Agenda - 10-03-2005-9a - Laserfiche WebLink

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7 Attachment 1 Orange County Claims Experience and Wellness Program Update The County's health insurance rate increase for 2006 results largely from claims experience during the 2005 plan year to date, Increases in frequency and cost of medical services figured most prominently, Outlined below is additional information related to the County's claims experience and an update on the employee wellness program. Contributions Compared to Claims During the two year period of 2003-04 and 2004-05, there was a close margin between County premiums paid versus actual claims costs, The chart below shows Orange County premiums paid as compared to total claims and related casts for these two fiscal years, Fiscal Year Premiums Claims* Difference 2004-05 $4,975,764 $4,767,684 $208,080 2003-04 $3,921,838 $3,892,386 $29,452 *Includes administrative costs and costs for stop loss insurance, Premiums papa amount is from County records and claims cost is from the NCACC. Utilization Trends While the County experience is below the NCACC norm in some areas of utilization such as inpatient hospital admissions and emergency room visits, it is above the norm in other areas such as outpatient visits, physician visits and prescription drugs, Several highlights of Orange County plan utilization during May 2004 through April 2005 are shown below; ^ Hospital outpatient visits increased six percent during the period as compared to the previous year and were above the NCACC norm. ^ While the average number of emergency rcom visits far Orange Cotanty has decreased and was below the NCACC norm, the average cost per visit rose 21 percent and exceeded the NCACC norm. ^ While the primary care visit rate has remained relatively stable and was comparable to the NCACC norm, the average allowed charge per office visit increased 22 percent and exceeded the NCACC norm. ^ Prescription drug costs and number of prescriptions per member increased far Orange County, and were above the NCACC norm, The increase in large part was due to an increase in cost of brand name drugs without generic equivalents. ^ All measures of hospital inpatient utilization were below NCACC averages including the total number of admissions, as well as the average cost per admission, The admission rate for Orange County employees was 21 percent below the NCACC norm and the average days per admission were 24 percent below the norm.