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,Mercer Government Human Services Consulting,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Final Trend Estimates and CY07 Rates,Tim Doyle,FSA,MAAA Brad Rhodes,Jeff Smith,July 28,2006,Final Trend Estimates and CY0,Outline of Presentation,A.Rate Impact,B.Rate-Setting Methodology,Mercer Government Human Services Consulting,Outline of PresentationA.Rate,A.Rate Impact,Recall from the June 22,2006 presentation 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,Mercer Government Human Services Consulting,A.Rate ImpactRecall from the,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 Consulting,A.Rate Impact(continued)Prog,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:Rate-Setting Methodology1.,B.1:CY04 Adjusted HFMR Base as Starting 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.1:CY04 Adjusted HFMR Base,B.2:Program Changes,Physician fee schedule,Increase to specified codes effective July 1,2005 and July 1,2006,Impacts physician 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 Government Human Services Consulting,B.2:Program ChangesPhysician,B.2:Program Changes (continued),TPL,$1.5 million removed from total expenses,Mercer Government Human Services Consulting,B.2:Program Changes,B.3:Medical Trends,Preliminary trend ranges presented on June 22,2006,Final trend estimates presented in this section,Mercer Government Human Services Consulting,B.3:Medical TrendsPreliminary,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 Human Services Consulting,Trend MethodologyData analysis,Inpatient Hospital Unit Cost Trends:HSCRC Component,Year Rate Update,FY05,4.81%,FY06,5.01%,FY07,3.56%,FY08*,3.91%,*Forecast,HSCRC rate updates,Mercer Government Human Services Consulting,Inpatient Hospital Unit Cost,Inpatient 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 HSCRC DRG day limit and GME discount impact,Mercer Government Human Services Consulting,Inpatient Trend Considerations,Inpatient Hospital PMPM,Annual Trend by COA and Year,F&C,Disabled,SOBRA,AIDS,HIV,Delivery/Birth,Total,CY04/05,5.4%,4.9%,5.4%,5.4%,5.1%,4.6%,5.0%,CY05/06,8.8%,8.2%,8.8%,8.3%,8.1%,6.7%,7.9%,CY06/07,7.7%,7.2%,7.7%,7.3%,7.2%,6.2%,7.0%,Total,7.3%,6.8%,7.3%,7.0%,6.8%,5.8%,6.6%,Mercer Government Human Services Consulting,Inpatient Hospital PMPM F&,Outpatient Hospital Unit Cost Trends:HSCRC Component,*Forecast,Year Rate Update,FY05,3.78%,FY06,3.98%,FY07,3.56%,FY08*,3.22%,HSCRC rate updates,Mercer Government Human Services Consulting,Outpatient Hospital Unit Cost,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 Services Consulting,Outpatient Trend Consideration,F&C,Disabled,SOBRA,AIDS,HIV,Delivery/Birth,Total,CY04/05,8.0%,8.2%,8.0%,8.5%,8.5%,8.0%,8.1%,CY05/06,12.1%,13.3%,12.1%,12.1%,12.1%,12.1%,12.5%,CY06/07,11.4%,12.6%,11.4%,11.4%,11.4%,11.4%,11.8%,Total,10.5%,11.4%,10.5%,10.7%,10.7%,10.5%,10.8%,Outpatient Hospital PMPM,Annual Trend by COA and Year,Mercer Government Human Services Consulting,F&CDisabled SOBRA AIDS,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 Human Services Consulting,Pharmacy Trend ConsiderationsC,F&C,Disabled,SOBRA,AIDS,HIV,Delivery/Birth,Total,CY04/05,5.5%,6.1%,5.5%,7.6%,7.6%,5.5%,6.1%,CY05/06,7.6%,8.4%,7.6%,9.9%,9.9%,7.6%,8.3%,CY06/07,7.6%,8.4%,7.6%,9.9%,9.9%,7.6%,8.3%,Total,6.9%,7.6%,6.9%,9.1%,9.1%,6.9%,7.6%,Pharmacy PMP
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