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Savings Report Summary

1/1/2014 – 12/31/2014

UFCW Unions and

Participating Employers

Health & Welfare Fund

Prepared by Joe Pedone and Steve Krasnoff

February 27, 2015

PROPRIETARY AND CONFIDENTIAL

Page Number

Executive Summary 3

Savings Summary Provider 6

Facility 7

Top 10 Provider Specialties Local NetLease 8

FlexLink 9

As a % of Total 10

Top 10 Facilities Local NetLease 11

FlexLink 12

As a % of Total 13

CareFirst Admin Fees Local NetLease 14

FlexLink 15

Aggregate Pricing 16

Savings Analysis Savings Net of CareFirst Admin Fees 17

Savings Per Dollar of Admin Fee 18

Savings Per Eligible Employee 19

3-Year Savings Recap 20

Contents

2


I. Provider and Facility Summary (See pages 6 - 7)

In 2014, there were 43,223 total claims. In 2013, there were 43,351 total claims (a <1% decrease from 2013 to 2014). • 38,870 provider claims in ’14. 38,750 provider claims in ’13 (a <1% increase)

• 4,353 facility claims in ’14. 4,601 facility claims in ’13 (a 5.39% decrease)

In 2014, there was an average of 2,470 eligible subscribers. In 2013, there

was an average of 2,587 eligible subscribers (a 4.52% decrease).

In 2014, there were 17.5 claims per eligible subscriber. In 2013, there were 16.76 claims per eligible subscriber (a 4.42% increase). • 15.73 provider claims per eligible employee in ’14. 14.98 provider claims per eligible

employee in ’13 (a 6.25% increase).

• 1.76 facility claims per eligible employee in ’14. 1.78 facility claims per eligible employee in ’13 (a 1.12% decrease).

In 2014, total billed amount was $35,125,966. In 2013, total billed amount was $35,758,271 (a 1.77% decrease). • Provider billed amount in ‘14 was $16,860,471. Provider billed amount in ‘13 was

$16,643,807 (a 1.3% increase).

• Facility billed amount in ‘14 was $18,265,495. Facility billed amount in ’13 was

$19,114,464 (a 4.44% decrease).

Executive Summary- UFCW Unions & Participating Employers Health & Welfare 1/1/2014 – 12/31/2014

3


I. Provider and Facility Summary (Continued)

In 2014, Total Savings was $17,271,482. In 2013, it was $17,477,663 (a 1.18% decrease). • Provider Savings in ‘14 was $10,362,576. In 2013, it was $10,117,121 (a 2.43% increase).

• Facility Savings in ‘14 was $6,908,906. In 2013, it was $7,360,542 (a 6.14% decrease).

In 2014, Savings as a % of Billed Charges was 49.17%. In 2013, it was 48.88%. • Provider Savings as a % of Billed Charges in ‘14 was 61.46%. In ‘13, it was 60.79%.

• Facility Savings as a % of Billed Charges in ‘14 was 37.82%. In ‘13, it was 38.51%.

II. Top 10 Provider Specialties and Top 10 Facilities (See pages 8 – 12)

Top 10 Provider Billing Specialties for Local NetLease and FlexLink represent $9,820,448 in Billed Charges (58.25% of all Provider Billed Charges). • In 2014, Laboratory Services was the highest Local NetLease provider specialty (in terms of billed

charges). In 2013, the highest Local NetLease provider specialty was Internal Medicine. In 2014, Orthopedic Surgery was the highest FlexLink provider specialty (in terms of billed charges). In 2013, the highest FlexLink provider service was Radiology.

Top 10 Facilities with the highest Billed Charges for Local NetLease and FlexLink represent a billed amount of $9,139,394 (50.04% of all Facility Charges) • In 2014, Washington Hospital Center was the highest Local NetLease facility in terms of billed

charges. In 2013, the highest Local Network Lease facility in terms of billed charges was

QCDC Southern Maryland. In 2014, Inova Health Systems Hospitals was the highest

FlexLink facility in terms of billed charges. In 2013, the highest FlexLink facility in

terms of billed charges was Potomac Hospital.


