73 / 537
Employer Group ABC
Incurred:
Apr 2014 thru Dec 2015
Paid:
Apr 2014 thru Mar 2016
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2.2.2 Expense Distribution by Percent Spending Band
Figure 2.2.4 shows claim payments for five different population bands including both current and termed members.
Members are ranked by total claims for purposes of creating the bands. For example, the band representing 1% of
the population consists of the most expensive 1% of members; approximately one-third of the total claims expense
is generally accounted for by this group. These members have extremely high claims expense and should be reviewed
to verify their case management status. A significant number of members in the next two bands will be high risk
members, often with multiple chronic conditions. The risk associated with these members, many of whom to date
have not generated significant claims expense, can be further evaluated using the Medical Intelligence Expense
Distribution module.
Figure 2.2.4 Claims Expense Distribution
10
Health Care Spend
Percentage of Total Claims Cost (Norm)
PMPM
$9,866.28
$2,357.93
$799.64
$343.56
$68.28
Membership Distribution Band
Percentage of Total
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Note:
Refer to Table 5.2.3 in Appendix 5.2 for further detail.
Source: Medical Intelligence : Expense Distribution Module.
PMPM Source: Medical Intelligence : Expense Distribution Module / Individual