Per Member Per Month (PMPM)

Per Member Per Month (PMPM)

Using MEPRS to Calculate the MHS’s Primary Efficiency Metric

Moving to a Performance Based Organization

2

Purpose of Briefing

• Provide information on calculation and drivers of MHS’s primary efficiency metric – Medical Cost per Prime Equivalent Life

• Also known as PMPM/PMPY (per member per month/year)

• Explain metric– Define PMPM/PMPY– Understand some common pitfalls when first

reviewing metric– Understand how metric is calculated

• Dissect drivers of yearly increase from FY04 to FY05

3

Stakeholder Perspective

Customer Perspective

Internal Process Perspective

Learning & Growth Perspective

Medically Ready and Protected Force and Homeland Defense for

Communities

F1 DoD Health Care Costs are

managed; Benefit is

sustained and shaped

Mission Centered Care

IP9 Continuous, efficient health

status monitoring focuses health improvement

activities

S2 Death, injuries and diseases are

reduced, function is restored, and

performance is enhanced during and after military

operations

S3 Beneficiaries are satisfied

with their health care

R1 Resources are predictably

available, aligned, and transparent

Patient Centered Care

C2 “It feels like the Military

Health System was designed just for me.”

C1 “I am a partner with my healthcare team. We know and

care about improving my

health.”

S4 The MHS creates healthy

communities

DoD Beneficiaries Commanders and Service Members

Resource Perspective

C3 “I have responsive, capable

& coordinated medical services

anywhere, anytime.”

IP10 Individual Medical Readiness

is assessed and managed to

improve health and enhance performance

C4 “The MHS supports me in

achieving individual medical readiness

and enhancing performance.”

S1 Forces are medically ready to deploy, their

performance is enhanced through medical

interventions, and both the force and communities are

protected from medical threats

“Total Customer Solution” “Product Leadership”

Manage and Deliver the Health Benefit

IP1 Evidence based medicine is used to improve

quality, safety and appropriate utilization of

services

IP3 Our health care processes

are patient centered, safe, effective and

efficient

IP2 Beneficiaries

partner with us to improve

health outcomes

Deployable Medical Capability

IP8 New products, processes and services are rapidly

developed and deployed to support the mission – “Bench

to Battlefield”

IP6 Comprehensive globally accessible health and business information enables medical surveillance, evidence based medicine and effective health care

operations

IP5 Joint, interoperable, and

interdependent processes

effectively deliver care anytime,

anywhere

L4 Authority and

accountability are aligned throughout

MHS

L5 Personnel are recruited, trained,

educated, and retained to meet

requirements

L6 DoD Biomedical R&D is coordinated

and focused on militarily relevant

issues

L7 IM/IT is leveraged to enhance capabilities

L3 Culture of jointness

and interagency cooperation

L2 The MHS embodies

performance based management and a

culture of innovation focused

on results

L1 Employees

create success for customers

R2 Infrastructure is maintained and

improved to optimize

performance

Science and TechnologyHuman CapitalOrganization & Culture

MHS Mission: To enhance DoD and our Nation’s security by providing health support for the full range of military operations and sustaining the health of all those entrusted to our care.

Financial Perspective

IP7 DoD homeland defenses, civil support and military medical

operations, are effectively supported

4

What is PMPM/PMPY?

• The accumulated medical costs associated with enrollees by enrollment site each month– Inpatient, Outpatient, Pharmacy, Ancillary– Wherever DHP care is received

• Direct Care, Purchased Care, TRICARE Mail Order Pharmacy• Direct Care costs calculated at MTF where care is delivered but

assigned to enrollment site

• Divide total cost by number of enrollees adjusted for age/gender/beneficiary category– Reflects differences in underlying demographics

• Done on a per person basis, not total volume• Only reflects cost for enrolled individuals

