Utilization, Enrollment, and Expenditure Trending. Data Run 4/7/10

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Utilization, Enrollment, and Expenditure Trending. Data run 4/7/10

Medical Loss Ratio (MLR) Trends

Table 1a: Medical Loss Ratio: Previous Contract: Contract Beginning 11/07 through 8/09

State Fiscal Year / Month ID / Total Direct Service Expenditures, including civil state hospital allocation / DSHS Payment including civil state hospital allocation / Medical Loss Ratio (MLR)
2008 / Nov-07 / $ 8,749,710.68 / $ 10,615,868.54 / 82.42%
2008 / Dec-07 / $ 8,536,811.38 / $ 10,315,013.14 / 82.76%
2008 / Jan-08 / $ 9,392,449.38 / $ 10,437,455.11 / 89.99%
2008 / Feb-08 / $ 9,088,498.68 / $ 10,199,670.25 / 89.11%
2008 / Mar-08 / $ 9,392,729.38 / $ 10,009,982.01 / 93.83%
2008 / Apr-08 / $ 9,479,292.68 / $ 10,402,888.31 / 91.12%
2008 / May-08 / $ 9,447,208.38 / $ 10,388,244.44 / 90.94%
2008 / Jun-08 / $ 9,454,173.68 / $ 10,419,079.51 / 90.74%
2008 / Jul-08 / $ 9,823,390.38 / $ 10,293,988.12 / 95.43%
2008 / Aug-08 / $ 9,403,488.38 / $ 11,742,897.88 / 80.08%
2009 / Sep-08 / $ 9,611,404.55 / $ 10,649,808.69 / 90.25%
2009 / Oct-08 / $ 10,162,334.25 / $ 10,378,138.22 / 97.92%
2009 / Nov-08 / $ 9,483,214.55 / $ 10,622,690.79 / 89.27%
2009 / Dec-08 / $ 9,936,540.25 / $ 11,088,659.65 / 89.61%
2009 / Jan-09 / $ 10,459,593.25 / $ 10,788,684.07 / 96.95%
2009 / Feb-09 / $ 9,957,897.55 / $ 11,004,342.79 / 90.49%
2009 / Mar-09 / $ 10,864,044.25 / $ 10,880,642.82 / 99.85%
2009 / Apr-09 / $ 11,051,044.55 / $ 11,885,350.97 / 92.98%
2009 / May-09 / $ 10,517,154.25 / $ 11,204,758.00 / 93.86%
2009 / Jun-09 / $ 10,718,493.55 / $ 10,982,933.53 / 97.59%
2009 / Jul-09 / $ 10,900,553.25 / $ 13,736,837.13 / 79.35%
2009 / Aug-09 / $ 10,496,308.25 / $ 16,010,712.68 / 65.56%
TOTAL
$ 216,926,335.55 / $ 244,058,646.65 / 88.88%
88% Level / $ 214,771,609.05 / 88.0%
Over/(under) spend of 88% / $ 2,154,726.49

Notes:

Includes $2, 5000,000 for July and $2, 5000,000 for August (supplemental)

Includes extra $400,000 in incentive dollars

Includes $1,529,353.19 in “freed up” GR for FY09, as a result of ARRA. On previous reports this was applied to the month of 9/09 (month of distribution), but should be applied in fiscal year 2009. For simplicity, it this amount was all applied as a revenue in August 2009.

Table 1b : Medical Loss Ratio Trends: Current Contract Beginning 9/1/09 through 2/28/10: The data below should be consider preliminary, as all encounter data and cost data is not yet factored in the calculation of

MLR

Table 2: Funding Levels and Enrollees Served in NorthSTAR FY00 Compared to FY09

FY00 / FY09 / Percent Change
Number of Enrollees Served (MH and SA/CD) / 30,742 / 62,023
101.75%
Cash Payments / $78,787,143.71 / $113,226,601.25
43.71%
FY00 / FY09 / Percent Change
Cash Funding per enrollee Served / Cash Fundingper enrollee Served
$2,562.85 / $1,825.56
-28.77%

Note: The NorthSTAR budget consists of Cash Funding and State Hospital Allocation. The top table represents the change in cash funding and persons served from Fiscal Year 2000 (beginning 9/1/99 and ending 8/31/00) to Fiscal year 2009 (beginning 9/1/08 and ending 8/31/09. The bottom table represents the cash funding per person served for the same periods.