4


III. CareFirst Administrative Charges (See pages 14 – 16)

In 2014, total CareFirst Admin charges were $212,405. In 2013, they were $216,870 (a 2.06% decrease). • In 2014, FlexLink Admin charges represented 53.35% of total CareFirst Admin costs, while Local

NetLease fees represented 46.65%. In 2013, FlexLink fees represented 55.07% of total CareFirst Admin costs, while Local NetLease fees represented 44.93%.

In 2014, aggregate cost on a per eligible employee per month (pepm) basis was $7.17. In 2013, aggregate cost on a pepm basis was $6.99.

In 2014, CareFirst Administrative Charges represented 1.23% of Gross Annual Savings. In 2013, CareFirst Administrative Charges represented 1.24% of Gross Annual Savings.

IV. Savings Analysis (See pages 17 – 19)

Savings net of CareFirst Administrative Charges in 2014 was $17,059,077. In 2013, it was $17,260,793 (a 1.17% decrease).

In 2014, Total Net Savings per Dollar of CareFirst Administrative Fee was $80.31. In 2013, Total Net Savings per Dollar of Administrative Fee was $79.59 (a <1% increase).

In 2014, Net Savings per Eligible Subscriber was $6,906.51. In 2013, Net

Savings per Eligible Subscriber was $6,672.13 (a 3.51% increase).


5


Provider Savings Summary- UFCW Unions & Participating Employers Health & Welfare Fund

6

*Rounded to the Nearest Dollar

# of Claims Billed

Amount* Savings off of Billed

Amount* Savings %

Local NetLease- Provider

31,763 $13,985,047 $8,632,898 61.73%

FlexLink- Provider 7,107 $2,875,424 $1,729,678 60.15%

Summary- Provider

38,870 $16,860,471 $10,362,576 61.46%

# of Claims Billed


Amount* Savings %

Local NetLease- Provider

31,982 $14,166,861 $8,739,056 61.69%

FlexLink- Provider 6,768 $2,476,946 $1,378,065 55.64%

Summary- Provider

38,750 $16,643,807 $10,117,121 60.79%

2014

2013


Facility Savings Summary- UFCW Unions & Participating Employers Health & Welfare Fund

7


# of Claims Billed


Amount* Savings %

Local NetLease- Facility

3,557 $14,121,475 $4,698,455 33.27%

FlexLink- Facility 796 $4,144,020 $2,210,451 53.34%

Summary- Facility

4,353 $18,265,495 $6,908,906 37.82%

# of Claims Billed


Amount* Savings %

Local NetLease- Facility

3,801 $16,113,057 $6,063,425 37.63%

FlexLink- Facility 800 $3,001,407 $1,297,117 43.22%

Summary- Facility

4,601 $19,114,464 $7,360,542 38.51%

2014

2013


Top 10 Local Network Lease Provider Specialties (by Billed Amount Volume)

8

# of

Claims

Billed

Amount*

Amount

Saved

off of

Billed

Amount*

Savings

%

LABORATORY SERVICES

4,212 $1,734,572 $1,415,886 81.63%

RADIOLOGY 2,937 $1,060,369 $641,816 60.53%

INTERNAL MEDICINE 4,310 $1,020,804 $459,996 45.06%

ANESTHESIOLOGY 756 $845,655 $519,276 61.41%

ORTHOPEDIC SURGERY

1,046 $631,410 $379,117 60.04%

HOME HEALTH CARE 169 $583,331 $510,563 87.53%

SURGERY 653 $545,089 $313,736 57.56%

CARDIOVASCULAR 1,161 $517,128 $289,734 56.03%

EMERGENCY MEDICINE

924 $498,212 $330,759 66.39%

OB - GYN 939 $445,526 $243,483 54.65%


# of

Claims

Billed

Amount*

Amount

Saved

off of

Billed

Amount*

Savings

%

INTERNAL MEDICINE

5,887 $2,031,588 $1,059,676 52.16%

LABORATORY SERVICES

3,366 $1,325,892 $1,100,264 82.98%

RADIOLOGY 1,899 $921,446 $605,719 65.74%

ANESTHESIOLOGY 628 $686,344 $443,962 64.69%

GENERAL PRACTICE

1,030 $491,815 $299,639 60.93%

OBSTETRICS & GYNECOLOGY

816 $437,929 $249,155 56.89%

FAMILY PRACTICE 2,051 $416,896 $208,106 49.92%

GENERAL SURGERY

339 $386,062 $217,312 56.29%

ORTHOPEDIC SURGERY

572 $332,983 $199,041 59.78%

EMERGENCY MEDICINE

569 $273,955 $180,561 65.91%

2014 2013


Top 10 FlexLink Provider Specialties (by Billed Amount Volume)