5

Things to keep in mind• PMPM metric is looking from an insurance point of view

– We both manage enrollee utilization like an insurance company and produce care

– So we have Enrollee Unit costs, and MTF Production Unit Costs

• Enrollee cost are based on care provided in any locale– Enrollee Direct Care Unit cost is not for your facility alone

• MTF Production costs are allocated to enrollees basedon their proportion of care– MTF Production Unit costs are based on all care produced, and

applied to enrollees based on amount used

• Enrollee utilization reduction does not automatically mean that MTF Production Unit costs will increase– Since MTF Production unit cost is based on all care, unit costs only

rise if MTF overall production decreases

6

How PMPM is built

• Direct Care cost information is based on cost allocation algorithms– MTF Production Inpatient Unit Cost

• Inpatient Cost per RWP

– MTF Production Outpatient Unit Cost• Outpatient Cost per APG

• Purchased Care based on claims data• Pharmacy costs are based on PDTS• Enrollee Equivalent Lives are based on

DEERS adjusted for Age/Gender/Bencat

7

MTF Production Inpatient Unit Cost(Inpatient Cost per RWP)

• Cost of producing one weighted unit of care at each MTF– RWP is common weighted unit for MHS– Based on all care produced at MTF

• This includes Active Duty, Prime, Standard, Tricare for Life

– Total RWPs are summed for all categories of care

• Expense data is from MEPRS– Inpatient is based on MEPRS A codes with step downs

• Depreciation costs are then removed

– Labor expense is based only on current month– All other expenses are based on Rolling 12 month

• Total Expenses are divided by RWPs to get– MTF Production Inpatient Unit Cost

8

MTF Production Outpatient Unit Cost(Outpatient Cost per APG)

• Cost of producing one weighted unit of care– APG is used to associate Ancillary with encounter– Based on all care produced at MTF

• This includes Active Duty, Prime, Standard, Tricare for Life– Total APGs are summed for all categories of care

• Expense data is from MEPRS– Inpatient is based on MEPRS B codes with step

downs• Depreciation costs and pharmacy are then removed

– Labor expense is based only on current month– All other expenses are based on Rolling 12 month

• Total Expenses are divided by APGs to get– MTF Production Outpatient Unit Cost

9

StandardTFL

Prime44 RWPs

87 RWPs

17 RWPs

148 RWPs

MTF Production Unit Cost

~~ $9K/RWP$1,324K /

MEPRS “A”

= $8,946/RWP 148 RWPs

10

Utilization

Prime87 RWPs

TFL44 RWPs

Standard17 RWPs

11

Total Cost: $620K

Total Cost: $1,608K

Dewitt ACH

NNMC

WRAMC Purchased Care

Claims Cost: $970K

DACH Enrollee Inpatient Care

$620K$1,608K

$970K$783K

$3,981K

Total Cost for Enrollee Care

MTF ProductionUnit Cost: $10K/RWP



Total Cost: $783K

Utilization: 62 RWPs



12

Equivalent Lives

• Developed to adjust for health utilization differences across populations– Age/Gender/Beneficiary Category adjustors

• By adjusting enrolled population, comparisons can be made across MTFs and Services

• While this is an overall adjustment, it may not be appropriate for just one component of PMPM – (i.e. Inpatient/Outpatient/Pharmacy)

13

WRAMC Fort Benning

10 Lives 10 Lives

1.001.00

1.001.00

1.00

1.001.00

1.001.00

1.00

1.001.00

1.001.00

1.00

1.001.00

1.001.00

1.00

Enrollees vs. Equivalent Lives

If enrollees all received the same type and amount of care they would all be average (1.00 EqLvs)

14

10 Lives 10 Lives14.79 EqLvs 8.67 EqLvs

COOKU.S. ARMY

COOK U.S. ARMY

COOK U.S. ARMY

COOKU.S. ARMY

COOK U.S. ARMY

COOKU.S. ARMY

.890.8901.60

.6522.96

2.00.855

1.123.45

.374

1.601.49

.471.652

.635

1.38.902

.562.600

.374

Enrollees vs. Equivalent Lives

WRAMC Fort Benning

15

PMPM Calculation Example

Sample MTF

85,976

Direct Care $ Purchased Care Total PMPMInpatient 3,881,887 813,669 4,695,557 55 Outpatient 9,071,664 1,437,805 10,509,469 122 Pharmacy 2,158,156 526,065 2,684,221 31 Total 15,111,708 2,777,540 17,889,248 208

