3.06% 3.25%

UNCLASSIFIABLE 0.16% 0.19% 0.22% 0.24%TOTAL 100.00% 100.00% 100.00% 100.00%

TOTAL CHARGES, AVERAGE PER PRESCRIPTION # of ALL RX

Total Charges

AVG Charge/RX

Eligible Charges

AVG Eligible/RX

AVG Plan Payment/RX

AVG Patient Pmt/RX

GENERIC 574 $18,820.31 $32.79 $15,681.75 $27.32 $16.92 $10.40BRAND 679 $86,189.29 $126.94 $69,361.99 $102.15 $69.26 $32.89BRAND - DAW 1 (DR. REQUEST) 23 $3,095.91 $134.60 $2,693.79 $117.12 $83.05 $34.07

UNCLASSIFIABLE 2 $204.09 $102.05 $194.52 $97.26 $70.13 $27.14TOTAL 1278 $108,309.60 $84.75 $87,932.05 $68.80 $46.00 $22.80

Prescription Utilization Summary


Overview # of All RX % of All RX Total Charges Plan Payment Average Plan Payment Per RX

GENERIC 574 44.91% $18,820.31 $9,710.22 $16.92BRAND 679 53.13% $86,189.29 $47,030.60 $69.26BRAND - DAW 1 (DR. REQUEST) 23 1.80% $3,095.91 $1,910.19 $83.05UNCLASSIFIABLE 2 0.16% $204.09 $140.25 $70.13TOTAL 1278 100.00% $108,309.60 $58,791.26 $46.00

Top 10 By Drug Class # of RX % of All RX Plan Payment Average Plan Payment Per RX % of Total Paid RX

1. Unclassified 288 22.54% $18,599.79 $64.58 31.64%2. HYPERLIPIDEMIA 56 4.38% $4,712.29 $84.15 8.02% LIPITOR TABLETS 24 1.88% $2,633.55 $109.73 4.48% PRAVACHOL TABLETS 7 0.55% $740.02 $105.72 1.26% ZOCOR TABLETS 7 0.55% $599.97 $85.71 1.02%3. BLOOD GLUCOSE REGULATORS 65 5.09% $3,916.55 $60.25 6.66% LIPITOR TABLETS 23 1.80% $1,459.44 $63.45 2.48% HUMALOG INJECTION 12 0.94% $849.95 $70.83 1.45% ACTOS TABLETS 3 0.23% $397.02 $132.34 0.68%4. DISORDERS, ACID/PEPTIC 29 2.27% $2,663.99 $91.86 4.53% ACIPHEX TABLETS 7 0.55% $1,155.64 $165.09 1.97% OMEPRAZOLE DELAYED RELEASE CAPSULES 1 0.08% $334.72 $334.72 0.57% MISOPROSTOL TABLETS 3 0.23% $333.66 $111.22 0.57%5. ANTIHYPERTENSIVES 117 9.15% $2,442.12 $20.87 4.15% DIOVAN HCT TABLETS 11 0.86% $409.40 $37.22 0.70% NORVASC TABLETS 9 0.70% $334.58 $37.18 0.57% DIOVAN TABLETS 9 0.70% $318.27 $35.36 0.54%6. NSAID 31 2.43% $2,380.92 $76.80 4.05% BEXTRA TABLETS 9 0.70% $991.92 $110.21 1.69% CELEBREX CAPSULES 8 0.63% $670.01 $83.75 1.14% VIOXX TABLET 7 0.55% $423.73 $60.53 0.72%7. ANTIDEPRESSANTS 61 4.77% $2,373.25 $38.91 4.04% ZOLOFT TABLETS 17 1.33% $978.36 $57.55 1.66% LEXAPRO TABLETS 13 1.02% $455.69 $35.05 0.78% CELEXA TABLETS 6 0.47% $248.06 $41.34 0.42%8. GASTROINTESTINAL, MISCELLANEOUS 18 1.41% $1,824.56 $101.36 3.10% PREVACID CAPSULES DELAYED RELEASE 10 0.78% $1,339.32 $133.93 2.28% ASACOL TABLETS DELAYED RELEASE 2 0.16% $273.42 $136.71 0.47% OMEPRAZOLE DELAYED RELEASE CAPSULES 2 0.16% $136.96 $68.48 0.23%9. ANTIFUNGALS 12 0.94% $1,667.70 $138.98 2.84% SPORANOX CAPSULES 4 0.31% $847.90 $211.98 1.44% LAMISIL TABLETS 3 0.23% $726.36 $242.12 1.24% FLUCONAZOLE TABLETS 2 0.16% $62.70 $31.35 0.11%10. ANTIHISTAMINES 36 2.82% $1,432.47 $39.79 2.44% ZYRTEC TABLETS 27 2.11% $1,197.34 $44.35 2.04% CLARINEX TABLETS 6 0.47% $235.13 $39.19 0.40% PROMETHAZINE HCL TABLETS 3 0.23% $0.00 $0.00 0.00%

