HORANalytics®: CLAIMS, UTILIZATION AND TRENDS REPORT
Key Elements: Rolling 12-month review of the following data points:
• Monthly Loss Ratio: premium vs. claims
• Paid claims distribution by member type (employee, spouse, dependent), paid amount and age range
• Medical and Rx utilization ( i.e., Inpatient, outpatient, PCP, specialists, Rx utilization, and top Rx therapeutic classes)
• Compares utilization to the prior 12 months and carrier benchmarks
Application: Identify cost drivers, trends and utilization patterns within time period
• Monitor specific data sets to analyze impact of plan changes
• Leverage data to adjust strategy and set pre-renewal goals
Most Recent 12 Months:
©HORAN 2020 1
HORAN
Enrolled Medical Claims Rx Claims Total Claims Total Premium Loss Ratio Mar-20 576 $513,875 $90,772 $604,647 $613,454 98.6% Apr-20 585 $267,654 $88,258 $355,912 $609,712 58.4% May-20 584 $366,361 $84,404 $450,765 $622,973 72.4% 576 $780,374 $87,499 $867,873 $610,609 571 $363,348 $96,932 $460,280 $446,614 556 $162,977 $62,745 $225,722 $492,151 45.9% 549 $291,173 $85,316 $376,489 $503,140 74.8% 547 $343,636 $70,646 $414,282 $503,844 82.2% 534 $222,029 $79,722 $301,751 $499,195 60.4% 521 $209,275 $72,132 $281,407 $481,730 58.4% 531 $239,923 $62,813 $302,736 $482,473 62.7% Feb-21 580 $254,184 $108,473 $362,658 $488,725 74.2% ● ● ● $6,354,618 78.8% Total/Avg. 559 $4,014,810 $989,712 $5,004,522 Claims over the Pooling Point ($100,000) $267,513 Adjusted Loss Ratio Net of Claims over the Pooling Point ($100,000) $4,737,009 $6,354,618 74.5% Top Prescribed Drugs - By Paid Amount: Therapeutic Class 1 Humira(Cf) Pen Antiarthritics 2 Humalog Diabetic Therapy 3 Topamax Anticonvulsants Prescription Drugs Indication Treats Rheumatoid Arthritis Insulin for Diabetes Prevents and Controls Seizures