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1、Final Trend Estimates and CY07 Rates,Tim Doyle, FSA, MAAA Brad Rhodes Jeff Smith,July 28, 2006,Mercer Government Human Services Consulting,Outline of Presentation,A. Rate Impact B. Rate-Setting Methodology,Mercer Government Human Services Consulting,A. Rate Impact,Recall from the June 22, 2006 prese
2、ntation that Trend = Rate Increase Aggregate rate increase/decrease is due to Medical inflation (trend) Benefit program changes Demographic mix changes (enrollment distribution across rate cells) Other (e.g., rebasing) Overall revenue increase/decrease is additionally due to Total enrollment changes
3、,Mercer Government Human Services Consulting,A. Rate Impact (continued),Program-wide CY07 PMPM increase of 5.2 percent over mid-year CY06 rates based on March member months simulations MCO-specific PMPM increases to be distributed after the presentation today,Mercer Government Human Services Consult
4、ing,B: Rate-Setting Methodology,1. CY04 adjusted HFMR base as starting point 2. Program changes 3. Medical trends 4. Administrative and profit load 5. Relational modeling 6. Regional factors 7. Low birth weight babies,Mercer Government Human Services Consulting,B.1: CY04 Adjusted HFMR Base as Starti
5、ng Point,MCOs submitted CY04 HFMRs adjusted for C&G and L&E reviews Non-State Plan services Removal of adult dental FQHC pricing,Mercer Government Human Services Consulting,B.2: Program Changes,Physician fee schedule Increase to specified codes effective July 1, 2005 and July 1, 2006 Impacts physici
6、an PMPM by 16 percent Pharmacy copay $3 copay for all brand drugs not on the preferred drug list, $1 copay for all generic drugs for adults. Pregnant women, children, and family planning drugs are excluded from copays Increase in dental fees for restorative services $0.52 million increase,Mercer Gov
7、ernment Human Services Consulting,B.2: Program Changes (continued),TPL $1.5 million removed from total expenses,Mercer Government Human Services Consulting,B.3: Medical Trends,Preliminary trend ranges presented on June 22, 2006 Final trend estimates presented in this section,Mercer Government Human
8、Services Consulting,Trend Methodology,Data analysis Analyze MCO-reported financial and encounter data Analyze HSCRC hospital data Trend estimation Past trends: Assessed based on the historical data Future trends: Assessed with past trends as baseline compared to other benchmarks,Mercer Government Hu
9、man Services Consulting,Inpatient Hospital Unit Cost Trends: HSCRC Component,*Forecast,HSCRC rate updates,Mercer Government Human Services Consulting,Inpatient Trend Considerations,CY04CY05 (also 3 months of CY06) trend estimates based on program-specific data CY05CY07 trend forecasts driven by HSCR
10、C rate updates Trends estimates incorporate HSCRC DRG day limit and GME discount impact,Mercer Government Human Services Consulting,Inpatient Hospital PMPM Annual Trend by COA and Year,Mercer Government Human Services Consulting,Outpatient Hospital Unit Cost Trends: HSCRC Component,*Forecast,HSCRC r
11、ate updates,Mercer Government Human Services Consulting,Outpatient Trend Considerations,CY04CY05 (also 3 months of CY06) trend estimates based on program-specific data CY05CY07 trend forecasts driven by HSCRC rate updates Trends estimates incorporate GME discount impact,Mercer Government Human Servi
12、ces Consulting,Outpatient Hospital PMPM Annual Trend by COA and Year,Mercer Government Human Services Consulting,Pharmacy Trend Considerations,CY04CY05 (also 3 months of CY06) trend estimates based on MCO-specific data CY05CY07 trend forecasts based on pharmacy industry research,Mercer Government Hu
13、man Services Consulting,Pharmacy PMPM Annual Trend by COA and Year,Mercer Government Human Services Consulting,Physician Trend Considerations,CY04CY05 (also 3 months of CY06) trend estimates based on MCO-specific data CY05CY07 trend forecasts based on above baseline and industry research,Mercer Gove
14、rnment Human Services Consulting,Physician PMPM Annual Trend by COA by Year,Mercer Government Human Services Consulting,Summary of Average Annual Trends by COA and COS (CY04CY07),*Reflects -9.3% trend for CY04/05 and 3.8% trend for both CY05/06 and CY06/07.,Mercer Government Human Services Consultin
15、g,Summary of Consolidated COS Annual Trend by COA and Year,Mercer Government Human Services Consulting,B.4: Administrative and Profit Load,From the audited CY04 HFMR base cost, grouped separately by F&C and Disabled Medical management costs Administrative costs Administrative trends Medical manageme
16、nt (at CPI +): 3.76 percent Administrative costs (at CPI): 2.80 percent Additional items Underwriting Gain: 1.5 percent of medical expense Reinsurance Administration Costs: $2.4 million added to base Risk/Contingency Margin: 0.4 percent of medical expense State policy decision: loading capped at CY06 level of 12.6 percent,Mercer Government Human Services Consulting,Administrative and Profit Load Allocation,Premium Tax: 2.3 percent of medical expense Ove
