ndpers executive summary executive summary | 2 contents 3 summary 6 ... poli;cal subs med. re;rees...

Quarter 1 | 2017 Presented August 2017

NDPERS Executive Summary

NDPERS EXECUTIVE SUMMARY | 2

CONTENTS 3Summary

6 Claims Analysis

8Membership & Utilization

12High Dollar Cases

15Prescription Drugs

18Dakota Wellness Program

22Performance Standards & Guarantees

3 | NDPERS EXECUTIVE SUMMARY

SummaryANNUAL MEMBERSHIP SUMMARY

MEMBERSHIP TREND

*Incurred between January 1, 2016 and March 31, 2017 and paid through May 31, 2017. Includes IBNR for January 2016 through March 2017, as of May 31, 2017. **Historically, 98% of claims will be accounted for within 90 days of the effective date.*Medicare Retirees PMPM excludes prescription drug coverage (Medicare Part D).

PMPM SUMMARY

MEMBERSHIP COMPARISON PERCENT CHANGE

Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q1 17/Q1 16

Actives 56,782 56,923 57,474 57,424 57,087 56,778 56,913 -1.0%

Early Retirees 1,211 1,152 1,121 1,124 1,071 1,060 1,071 -4.5%

Medicare Retirees 8,648 8,635 8,524 8,530 8,605 8,676 8,686 1.9%

56,782 56,923 57,474 57,424 57,087 56,778 56,913

8,648 8,635 8,524 8,530 8,605 8,676 8,686

1,211 1,152 1,121 1,124 1,071 1,060 1,071-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Q32015

Q42015

Q12016

Q22016

Q32016

Q42016

Q12017

QuarterlyChangesinMembershipTrend

Ac1ves MedicareRe1rees EarlyRe1rees

402 387 391357

1,169

168 178

489 424440 382

996

150 152

425445

440397

1,165

137

137

481 458 464434

1,113

136134

416 419 418

334

840

181169

366 356 359

940

168

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

Poli2calSubs StateEmployees Ac2ves SHPCommercial EarlyRe2rees MedicareRe2rees SHPMedicare

PerMemberPerMonthQuarterlyAverageJan2016-March2017

Q12016 Q22016 Q32016 Q42016 Q12017 Expected


Summary FITNESS CENTER REIMBURSEMENT

*Activity decline is the result of the wellness program suspension effective January 1 through May 31, 2017.

0.24% 0.33% 0.36% 0.01%

1.03% 1.43% 1.63%

0.09%

2.09% 2.74% 3.17%

0.26%

9.4%

12.2%14.3%

0.5%

0%

5%

10%

15%

20%

Q2-2016 Q3-2016 Q4-2016 Q1-2017

%ofEligibleMembersComple1ngaHealthAssessment

EarlyRe6rees MedicareRe6rees Poli6calSubs StateEmployees

HEALTH ASSESSMENT

*Activity decline is the result of the wellness program suspension effective January 1 through May 31, 2017. *Gym reimbursements in Q1 reflect unpaid 2016 gym activity. Gyms had until February 8, 2017 to submit 2016 gym activity.

228 189 190 56

1,418 1,219 1,323

362

768494 547

142

4,201

2,6973,154

751

0

600

1,200

1,800

2,400

3,000

3,600

4,200

4,800

Q22016 Q32016 Q42016 Q12017

#ofReimbu

rsem

ents

TotalNumberofFitnessCenterReimbursements

EarlyRe5rees MedicareRe5rees Poli5calSubs StateEmployees


Summary

Q22016 Q32016 Q42016 Q12017EarlyRe1rees 125 69 42 35

MedicareRe1rees 519 274 163 128

Poli1calSubs 1,067 739 649 351

StateEmployees 4,828 3,367 3026 1049

4,828

3,367 3026

1049

1,067

739649

351

519

274

163

128

125

69

42

35

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

#ofM

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#ofMembersComple8ngOnlineWellnessAc8vi8es

*Activity decline is the result of the wellness program suspension effective January 1 through May 31, 2017.

*This data was prepared by Express Scripts Inc. (ESI)

ONLINE WELLNESS ACTIVITIES

Sanford Health Plan – NDPERS EGWPDescription 1H16 1H17 Change

Avg Members per Month 8,526 8,696 2.0%

Number of Unique Patients 8,069 8,278 2.6%

Pct Members Utilizing Benefit 94.6% 95.2% 0.6

Total Days 6,098,596 6,384,389 4.7%

Total Adjusted Rxs 223,255 233,940 4.8%

Average Member Age 74.8 75.0 0.3%

Nbr Adjusted Rxs PMPM 4.36 4.48 2.7%

Generic Fill Rate 89.6% 91.3% 1.7

Home Delivery Utilization 1.0% 1.2% 0.2

Member Cost % 23.3% 21.3% -1.9

Specialty Percent of Plan Cost 26.5% 31.2% 4.8

Formulary Compliance Rate 98.8% 99.0% 0.2


ClaimsAnalysis

PAID CLAIMS PER CONTRACT PER MONTH

*Incurred between July 1, 2015 and March 31, 2017 and paid through May 31, 2017. Includes IBNR for July 2015 through March 2017 as of May 31, 2017.