Equivalent Lives

16

Drivers of PMPM

• Utilization of Services• Average Cost of Services

– Enrollee Direct Care Unit Cost– Enrollee Purchased Care Unit Cost– Direct/Purchased Care Market Share

17

Analysis

• How much of total increase is driven by each factor

• Contribution by driver is a function of the increase in driver and contribution toward total PMPM– For example, a driver that had a large

increase but was only a small percentage of PMPM may not contribute much to overall increase

18

FY04/05/06 Prime Enrollee PMPY Comparison

PMPY increased 8.2% from FY05 to FY06

9.1% for Army (9.1%) Navy (7.5%) AF (9.5%) MCSC (7.6%)

536 609 646 575 669 732 566 674 719516 567 595 489 549 573

1,3621,436

1,5671,491

1,6091,772

1,4591,511

1,658

1,461 1,5191,700

1,0231,134 1,220

403448

485

339

363

378

348383

384

378412

441

547609

672

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500F

Y04

FY

05

FY

06

FY

04

FY

05

FY

06

FY

04

FY

05

FY

06

FY

04

FY

05

FY

06

FY

04

FY

05

FY

06

Do

llars

Inpatient Outpatient Pharmacy

MHS NavyArmy MCSCAir Force

2,4932,698 2,641

2,8812,567

2,7602,498

2,736

2,2922,4662,300 2,405 2,373 2,356

2,059

19

FY04/05/06 Prime Enrollee PMPY Cost Increases

by Care Categories

• For FY05/06 Increases:– Inpatient costs account for 18% of the total PMPY increase– Outpatient costs account for 64% of total PMPY increase– Pharmacy cost increases account for 18% of total PMPY increase

7337

9463

108

45 5128

6024

74 131

118 16351

147

58

181 111

87

4537

15

34

2962

64

1

35

24

$0

$50

$100

$150

$200

$250

$300F

Y04

/05

FY

05/0

6

FY

04/0

5

FY

05/0

6

FY

04/0

5

FY

05/0

6

FY

04/0

5

FY

05/0

6

FY

04/0

5

FY

05/0

6

Do

lla

rs


+205

+240 +193 +238

+174

MHS NavyArmy MCSCAir Force

+193

+236

+195

+142

+232

20

FY05/06 Prime Enrollee PMPY Cost Increasesby Utilization and Average Unit Cost

11

93

1726

38

20

$0

$20

$40

$60

$80

$100

$120


Do

llars

Utilization Unit Cost

Utilization increases account for 59% of the total PMPY increase.

21

Average Unit Cost Increases

• Three factors– Direct care unit costs– Purchased care unit costs

• Plus TMOP for pharmacy

– Market share shifts

22

MHS Prime Enrollee PMPY Increase Factors

11

93

1726 382025

46

-10

6

8

13

18

-16-5

-1

-$60

-$40

-$20

$0

$20

$40

$60

$80

$100

$120

Utilization Avg UnitCost

CostFactors


CostFactors


CostFactors

Do

lla

rs

Utilization Net Cost Market Share DC Cost PC Cost TMOP Cost


• Direct Care average unit cost increase account for 29% of total PMPY increase• Purchased Care average unit cost increases account for 13% of total PMPY increase• Market Share accounts for -1% of total PMPY increase

23

Prime EnrollmentService Observations

• Army– Significant increased outpatient utilization and direct care unit

costs (65% of total change)– Shifting of workload to purchased care

• Navy– Increased outpatient utilization and direct care unit costs (77%

of total change)