Top 10 By RX # of RX % of All RX Plan Payment Average Plan Payment Per RX % of Total Paid RX

1. LIPITOR TABLETS 47 3.68% $4,092.99 $87.08 6.96%2. NEXIUM CAPSULES DELAYED RELEASED 26 2.03% $3,146.19 $121.01 5.35%3. AVONEX ADMIN PACK 30MCG S 1 0.08% $3,102.81 $3,102.81 5.28%4. RYTHMOL SR 425MG CAPSULE 2 0.16% $1,792.62 $896.31 3.05%5. PREVACID CAPSULES DELAYED RELEASE 12 0.94% $1,524.62 $127.05 2.59%6. ZYRTEC TABLETS 27 2.11% $1,197.34 $44.35 2.04%7. GEODON CAPSULES 3 0.23% $1,172.26 $390.75 1.99%8. ACIPHEX TABLETS 7 0.55% $1,155.64 $165.09 1.97%9. BEXTRA TABLETS 9 0.70% $991.92 $110.21 1.69%10. ZOLOFT TABLETS 17 1.33% $978.36 $57.55 1.66%

Top 25 Prescription Drug Utilization by Drug


Rank Drug Name(s) Drug Class # of Rx

Total Charges

Paid Amount

% of Total Paid Amount

Average Paid Per Rx

1 NEXIUM CAPSULES DELAYED RELEASED CLASSIFICATION NOT AVAILABLE 26 5144.71 3146.19 5.4 121.01 Details

2 AVONEX ADMIN PACK 30MCG S CLASSIFICATION NOT AVAILABLE 1 4886.44 3102.81 5.3 3102.81 Details3 LIPITOR TABLETS HYPERLIPIDEMIA 24 4110.76 2633.55 4.5 109.73 Details4 RYTHMOL SR 425MG CAPSULE CLASSIFICATION NOT AVAILABLE 2 2163.36 1792.62 3.0 896.31 Details5 LIPITOR TABLETS BLOOD GLUCOSE REGULATORS 23 2720.53 1459.44 2.5 63.45 Details

6 PREVACID CAPSULES DELAYED RELEASE

GASTROINTESTINAL MISCELLANEOUS 10 1923.18 1339.32 2.3 133.93 Details

7 ZYRTEC TABLETS ANTIHISTAMINES 27 2653.25 1197.34 2.0 44.35 Details8 GEODON CAPSULES ANTIPSYCHOTICS/ANTIMANICS 3 1457.74 1172.26 2.0 390.75 Details9 ACIPHEX TABLETS DISORDERS ACID/PEPTIC 7 1369.54 1155.64 2.0 165.09 Details

10 BEXTRA TABLETS NSAID 9 1513.77 991.92 1.7 110.21 Details11 ZOLOFT TABLETS ANTIDEPRESSANTS 17 1753.98 978.36 1.7 57.55 Details12 HUMALOG INJECTION BLOOD GLUCOSE REGULATORS 12 1610.36 849.95 1.4 70.83 Details13 SPORANOX CAPSULES ANTIFUNGALS 4 1134.25 847.9 1.4 211.98 Details14 ALLEGRA TABLETS CLASSIFICATION NOT AVAILABLE 10 1403.69 767.21 1.3 76.72 Details15 PRAVACHOL TABLETS HYPERLIPIDEMIA 7 1155.68 740.02 1.3 105.72 Details16 LAMISIL TABLETS ANTIFUNGALS 3 979.47 726.36 1.2 242.12 Details