9

# of

Claims

Billed

Amount*

Amount

Saved

off of

Billed

Amount*

Savings

%

ORTHOPEDIC SURGERY

294 $486,945 $411,300 84.47%

RADIOLOGY 741 $282,401 $180,898 64.06%

INTERNAL MEDICINE 930 $198,320 $76,589 38.62%

LABORATORY INDEPENDENT

727 $192,923 $158,528 82.17%

FAMILY PRACTICE 894 $177,543 $69,841 39.34%

ANESTHESIOLOGY 115 $165,538 $87,912 53.11%

EMERGENCY MEDICINE

290 $149,904 $106,964 71.35%

PHYSICAL THERAPIST 422 $112,069 $74,778 66.73%

SURGERY GENERAL 94 $86,536 $44,375 51.28%

PATHOLOGY 226 $86,173 $67,367 78.18%


# of

Claims

Billed

Amount*

Amount

Saved

off of

Billed

Amount*

Savings

%

RADIOLOGY 611 $260,664 $164,751 63.20%

LABORATORY SERVICES 780 $238,309 $190,269 79.84%

ORTHOPEDIC SURGERY

307 $225,774 $160,211 70.96%

FAMILY PRACTICE 973 $189,993 $71,452 37.61%

INTERNAL MEDICINE 870 $187,057 $68,085 36.40%

ANESTHESIOLOGY 145 $156,550 $79,309 50.66%

EMERGENCY MEDICINE 223 $127,752 $87,796 68.72%

GASTROENTHEROLOGY 143 $92,690 $51,069 55.10%

OBSTETRICS & GYNECOLOGY

178 $82,063 $46,464 56.62%

PATHOLOGY 239 $76,343 $57,134 74.84%

2014 2013


Top 10 Provider Specialties (as a % of Total Billed)

10

Top 10 Provider Specialties

All Other Provider Specialties

*Top 10 Provider Specialties represent 58.25% of all Provider Billed Charges *All Other Provider Specialties represent 41.75% of all Provider Billed Charges

Top 10 Provider Specialties

All Other Provider Specialties

*Top 10 Provider Specialties represent 53.73% of all Provider Billed Charges *All Other Provider Specialties represent 46.27% of all Provider Billed Charges

2013

2014


Top 10 Local Network Lease Facilities (by Billed Amount Volume)