Revenue Trends

Table 3a: Revenue, FY08 to FY09

$ 100,496,696.14 / Annual Cash to ValueOptions FY08
$ 113,226,601.25 / Annual Cash to ValueOptions FY09
$ 12,729,905.11 / Increase from FY08 to FY09**

**Note: This includes $5,000,000 in supplemental funding, and $400,000 incentive payments for FY09.

Table 3b: Projected Revenue, FY09 to FY10

$113,226,601.25 / Annual Cash to ValueOptions FY09
$118,961,436.60 / Projected Annual Cash to ValueOptions FY10**
$5,734,835.35 / Projected Increase from FY09 to FY10**

**Note: This includes additional FY09 GR ($1,529,353.19 as a result FMAP increases associated with ARRA, and additional $400,000 in incentive payments. Projections were done using average 9/09-01/10 payment amounts multiplied by 12 months. Actual amounts may ultimately be more or less.

Utilization Trends

Table 4: Medicaid and non Medicaid Served Trends, 11/07-02/10

Table 5: Select Outpatient MH Trends- Enrollees Served

Table 6: Select Outpatient MH Trends-Units of Service Provided

Table 7: SA/CD Trends- Enrollees Served

Table 8: SA/CD Trends-Units of Service Provided

Table 9: Community Inpatient vs ER/23 hour Observation Trends- Enrollees Served

Table 10: Community Inpatient vs ER/23 hour Observation Trends-Units of Service Provided

Table 11: Combined Community Inpatient and ER/23 hour Observation Costs Per Enrollee Served (all enrollees)

Table 12: Units of Outpatient MH Services Compared to Acute Care Costs (Acute=ER/23 Hour Observation, Community Hospital Inpatient, MH outpatient=ACT, Rehabilitative Services, Case Management, Counseling, other MH community outpatient services

Table 13: Medication Data Trends

Month / Persons Who Received a Prescription / Number of Claims / Amount Paid
Nov-07 / 8,302 / 23,571 / $518,044
Dec-07 / 8,047 / 22,468 / $532,573
Jan-08 / 8,504 / 24,474 / $553,517
Feb-08 / 8,392 / 23,609 / $556,147
Mar-08 / 8,258 / 23,228 / $554,987
Apr-08 / 8,494 / 24,771 / $584,846
May-08 / 8,297 / 23,969 / $581,663
Jun-08 / 8,462 / 24,271 / $598,998
Jul-08 / 8,920 / 26,684 / $681,020
Aug-08 / 8,710 / 24,799 / $652,131
Sep-08 / 8,997 / 26,232 / $712,269
Oct-08 / 9,502 / 28,795 / $833,007
Nov-08 / 9,060 / 25,637 / $738,070
Dec-08 / 9,947 / 30,787 / $843,960
Jan-09 / 10,003 / 29,978 / $814,838
Feb-09 / 9,870 / 28,443 / $771,412
Mar-09 / 10,573 / 32,046 / $848,017
Apr-09 / 10,823 / 32,783 / $907,873
May-09 / 10,633 / 31,554 / $813,897
Jun-09 / 10,976 / 34,056 / $869,558
Jul-09 / 11,367 / 35,729 / $883,289
Aug-09 / 11,162 / 33,965 / $854,601
Sept 09 / 11,171 / 34,678 / $859,834
Oct 09 / 11,495 / 35,752 / $897,293
Nov 09 / 11,057 / 33,551 / $745,911
Dec-09 / 11,409 / 36,201 / $810,870
Jan-10 / 11,226 / 34,505 / $776,212
Feb-10 / 7,957 / 22,616 / $501,975

*Feb 09 Medication expenditures excludes jail drug expenditures ($184,000).

Later months are incomplete due to claims lag

Table 14a State Hospital Trends- Allocation Compared to

Bed Utilization - 9/1/08-8/09

FY09
Allocation / End Of Year Expenditure / End Of Year Over/Under
$34,968,007 / $35,159,759 / $191,752

Table 14b State Hospital Trends- Allocation Compared to

Bed Utilization – 9/1/09-1/31/10

FY09
Allocation / Projected Annual Expenditure / Projected Over/(Under)
$39,450,379 / $ 38,440,209 / $ (1,010,170)

Note: NorthSTAR has a slightly increased % of the overall statewide allocation, but the beds day costs have also risen, and whether NorthSTAR experiencesincreased access depends on their usage of the various bed days, as well as other LMHA usages

Table 15: Non Medicaid Enrollment Trends

Note: Most Recent Months may show Medicaid retroactive enrollment, and thus the

latest months could decrease.