*Historically, 98% of claims will be accounted for within 90 days of the effective date.

*NDPERS Active contracts have approximately 2.62 members per contract.

$1,137 $1,167

$1,019$1,148 $1,150 $1,212

$1,098

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

Q320

15

Q420

15

Q120

16

Q220

16

Q320

16

Q420

16

Q120

17

AVERAGEQUARTERLYINCURREDCLAIMSPERCONTRACTAcAves

Expected

*Incurred between July 1, 2015 and March 31, 2017 and paid through May 31, 2017. Includes IBNR for

July 2015 through March 2017 as of May 31, 2017.


*NDPERS Early Retirees contracts have approximately 1.22 members per contract.

$1,071

$1,294$1,419

$1,210

$1,415 $1,357

$1,016Expected

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

Q320

15

Q420

15

Q120

16

Q220

16

Q320

16

Q420

16

Q120

17

AVERAGEQUARTERLYINCURREDCLAIMSPERCONTRACTEarlyReDrees


ClaimsAnalysis

$172 $172

$224$200

$183 $183

$243

$0

$50

$100

$150

$200

$250

$300

Q32015

Q42015

Q12016

Q22016

Q32016

Q42016

Q12017

AVERAGEQUARTERLYINCURREDCLAIMSPERCONTRACTMedicareReBrees

Expected

PAID CLAIMS PER CONTRACT PER MONTH

*Incurred between July 1, 2015 and March 31, 2017 and paid through May 31, 2017. Includes IBNR forJuly 2015 through March 2017 as of May 31, 2017.


*NDPERS Medicare Retirees contracts have approximately 1.34 members per contract.


Membership& Utilization

MEMBERSHIP PERCENTAGE

*Incurred between January 1, 2016 and March 31, 2017 and paid through May 31, 2017. Includes IBNR for January 2016 through March 2017 as of May 31, 2017.

43,916 43,810 43,619 43,288 43,292

13,557 13,614 13,468 13,490 13,621

8,524 8,530 8,605 8,676 8,686

1,121 1,124 1,071 1,060 1,0710

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

Q12016 Q22016 Q32016 Q42016 Q12017

QuarterlyMembershipTrend

StateEmployees

Poli;calSubs

Med.Re;rees

EarlyRe;rees

85%

2%

13%

MembershipbyPercentage

Ac*ves EarlyRe*rees MedicareRe*rees

91%

4% 5%

PercentageofTotalIncurredClaims

Ac)ves EarlyRe)rees Med.Re)rees

387

424

445458 419

402

489

425

481

416391

440440

464

418

$300

$350

$400

$450

$500

$550

Q12016 Q22016 Q32016 Q42016 Q12017

PaidPMPMTrendbyQuarter

StateEmployees Poli;calSubs TotalAc;ves

PAID PMPM TREND BY QUARTER



PMPM BY CLAIM TYPE

*Incurred between April 1, 2016 and March 31, 2017 and paid through May 31, 2017. Includes IBNR for April 2016 through March 2017 as of May 31, 2017.

206

2

01

213

203

180

1

91

209

162

422

577

48

239

3

95

8

9

90

110

108

9

4

91

107

156

1

63

174

145

125

1

29

143

102

371

415

447

277

54

4

7

46

71

44

4

2

42

62

77

7

6

76

70

77

7

7

81

70

203

172

18

3

171

440

4

40

464

4

18

382

3

97

434

334

996

1,1

65

1,1

13

840

150

1

37

136

1

81

152

1

37

134

1

69

-

200

400

600

800

1,0

00

1,2

00

1,4

00

Q2

2016

Q

320

16

Q4

2016

Q

120

17

Q2

2016

Q

320

16

Q4

2016

Q

120

17

Q2

2016

Q

320

16

Q4

2016

Q

120

17

Q2

2016

Q

320

16

Q4

2016

Q

120

17

Q2

2016

Q

320

16

Q4

2016

Q

120

17

Incurred

PMPM

byClaimType

Rx

Pro

fess

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Ins<

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SHP

Com

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PAID CLAIMS BY STATE

*Paid Claims by State charts include both active and retiree membership.