17 OXYCONTIN TABLETS CONTROLLED RELEASE ANALGESICS GENERAL 3 988.5 697.23 1.2 232.41 Details

18 CELEBREX CAPSULES NSAID 8 1023.88 670.01 1.1 83.75 Details19 ONE TOUCH ULTRA TEST STRI CLASSIFICATION NOT AVAILABLE 3 932.48 666.72 1.1 222.24 Details

20 IMITREX INJECTION STATDOSE KIT

ANTIMIGRAINE/OTHER HEADACHES 1 736.86 625.8 1.1 625.8 Details

21 ZOCOR TABLETS HYPERLIPIDEMIA 7 976.7 599.97 1.0 85.71 Details

22 PENTASA CAPSULES CONTROLLED RELEASE CLASSIFICATION NOT AVAILABLE 4 1306.76 502.66 0.9 125.67 Details

23 NEURONTIN CAPSULES ANTICONVULSANTS 4 708.06 473.52 0.8 118.38 Details24 LEXAPRO TABLETS ANTIDEPRESSANTS 13 1091.06 455.69 0.8 35.05 Details25 ADVAIR DISKUS INH PWR CLASSIFICATION NOT AVAILABLE 2 570.74 439.03 0.7 219.52 Details

DISTRIBUTION OF PAID AMOUNT # of

Prescriptions Total

Charges Paid

Amount % of Total Rx

Plan Spending

Average PaidPer

Prescription TOP 25 DRUGS 230 $44,315.75 $28,031.52 47.68% $121.88OTHER DRUGS 1048 $63,993.85 $30,759.74 52.32% $29.35TOTAL PLAN SHARE

1278 $108,309.60 $58,791.26 100.00% $46.00

Shock Claim Detail

Shock Claim Threshold: $10,000.00


# of members with claims above threshold: 6Total Plan Payment in claims above threshold: $33,773.48Total Plan Payment for claimants with claims above threshold: $93,773.48Total Plan Payment in claims: $470,670.68

Member SSN Plan Payment

Cumulative Plan

Payment

Claim Over

ThresholdClaim

Number Diagnosis Procedure Service From

Service Through Provider(s)

1. WXOJFET, LESLIE

995876656 $65.00 $65.00 No 992616615 304 - DRUG DEPENDENCE

99213 - OFFICE/OUTPATIENT VISIT, EST

12/12/2009 12/12/2009 ASSOCIATED ASSOC

$65.00 $130.00 No 994465328 461 - ACUTE SINUSITIS



$259.00 $389.00 No 991181556 303 - ALCOHOL DEPENDENCE SYNDROME

80053 - COMPREHEN METABOLIC PANEL 80061 - LIPID PANEL 80074 - ACUTE HEPATITIS PANEL 80076 - HEPATIC FUNCTION PANEL 80100 - DRUG SCREEN, QUALITATE/MULTI 80154 - ASSAY OF BENZODIAZEPINES

1/17/2010 1/17/2010 ASSISTANCE LAB


81003 - URINALYSIS, AUTO, W/O SCOPE 82055 - ASSAY OF ETHANOL 82145 - ASSAY OF AMPHETAMINES 82205 - ASSAY OF BARBITURATES 82520 - ASSAY OF COCAINE 83840 - ASSAY OF METHADONE

1/17/2010 1/17/2010 ASSISTANCE LAB


83925 - ASSAY OF OPIATES 83992 - ASSAY FOR PHENCYCLIDINE 84703 - CHORIONIC GONADOTROPIN ASSAY 85025 - COMPLETE CBC W/AUTO DIFF WBC 86592 - BLOOD SEROLOGY, QUALITATIVE