11

# of

Claims

Billed

Amount*

Amount

Saved

off of

Billed

Amount*

Savings

%

WASHINGTON HOSPITAL CENTER

124 $1,195,334 $492,656 41.21%

FMC OF PORTER WHITE MARSH

70 $822,157 $651,207 79.21%

FMC PRINCE GEORGE COUNTY

47 $688,267 $587,647 85.38%

FRANKLIN SQUARE HOSPITAL

115 $610,136 $6,101 1.00%

INOVA FAIRFAX HOSPITAL

86 $577,497 $191,649 33.19%

DOCTORS COMMUNITY HOSP

108 $447,620 $4,476 1.00%

JOHNS HOPKINS HOSPITAL

108 $437,104 $4,371 1.00%

ANNE ARUNDEL MEDICAL CENT

140 $418,327 $4,183 1.00%

QCDC OF SOUTHERN MARYLAND

5 $399,760 $338,920 84.78%

GEORGETOWN UNIVERSITY HOSP

34 $392,565 $200,546 51.09%


# of

Claims

Billed

Amount*

Amount

Saved

off of

Billed

Amount*

Savings

%

QCDC SOUTHERN MARYLAND

174 $1,742,268 $1,611,528 92.50%

GEORGETOWN UNIVERSITY HOSP

68 $1,467,842 $737,995 50.28%

WASHINGTON HOSPITAL CENTER

117 $1,409,067 $647,250 45.93%

INOVA ALEXANDRIA HOSPITAL

202 $1,363,082 $479,174 35.15%

MANASSAS DIALYSIS 21 $708,643 $625,348 88.25%

DOCTORS COMMUNITY HOSP

158 $499,944 $4,999 1.00%

WASHINGTON ADVENTIST HOSP

110 $454,629 $4,546 1.00%

MEDSTAR SO MD HOSP

119 $438,187 $4,352 0.99%

UPPER CHESAPEAKE MED

18 $344,049 $3,441 1.00%

GEO WASHINGTON UNIVERSITY HOSPIT

36 $335,265 $175,097 52.23%

2014 2013


Top 10 FlexLink Facilities (by Billed Amount Volume)

12

# of

Claims

Billed

Amount*

Amount

Saved

off of

Billed

Amount*

Savings

%

INOVA HEALTH SYSTEM HOSPITALS

92 $681,345 $212,165 31.14%

PRINCE WILLIAM HOSPITAL

151 $503,030 $308,178 61.26%

STAFFORD HOSPITAL CENTER

55 $499,644 $318,947 63.83%

RENAL TREATMENT CENTERS MIDATLA

25 $420,035 $388,339 92.45%

RESTON HOSPITAL CENTER

26 $322,669 $193,054 59.83%

MARY WASHINGTON HOSPITAL

39 $246,613 $125,304 50.81%

SPOTSYLVANIA MEDICAL CENTER INC

13 $158,566 $101,860 64.24%

POTOMAC HOSPITAL 31 $124,599 $39,294 31.54%

WINCHESTER MEDICAL CENTER INC

28 $97,738 $19,033 19.47%

UVA MEDICAL CENTER 19 $96,388 $49,636 51.50%


# of

Claims

Billed

Amount*

Amount

Saved

off of

Billed

Amount*

Savings

%

POTOMAC HOSPITAL 33 $307,350 $97,912 31.86%

PRINCE WILLIAM HOSPITAL

124 $286,888 $99,929 34.83%

STAFFORD HOSPITAL CENTER

47 $263,196 $150,611 57.22%

RESTON HOSPITAL CENTER

24 $189,587 $113,586 59.91%

INOVA HEALTH SYSTEM HOSPITALS

42 $184,218 $51,084 27.73%

VIRGINIA HOSPITAL CENTER ARLING

8 $148,770 $45,909 30.86%

MARY WASHINGTON HOSPITAL

59 $133,272 $82,540 61.93%

LOUDOUN HOSPITAL CENTER

28 $129,582 $19,127 14.76%

VCU HEALTH SYSTEM AUTHORITY

6 $126,476 $99,189 78.43%

STAFFORD HOSPITAL LLC

26 $101,102 $61,580 60.91%

2014 2013


Top 10 Facilities (as a % of Total Billed)

13

Top 10 Facilities

All Other Facilities

*Top 10 Facilities represent 50.04% of all Facility Billed Charges *All Other Facilities represent 49.96% of all Facility Billed Charges

Top 10 Facilities

All Other Facilities

*Top 10 Facilities represent 55.63% of all Facility Billed Charges *All Other Facilities represent 44.37% of all Facility Billed Charges

2013

2014


2014 Local NetLease Admin Charges: $4.00 per subscriber per month

from Jan. 1, 2014 – Oct. 31, 2014

$4.12 per subscriber per month from Nov. 1, 2014 – Dec. 31, 2014

Average number of Local NetLease subscribers in 2014 was 2,014. (In 2013, it was 2,082). 2014 was a 3.27% decrease from the previous year.

Total average monthly CareFirst Administrative Cost for Local NetLease in 2014 was $8,257.40. (In 2013, it was $8,119.80).

Total CareFirst Administrative Cost for Local NetLease to UFCW Unions and Participating Employers Health and Welfare Fund in 2014 was $99,089. (In 2013, it was $97,438). 2014 was a 1.69% increase from the previous year.

Local Network Lease Administrative Fees- UFCW Unions & Participating Employers Health & Welfare

14

2014 CareFirst Administrative Fees

NetLease*

FlexLink**

*NetLease Admin Fees

represented 46.65% of

total CareFirst admin

fees.