• Air Force– Increased overall utilization (73% of total change)

• MCSC– Large increase in outpatient utilization (39% of total change)– Less care in MTFs for enrollees

24

Service Prime Enrollee PMPY Factors

8

68

3216 19 31

6 7 -311 16 26

6-4-1

1

-$60

-$40

-$20

$0

$20

$40

$60

$80

$100

$120


CostFactors


CostFactors


CostFactors

Dol

lars


16

142

161140

1419

53

-8-2

2

714

-15-6

1

-$60

-$40

-$20

$0

$20

$40

$60

$80

$100

$120


CostFactors


CostFactors


CostFactors

Dol

lars


-17

57

9

6290

-8

52

93

-22

11

6

127

-9-1

-4

-$60

-$40

-$20

$0

$20

$40

$60

$80

$100

$120


CostFactors


CostFactors


CostFactors

Do

llars


21

102

1442

61

1

3554

-13

9

12

59

-5-2

-1

-$60

-$40

-$20

$0

$20

$40

$60

$80

$100

$120


CostFactors


CostFactors


CostFactors

Do

llars


Inpatient Outpatient Pharmacy PharmacyOutpatientInpatient

Army Navy

Air Force MCSC

PharmacyOutpatientInpatientInpatient Outpatient Pharmacy

25

Summary

• Utilization increased for all sectors – Inpatient/outpatient/pharmacy– 59% of total change

• Direct Market share declined – 39% to 36% for inpatient– 50% to 47% for outpatient– 74% to 70% for pharmacy

• Drivers significantly different across enrollment service– Most likely different by enrollment site

26

Stakeholder Perspective

Customer Perspective

Internal Process Perspective

Learning & Growth Perspective

Medically Ready and Protected Force and

Homeland Defense for Communities

F1 DoD Health Care Costs are managed;

Benefit is sustained and shaped

Mission Centered Care

S2 Death, injuries and diseases are reduced,

function is restored, and performance is enhanced during and after military

operations

S3 Beneficiaries are satisfied with their health care

R1 Resources are predictably

available, aligned, and transparent

Patient Centered Care

C2 “It feels like the Military Health System was

designed just for me.”

C1 “I am a partner with my healthcare team. We know and care about improving

my health.”

S4 The MHS creates healthy

communities

DoD Beneficiaries Commanders and Service Members

Resource Perspective

S1 Forces are medically ready to deploy, their performance is enhanced through medical

interventions, and both the force and communities are protected

from medical threats

“Total Customer Solution” “Product Leadership”

Manage and Deliver the Health Benefit

IP1 Evidence based medicine is used to improve

quality, safety and appropriate utilization of

services

IP3 Our health care processes are patient

centered, safe, effective and efficient

IP2 Beneficiaries partner with us to

improve health outcomes

Deployable Medical Capability

IP6 Comprehensive globally accessible health and business information enables medical surveillance, evidence based medicine and effective health care

operations

L4 Authority and

accountability are aligned throughout

MHS

L5 Personnel are recruited, trained,

educated, and retained to meet

requirements

L6 DoD Biomedical R&D is

coordinatedand focused on

militarily relevant issues

L7 IM/IT is leveraged to

enhance capabilities

L3 Culture of jointness and interagency cooperationL2 The MHS

embodies performance based management and a culture of innovation focused on results

L1 Employees

create success for customers

R2 Infrastructure is maintained and

improved to optimize

performance

Science and TechnologyHuman CapitalOrganization & Culture

Financial Perspective

PMPM

RVU/BeneficiaryRWP/BeneficiaryRx/Beneficiary

Cost/RVUCost/RWPCost/Rx

Hypothesized Cause Effect Relationships for Managing the Cost of Delivering the Healthcare

27

Questions?

