78 / 537
Employer Group ABC
Incurred:
Apr 2014 thru Dec 2015
Paid:
Apr 2014 thru Mar 2016
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3. ECONOMIC FINDINGS AND OPPORTUNITIES
Economic findings are broken out into Medical and Pharmaceutical subsections.
In section 3.1 - the Medical Economics subsection- this report examines:
Factors that primarily impact
unit pricing,
including contract discount power and in versus out-of-network
utilization rates. We also examine which geographic areas are associated with the most out-of-network spend.
Factors that drive
utilization,
including specialty procedures and consultations, diagnostic testing, and the place
of service. For these utilization-based drivers, we assess both changes in utilization and cost.
In section 3.2 - the Pharmaceutical section - this report examines:
Drug classes that affect PBM drug spend, and whether the change in this spend is due to pricing growth or
utilization growth. This section also details the highest cost drugs and opportunities for generic and branded
switching.
Overall Non-PBM drug spend: because this spend is a "medical" cost - not a PBM cost - the impact of these high-
cost drugs is often hidden.
Figure 3.1 Expense Drivers
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Note:
Medical PMPM includes Non-PBM drug spend (J-Codes).
Source: Medical Intelligence : Claims Module / Custom timeframes for medical and pharmacy expenses.