Pike RFP

Employer Group ABC

Incurred:

Apr 2014 thru Dec 2015

Paid:

Apr 2014 thru Mar 2016

Page

The table below breaks down the cost driver for each category analyzed in the prior chart. This allows you to understand whether the changes in cost are

driven by a change in pricing or a change in utilization. Also displayed is the average cost from the Verscend Normative Database, and the population's cost

rank relative to the Norm.

Table 3.1.4 Cost drivers: Change in unit price and change in utilization breakout for Inpatient and high acuity locations of care

28,

Category

Subcategory

Current PMPM

Change in PMPM

Change in

utilization per

1,000

Change in Unit

pricing

Norm value of

PMPM

Percent

Rank(Norm value

= 50%)

ASC

All

$3.16

-50.8%

-39.1%

-19.2%

$1.28

All

$14.12

-24.3%

-26.6%

3.1%

$11.73

All

$33.78

5.0%

-11.1%

17.6%

$30.25

Ward

$12.02

2.7%

-24.9%

36.7%

$9.23

Intensive care

$10.18

38.1%

11.2%

24.2%

$6.01

Mother/baby

$7.05

-19.6%

-26.1%

8.8%

$9.18

Observation

$2.29

1.4%

-3.6%

5.2%

$0.79

Subsequent Hospital Care

$1.77

7.9%

-0.5%

8.5%

$1.16

Psychiatry

$0.45

7.6%

-7.9%

16.8%

$1.63

Homegrown

$0.01

36.6%

84.4%

-25.9%

$2.24

OP Hospital

All

$0.30

788.5%

-11.1%

900.0%

$0.07

All

$18.33

-21.1%

-24.6%

4.7%

$4.34

Note:

Table 3.1.4 is based on select categories of Verscend Procedure Groups which utilize CPT4 Procedure Codes.

Source: Medical Intelligence : Claims Module / Trend / Medical / drill by Plan Type / Zoom Fwd / drill by Procedure Group

Norm or Verscend Norm in this report refers to the values from Verscend's Commercial Normative database.