28

BACKUP SLIDES

29

PMPM SpreadsheetPMPY Analysis

PMPY FY04 FY05 Drivers of change Utilization and Unit Cost - Monthly basis PMPMInpt 642 708 % Total $ Value RWP/1k Inpt FY04 FY05 % ChngOutpt 1,306 1,387 Inpt Util 13% 26 Total RWP 7.03 7.32 4%Rx 443 494 Inpt Cost 20% 40 DC 3.07 2.98

2,391 2,589 DC Cost 13% 25 PC 3.96 4.34 8.3% PC Cost 10% 19 Avg Cost 7,607 8,061 6%

Mkt -2% (5) DC Cost 8,588 9,287 8%FY04 FY05 PC Cost 6,845 7,217 5%

Inpt Mkt 44% 41%Outpt Mkt 51% 46% % Total $ Value RVU/100 Outpt FY04 FY05 % ChngRx Mkt 75% 69% Outpt Util 28% 55 Total RVU 73 77 4%

Outpt Cost 13% 26 DC 38 35 % Total $ Value DC Cost 17% 33 PC 36 41

PMPY Increase 199 PC Cost 14% 29 Avg Cost 148 151 2%Inpt 33% 66 Mkt -18% (36) DC Cost 187 195 4%Outpt 41% 81 PC Cost 107 113 5%Rx 26% 52

% Total $ Value Script/100 Rx FY04 FY05 % ChngSummary Drivers of change % Total $ Value Rx Util 8% 17 Total Script 84 87 4%DC Unit 33% 65 Rx Cost 18% 35 DC 62 60 PC Unit 30% 61 DC Cost 4% 7 PC 20 25 Mkt -13% (25) PC Cost 5% 11 TMOP 1 2 Util 49% 98 TMOP Cost 1% 2 Avg Cost 44 47 8%

Mkt 8% 15 DC Cost 37 38 3%PC Cost 62 66 6%TMOP Cost 113 122 8%

30

Issue: Ages that didn’t work with DMIS Age Groups

• Age 0-4– Break into two Groups 0-1 2-4

• Female ADFM/Other 13-18– Developed Linear Estimate

• Other Male 24-38/Female 24-29– Medical disabled Active Duty– Developed Linear Estimate

• All Groups 35-44– Developed Linear Estimate

• All Groups 45-64– Used Other Category to develop slope– Linear Estimate based on value at Age 45 Plus Slope

31

PMPM Eq Lvs - Other Females

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64

F Other F Other DMIS Age Adj Factor F Other

32

PMPM Eq Lvs – Other Males

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64

M Other M Other DMIS Age Adj Factor M Other

33

PMPM Eq Lvs - Other Females

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64

F Other Adj Factor F Other

34

Eq Lives Factors

Note: Age 45+ are based on single slope for Male/Female.Only adjustment for Beneficiary category is at starting point.

Females 0-1 2-4 5-12 13-14 15-17 18 19-23 24 25-29 30-34 35-38 39-44 45-64AD 1.679 1.947 + ((Age-45)*0.079)ADFM 1.591 0.471 0.374 1.465 + ((Age-45)*0.079)Other 1.561 0.416 0.347 0.667 1.213 1.382 + ((Age-45)*0.079)

Males 0-1 2-4 5-12 13-14 15-17 18 19-23 24 25-29 30-34 35-38 39-44 45-64AD 0.627 1.075 + ((Age-45)*0.109)ADFM 1.841 0.550 0.554 0.892 + ((Age-45)*0.109)Other 2.086 0.527 0.490 -0.553+(Age * 0.032) 0.890 + ((Age-45)*0.109)

0.361+(Age * 0.021)

0.445 0.470

0.041+(Age * 0.039)

-0.578+(Age * 0.037)-0.211+(Age * 0.024)

-0.870+(Age * 0.098)-0.238+(Age * 0.05)

0.277+(Age * 0.025)