**FlexLink Admin Fees


total CareFirst admin fees.

2013 CareFirst Administrative Fees

NetLease*

FlexLink**

*NetLease Admin Fees


total CareFirst admin

fees.

**FlexLink Admin Fees


total CareFirst admin fees.


2014 FlexLink Admin Charges: $20.20 per subscriber per month

from Jan. 1, 2014 – Oct. 31, 2014

$20.81 per subscriber per month from Nov. 1, 2014 – Dec. 31, 2014

Average number of FlexLink subscribers in 2014 was 456. (In 2013, it was 505). 2014 was a 9.7% decrease from the previous year.

Total average monthly CareFirst Administrative Cost for FlexLink in 2014 was $9,443. (In 2013, it was $9,952.75).

Total CareFirst Administrative Cost for Local NetLease to UFCW Unions and Participating Employers Health and Welfare Fund in 2014 was $113,316. (In 2013, it was $119,433). 2014 was a 5.12% decrease from the previous year.

FlexLink Administrative Fees- UFCW Unions & Participating Employers Health & Welfare Fund

15

2014 Enrollment

NetLease*

FlexLink**

*81.54% of UFCW Non-Food’s

enrollment in 2014 was

Net Lease (2,014 subscribers)

**18.46% of UFCW Non-Food’s


FlexLink (456 subscribers)

2013 Enrollment

NetLease*

FlexLink**

*80.48% of UFCW Non-Food’s


Net Lease (2,082 subscribers)

**19.52% of UFCW Non-Food’s


FlexLink (505 subscribers)


NetLease: $8,257.40 per month

FlexLink: $9,443 per month

$17,700.40 per month / 2,470 total UFCW Non-Food subscribers=

$7.17

per subscriber per month Aggregate Cost

to UFCW Unions and Participating Employers Health & Welfare Fund

In 2013, Aggregate cost to UFCW Non-Food was $6.99 per subscriber per month

Aggregate Pricing- UFCW Unions & Participating Employers Health & Welfare Fund

16


$17,271,482 Gross Annual Provider and Facility Savings

($99,089) (Less: Local NetLease Charges)

($113,316) (Less: FlexLink Charges)

$17,059,077* Savings Net of CareFirst Administrative Charges

*CareFirst Administrative Charges in this exhibit represent 1.23% of Gross Annual Savings.

In 2013, CareFirst admin charges represented 1.24% of Gross Annual Savings.

Savings Net of Administrative Charges- UFCW Unions & Participating Employers Health and Welfare Fund

17


Net Savings for UFCW Non-Food in 2014 was $17,059,077

CareFirst Administrative cost in 2014 was $212,405

Total Net Savings Per Dollar of CareFirst Administrative Fee:

$80.31 (For every $1.00 that was spent in Administrative Fees,

$80.31 was saved in Total Billed Charges)

In 2013, Total Net Savings Per Dollar of CareFirst Administrative Fee was $79.59.

2014 was a <1% increase over the previous year.

Net Savings per Dollar of CareFirst Administrative Fee

18


Total Net Savings for UFCW Non-Food for 2014 was $17,059,077

UFCW Non-Food had 2,470 subscribers (contracts) in 2014

Total Net Savings Per Eligible

UFCW Non-Food Subscriber:

$6,906.51

In 2013, Total Net Savings per Eligible Subscriber was $6,672.13

2014 was a 3.51% increase over the previous year.

Net Savings per Eligible Subscribers- UFCW Unions & Participating Employers Health & Welfare Fund

19


2012 2013 2014

Local Network

Lease- Provider

Savings 60.60% 61.69% 61.73%

FlexLink-

Provider

Savings 53.96% 55.64% 60.15%

Local Network

Lease- Facility

Savings 36.29% 37.63% 33.27%

FlexLink-

Facility Savings 41.64% 43.22% 53.34%

3 Year Savings Recap- UFCW Unions and Participating Employers Health & Welfare Fund

20

savings report summary 1/1/2014 12/31/2014 ufcw unions … › zsvgml26 › ufcw unions and...in...

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