1/17/2010 1/17/2010 ASSISTANCE LAB


85025 - COMPLETE CBC W/AUTO DIFF WBC

1/23/2010 1/23/2010 ASSISTANCE LAB

$24.00 $761.60 No 998547311 V70.0 - ROUTINE MEDICAL EXAM

71020 - CHEST X-RAY 2/27/2010 2/27/2010 ASSOCIATED RADIOLOGY

$65.00 $826.60 No 997182357 070 - VIRAL HEPATITIS



$8,720.40 $9,547.00 No 991364217 304.80 - COMB DRUG DEP NEC-UNSPEC

Not Specified 1/16/2010 1/23/2010 GREEN SURGERY

$22.00 $9,569.00 No 991726664 070 - VIRAL HEPATITIS 599 - OTHER DISORDERS OF URETHRA AND URINARY TRACT

81001 - URINALYSIS, AUTO W/SCOPE 87086 - URINE CULTURE/COLONY COUNT


$0.00 $9,569.00 No 996428783 786 - SYMPTOMS INVOLVING RESPIRATORY SYSTEM AND OTHER CHEST SYMPTOMS

71020 - CHEST X-RAY 2/27/2010 2/27/2010 ASSOCIATED ASSOC

$14,663.25 $24,232.25 Yes 995351621 304.80 - COMB DRUG DEP NEC-UNSPEC


$56.00 $24,288.25 Yes 997444173 786 - SYMPTOMS INVOLVING RESPIRATORY SYSTEM AND OTHER CHEST SYMPTOMS

71020 - CHEST X-RAY 2/27/2010 2/27/2010 ASSOCIATED ASSOC

$65.00 $24,353.25 Yes 995137882 305 - NONDEPENDENT ABUSE OF DRUGS



($14,663.25) $9,690.00 No 995351621 304.80 - COMB DRUG DEP NEC-UNSPEC


$155.40 $9,845.40 No 993181165 Not Specified Not Specified 3/6/2010 3/6/2010 ASSOCIATED CARE

$14,413.25 $24,258.65 Yes 991348464 304.80 - COMB DRUG DEP NEC-UNSPEC


$177.00 $24,435.65 Yes 9951515582 070 - VIRAL HEPATITIS

87522 - HEPATITIS C, RNA, QUANT

2/16/2010 2/16/2010 ASSOCIATED SURGERY

$35.00 $24,470.65 Yes 9973124318 070 - VIRAL HEPATITIS

36415 - ROUTINE VENIPUNCTURE

2/16/2010 2/16/2010 ASSOCIATED SURGERY

Preventable Conditions

This table displays your group's experience with certain illnesses that may be modifiable using disease prevention and health promotion initiatives. Diseases and injuries are categorized as preventable when there is a modifiable factor that influences the development or severity of the condition. For example, hypertension, dietary fat, cholesterol, tobacco use, inadequate exercise and obesity are all modifiable factors that influence the risk of heart disease and stroke. Genetic predisposition and age also influence the risk of heart disease and stroke, but these factors cannot be modified.


Diagnosis Category # of Admissions

Avg Length of

Stay

Avg Plan Payment per day

# of Services

# of Patients

Avg Plan Payment per

patient

Total Charges

Total Plan Payment

Diagnosis Prefixes

ConsideredCerebrovascular Disease

- Cerebral Hemorrhage 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 430 - 432- Occlusion Cerebral Artery 0.00 0.00 0.00 2.00 1.00 $293.00 $405.00 $293.00 433 - 434

- Trans-ischemic Attack 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 435- Stroke 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 436

- Other Cerebrovascular Disease 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 437 - 438

Heart Disease- Heart Attack 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 410 & 412 - 413

- Other Acute Heart Disease 0.00 0.00 0.00 28.00 8.00 $103.64 $3,537.70 $829.08 411 & 420 - 427 &

429- Chronic Heart Disease 0.00 0.00 0.00 6.00 4.00 $64.15 $444.58 $256.58 414

- Congestive Heart Failure 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 428Manageable

- Diabetes & Related 4.00 1.00 1,004.68 147.00 20.00 $706.58 $26,584.40 $14,131.56250 & 357.2 &

362.00 & 366.41 & 648.0

- Asthma 0.00 0.00 0.00 18.00 9.00 $86.49 $1,875.38 $778.40 493Vascular Disease

- Arteriosclerosis 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 440- Aneurysm 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 441 - 442

- Peripheral Vascular Disease 0.00 0.00 0.00 1.00 1.00 $65.00 $120.00 $65.00 443

Weight-Related Disease- Obesity/Hyperalimentation 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 278