N/A

1.604 1.378

1.644

1.491 1.284

N/A

0.652 0.635 0.486 0.471

0.414 1.648

35

Average Unit Cost Increases

• Three Factors– Direct Care Unit Costs– Purchased Care Unit Costs

• Plus TMOP for Pharmacy

– Market Share Shifts

36

MHS Prime Enrollee PMPY Increase Factors

44 55

1640

203524 34 7

2026

11

15

-40-4

2

-$60

-$40

-$20

$0

$20

$40

$60

$80

$100

$120

Utilization AvgEnrolleeUnit Cost

CostFactors


CostFactors


CostFactors

Do

llars



• Direct Care average Enrollee unit cost increase account for 31% of total PMPY increase

• Purchased Care average Enrollee unit cost increases account for 28% of total PMPY increase

• Market Share accounts for -13% of total PMPY increase

37

Prime Enrollment Service Observations

• Army– Significant increased Enrollee Unit Cost for outpatient (42% of

Total Change)– Shifting of workload to purchased care

• Navy– Increased direct care inpatient Utilization and Enrollee Unit

Costs (41% of Total Change)

• Air Force– Shift to purchased care in all areas– Most utilization management

• MCSC– Large increase in Outpatient Utilization (36% of Total Change)– Less direct care across all areas

38

37

88

2635 34 286 6 3

29 3820

3-10

0

2

-$60

-$40

-$20

$0

$20

$40

$60

$80

$100

$120


CostFactors


CostFactors


CostFactors

Do

llars


29 3613

3114

4018 13

1419 289

18

-27-6

0

-$60

-$40

-$20

$0

$20

$40

$60

$80

$100

$120


CostFactors


CostFactors


CostFactors

Do

llars


44 36

9

75

1539

52

10

17

21

214

11-16

1

6

-$60

-$40

-$20

$0

$20

$40

$60

$80

$100

$120


CostFactors


CostFactors


CostFactors

Do

llars


53

1223

45

96

1633

99

-2

14

15

612

-18-2

0

-$60

-$40

-$20

$0

$20

$40

$60

$80

$100

$120


CostFactors


CostFactors


CostFactors

Do

llars


Service Prime Enrollee PMPY Factors



Pharmacy

Pharmacy

Outpatient

Outpatient

Inpatient

Inpatient

Army Navy

Air ForceMCSC

39

FY04/05 Prime Enrollee PMPY Cost Increases by Utilization and Average Enrollee Unit Cost

2640

68

30 3648 38

56 26

60

85 7336

47

1635

106 9

32

1546

-11 -2-$20

$0

$20

$40

$60

$80

$100

$120

$140

$160

Utilization Enrollee UnitCost




Do

llars


• Utilization increases account for 49% of the total PMPY increase– Active Duty 53% of total– AD Family 50% of total– Retiree and Family 38% of total

MHS AD Family

ActiveDuty Retiree &

Family

40

Prime Enrollment Beneficiary Observations

• Active Duty– Increases in Utilization 53% of Increase

• Majority focused on Inpatient 26% and Outpatient 23%– Direct Care Unit cost 45% of increase

• Outpatient cost 34%

• Active Duty Family– Outpatient Utilization 31% of Increase– Shift to purchased care in all area

• Retiree and Family– Outpatient Utilization 36% and Rx Costs 33% largest

drivers– Shift to purchased care in all areas– Most utilization management

41

Summary

• Utilization increased for all sectors – Inpatient/Outpatient/Pharmacy– 49% of Total Change

• Direct Market Share declined– 44% to 41% for inpatient– 51% to 46% for outpatient– 75% to 69% for Pharmacy

• Drivers different across beneficiary category– Outpatient utilization up across all