- Phlebitis 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 451- Varicose Veins 0.00 0.00 0.00 0.00 0.00 $0.00 $0.00 $0.00 454

Totals: 4.00 1.00 1,004.68 202.00 43.00 $380.32 $32,967.06 $16,353.62

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4.59

Cost by Age Group


Age Group

# of Clmnts

# of Empl

Clmnts

# of Dep

Clmnts# of Svcs

Claim Amount

Discount Amount

Discount Amount

% of Charges

Employee Resp

Employee Resp % of

Charges

Plan Payment

Plan Payment

% of Charges

0-9 73 0 73 460 $42,910.88 $10,111.04 23.56% $5,824.96 13.57% $19,448.36 45.32%10-19 119 5 114 946 $111,461.45 $19,847.95 17.81% $9,924.61 8.90% $57,491.38 51.58%20-29 69 12 57 647 $112,204.35 $27,036.29 24.10% $11,853.08 10.56% $39,968.98 35.62%30-39 62 43 19 876 $200,212.90 $47,027.70 23.49% $14,745.65 7.36% $90,489.80 45.20%40-49 113 65 48 1,378 $211,664.32 $51,350.29 24.26% $21,498.15 10.16% $83,880.04 39.63%50-59 119 74 45 1,737 $330,297.21 $50,681.49 15.34% $27,054.26 8.19% $188,849.43 57.18%60-69 36 26 10 829 $101,722.71 $21,658.70 21.29% $11,745.77 11.55% $58,074.94 57.09%70-79 6 2 4 126 $26,885.25 $2,262.37 8.41% $3,011.10 11.20% $6,474.98 24.08%80-89 0 0 0 0 $0.00 $0.00 N/A $0.00 N/A $0.00 N/ATotal 597 227 370 6,999 $1,137,359.07 $229,975.83 20.22% $105,657.58 9.29% $544,677.91 47.89%

65 & Over 11 6 5 205 $40,385.27 $5,654.92 14.00% $4,335.14 10.73% $13,724.08 33.98%

This report can be used to monitor claim amounts and network discounts by age bands for your plan.

Benefit Cost Summary By Employee

Excluded Prescription Details from PBM Included Prescription Payments from Adjudication System (If grid is empty click here to refresh.) Page 1 of 20 Table Usage Hints

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Total Claimants: 476 $1,000,530.73 $470,670.68 $454,802.95 $35,262.67 $8,856.52 $23,757.14 $0.00 $7,180.77

This report provides a per-patient indication of employee-responsibility and other claim costs during the timeframes specified.

Employee Name Patient Name SSN Total Charge Plan Payment Discount A... Coinsurance Copay Deductible Ineligible Other/COB

1 AKOLGX LESLIE A AKOLGX FRANK R 997248546 $205.00 $179.50 $25.50 $0.00 $0.00 $0.00 $0.00 $0.002 AKOLGX LESLIE A AKOLGX LESLIE M 997248546 $1,897.00 $952.88 $944.12 $0.00 $0.00 $0.00 $0.00 $0.003 AKOLGX LESLIE A AKOLGX MICHELLE A 997248546 $2,053.00 $775.00 $1,278.00 $0.00 $0.00 $0.00 $0.00 $0.004 AKOLGX LESLIE A AKOLGX TERRY M 997248546 $195.00 $157.50 $37.50 $0.00 $0.00 $0.00 $0.00 $0.005 AKOLGX LESLIE A AKOLGX TOM J 997248546 $475.00 $313.50 $146.50 $0.00 $15.00 $0.00 $0.00 $0.006 BAJJAQCEJ AL BAJJAQCEJ RON G 995534314 $103.47 $0.00 $103.47 $0.00 $0.00 $0.00 $0.00 $0.007 BBIPL ISABEL J BBIPL ED J 996825836 $1,704.40 $543.23 $101.17 $110.00 $0.00 $950.00 $0.00 $0.008 BBIPL ISABEL J BBIPL ISABEL A 996825836 $780.50 $377.75 $387.75 $0.00 $15.00 $0.00 $0.00 $0.009 BEHAG WILLIE B BEHAG JEANNIE G 997342173 $3,026.57 $698.52 $489.69 $248.69 $0.00 $300.00 $0.00 $1,289.6710 BEHAG WILLIE B BEHAG MEGAN G 997342173 $67.00 $25.00 $42.00 $0.00 $0.00 $0.00 $0.00 $0.0011 BEHAG WILLIE B BEHAG WILLIE B 997342173 $1,040.00 $648.00 $180.00 $162.00 $0.00 $50.00 $0.00 $0.0012 BESKELA KAYTIE BESKELA KAYTIE 998446227 $634.00 $175.00 $429.00 $0.00 $30.00 $0.00 $0.00 $0.0013 BESKELA KAYTIE BESKELA MICHELLE 998446227 $1,128.00 $323.80 $693.00 $61.20 $0.00 $50.00 $0.00 $0.0014 BESKELA KAYTIE BESKELA NED 998446227 $493.00 $272.00 $221.00 $0.00 $0.00 $0.00 $0.00 $0.0015 BILIQ ELIZABETH BILIQ NED 993562457 $504.63 $122.00 $382.63 $0.00 $0.00 $0.00 $0.00 $0.0016 BILIQ ELIZABETH BILIQ TOM 993562457 $85.00 $42.00 $28.00 $0.00 $15.00 $0.00 $0.00 $0.0017 BIXOGEKPNI WILLIE BIXOGEKPNI EDDY L 991545274 $2,037.94 $821.26 $1,078.18 $88.50 $0.00 $50.00 $0.00 $0.0018 BIXOGEKPNI WILLIE BIXOGEKPNI MATT... 991545274 $466.00 $283.00 $183.00 $0.00 $0.00 $0.00 $0.00 $0.0019 BIXOGEKPNI WILLIE BIXOGEKPNI WILLIE A 991545274 $186.00 $65.00 $121.00 $0.00 $0.00 $0.00 $0.00 $0.0020 BLMFAAXEG BRIAN P BLMFAAXEG BRIAN P 996551257 $2,763.00 $335.60 $2,410.40 $17.00 $0.00 $0.00 $0.00 $0.0021 BOHDIQOC AL G BOHDIQOC AL G 992156377 $79.00 $79.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.0022 BOHDIQOC AL G BOHDIQOC AL G 992156377 $353.00 $292.00 $35.00 $0.00 $0.00 $26.00 $0.00 $0.0023 BOHDIQOC AL G BOHDIQOC DAWN 992156377 $251.00 $191.00 $45.00 $0.00 $15.00 $0.00 $0.00 $0.0024 BOHDIQOC AL G BOHDIQOC KELLY F 992156377 $613.54 $359.46 $97.22 $35.27 $0.00 $121.59 $0.00 $0.0025 BOHDIQOC AL G BOHDIQOC RON E 992156377 $1,134.00 $327.00 $766.00 $0.00 $15.00 $26.00 $0.00 $0.00

Eligibility Overview

A1 Manufacturing - Group ID: DEMO3 Output Generated: 5/7/2010Eligibility Date Range: 04/01/2009 through 03/31/2010Comparisons: None

Location Employee Only Employee Plus Children Employee Plus Spouse Family TotalLocID1 66 6 27 54 153LocID13 0 0 0 1 1LocID3 14 3 9 20 46LocID8 2 0 1 5 8LocID9 12 3 4 10 29Totals 94 12 41 90 237

Headcount by Benefit

Benefit Employees MembersMedical 236 576Dental 236 575

Eligibility By Tier

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A1 Manufacturing - Group ID: DEMO3 Output Generated: 5/7/2010Eligibility Date Range: 04/01/2009 through 03/31/2010Comparisons: NoneEnrollment Tier: 4-Tier(STD)Breakdown Type: Location

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Totals: 94 12 41 90 237

Employer Location Employee Only Employee Plus C... Employee Plus S... Family Total

1 Imperium Corporation (a Sample Company) (... LocID1 66 6 27 54 1532 Imperium Corporation (a Sample Company) (... LocID13 0 0 0 1 13 Imperium Corporation (a Sample Company) (... LocID3 14 3 9 20 464 Imperium Corporation (a Sample Company) (... LocID8 2 0 1 5 85 Imperium Corporation (a Sample Company) (... LocID9 12 3 4 10 29

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