42

Inpatient Prime Enrollee InformationUtilizaton

0123456789

10

FY04 FY05 FY04 FY05 FY04 FY05 FY04 FY05 FY04 FY05

RW

Ps p

er

1k E

nro

llees

DC PC

MHS Army Navy Air Force MCSC

Average Unit Cost

$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000$9,000

$10,000


Co

st

per

RW

P


Direct Care Average Unit Cost

$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000$9,000

$10,000


Co

st

per

RW

P

Purchased Care Average Unit Cost

$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000$9,000

$10,000


Co

st

per

RW

P

FY04/05 Change+7% +8% +7% +5% +6%

FY04/05 Change+6% +6% +11% +5% +5%

FY04/05 Change+5% +6% +9% +6% +5%

FY04/05 Change+8% +6% +12% +6% +11%

DC Mkt 42% 40% 60% 63% 7% 7%43% 40%65% 64%



43

Outpatient Prime Enrollee InformationUtilizaton

0123456789

10


RV

Us

pe

r E

nro

llee

DC PC


Average Unit Cost

$0

$50

$100

$150

$200

$250


Co

st

per

RV

U



$0

$50

$100

$150

$200

$250


Co

st

per

RV

U


$0

$50

$100

$150

$200

$250


Co

st

per

RV

U

FY04/05 Change+4% +1% +3% +3% +8%

FY04/05 Change+1% +7% +1% +1% +3%

FY04/05 Change+5% +5% +7% +7% +4%

FY04/05 Change+4% +9% +1% +1% +8%

DC Mkt 51% 46% 70% 68% 6% 4%59% 55%74% 71%



44


$0

$10

$20

$30

$40

$50

$60

$70

$80

$90


Cos

t per

Scr

ipt

Utilizaton

0102030405060708090

100


Scri

pts

per

100 E

nro

llees

DC PC TMOP


Average Unit Cost

$0$10$20$30$40$50$60$70$80$90


Co

st

per

Scri

pt



$0$10$20$30$40$50$60$70$80$90


Co

st p

er S

crip

t

FY04/05 Change+4% +5% +2% +3% +5%

FY04/05 Change+8% +3% +10% +9% +5%

FY04/05 Change

+6% +7% +5% +7% +5%FY04/05 Change

+3% -1% +5% +4% +4%

DC Mkt 75% 69% 92% 89% 20% 17%87% 82%91% 88%



TMOP Average Unit Cost

$0

$20

$40

$60

$80

$100

$120

$140

$160


Co

st p

er S

crip

t


FY04/05 Change

+8% -1%+48%

-4% +4%

Pharmacy Prime Enrollee Information

45

FY04/05 Care Utilization and Unit Cost Driving Prime Enrollee PMPY Cost Increases

Army

53

1223

45

96

16

$0

$20

$40

$60

$80

$100

$120


Do

llars


Navy

4436

9

75

15

39

$0

$20

$40

$60

$80

$100

$120


Do

llars


Air Force

2936

13

31

14

40

$0

$20

$40

$60

$80

$100

$120


Do

llars


MCSC

37

88

2635 34

28

$0

$20

$40

$60

$80

$100

$120


Do

llars


46

Note: Enrollees are adjusted for age/gender

The Goal is to stay below a 11% increase. 11% is the projected increase for Private Sector Health Care premium increases

FinancialMedical Cost per Prime Equivalent Life

% Change from Prior Year

-10%-5%0%5%

10%15%20%25%

FY

03 O

ct

Dec

Feb Ap

r

Jun

Au

g

FY

04 O

ct

Dec

Feb Ap

r

Jun

Au

g

FY

05 O

ct

Dec

Feb Ap

r

Jun

Au

g

Army Navy Air Force MCSC MHS Goal

47

Medical Cost per Prime Equivalent Life Percent of Total by Care Category

MHS

0%

10%

20%

30%

40%

50%

60%

70%

FY

04 O

ct

No

v

Dec

Jan

Feb

Mar

Ap

r

May

Jun

Jul

Au

g

Sep

FY

05 O

ct

No

v

Dec

Jan

Feb

Mar

Ap

r

May

Jun

Jul

Au

g

Sep

Inpatient $ Outpatient $ Pharmacy $

48

PMPM Eq Lvs – Other Males

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64

M Other M Other DMIS Age Adj Factor M Other

Date post:	04-Jan-2016
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Per Member Per Month (PMPM)

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