76% 80% 80% 78% 79% 78% 79%

24% 20% 20% 22% 21% 22% 21%

0%

20%

40%

60%

80%

100%

120%

Q32015 Q42015 Q12016 Q22016 Q32016 Q42016 Q12017

%ofTotalClaimsPaid-NDvs.Out-of-State

NorthDakota Out-ofState

$5.4M

$4.5M $4.3M

$5.1M $4.9M$5.1M

$4.4M

$0

$1

$2

$3

$4

$5

$6

Q32015 Q42015 Q12016 Q22016 Q32016 Q42016 Q12017

Millions

Avg.QuarterlyMedicalSpendbyStateforOutofStateServices

Minnesota SouthDakota Montana Others



MEMBER RISK PROFILE & UTILIZATION

*Incurred between April 1, 2016 and March 31, 2017 and paid through May 31, 2017.

*All data was normalized using Verisk’s methodologies and algorithms.

*NDPERS includes Political Subdivisions, Early (Pre-Medicare) Retirees and State Employees.

NDPERS SHP BoBAverage Age 35.11 33.65 % Male (Current) 49.17 44.74Average Risk Score 1.25 1.11 Average Care Gap Index 1.31 1.04 Inpatient Days Per 1000 287 274 Total Admissions Per 1000 64 71 ER Visits Per 1000 219 165Total Office Visits Per 1000 4,295 4,014 Pharmacy Scripts Per 1000 8,532 9,280


High DollarCases

ACTIVES

Avg. Paid/Case $202,303% of Total Payments 26.9%

$69.8

$49.2

$0

$10

$20

$30

$40

$50

$60

$70

$80$M

illions

TotalPaidforHighDollarClaimants(over$100,000/member)-AcAves

302Members

July15-June167

302Members

July16-Mar17

243Members

26.9%

73.1%

HighClaimantAc6vesas%ofTotalPaymentsJuly2016-Mar2017

HighDollarPay AllOtherMembers


High DollarCases

EARLY RETIREES

$0

$1

$2

$3

$4

$5

$6

$Millions

TotalPaidforHighDollarClaimants(over$100,000/member)-EarlyReBrees

15Members$3.7M

20Members

July15-June16July16-Mar17

$4.8M

Avg. Paid/Case $183,999

% of Total Payments 44.9%

44.9%55.1%

HighClaimantEarlyRe7reesas

%ofTotalPaymentsJuly2016-Mar2017

HighDollarPay AllOtherMembers


High DollarCases

PRIMARY DIAGNOSIS

36%

16%15%

12%

7%

5%4%

3%

2%

HighestPaidDiagnosisGroupApr2016-Mar2017

Cancer(36%) OtherDiagnosis(16%)

GI/GU(15%) Heart/Circulatory(12%)

Musculoskeletal/Back/Joints(7%)

&BehavioralHealth/SubstanceAbuse(5%)

NewbornCare(4%)

Respiratory/COPD(3%)

Neuro/Spine(2%)

$29

$13 $12$10 $5

$4 $3 $3 $20

40

80

120

160

0

10

20

30

40

# of

Mem

bers

$ M

illio

ns

Highest Paid Diagnosis Group w/ Member CountApr 2016 - Mar 2017

Sum of Total Paid Count of Individuals

*High dollar cases consist of claims with a total over $100,000.

36%

16%15%

12%

7%

5%4%

3%

2%






NewbornCare(4%)


Neuro/Spine(2%)

36%

16%15%

12%

7%

5%4%

3%

2%






NewbornCare(4%)


Neuro/Spine(2%)

2%

36%

16%15%

12%

7%

5%4%

3%

2%






NewbornCare(4%)


Neuro/Spine(2%)


PrescriptionDrugs

GENERIC UTILIZATION

$17$187

$2,973

AveragePaid/RxAc7ves&EarlyRe7rees

Apr2016-Mar2017

Generic Brand Specialty

86.6%87.0% 87.1% 88.4%

85.1%85.6% 86.0% 86.5%

84.1%

85.9% 86.4% 87.0%

80%

85%

90%

Q22016

Q32016

Q42016

Q12017

GenericU)liza)onRate#ofRxClaims

SHPCommercial Ac<ves EarlyRe<rees

21.5% 21.7%22.6% 22.4%

20.9% 21.5%

22.7% 23.8%

16.5%20.5% 21.2%

20.1%

15%

20%

25%

30%

Q22016

Q32016

Q42016

Q12017

GenericU)liza)onRate$ofRxClaims




PrescriptionDrugs

SPECIALTY PHARMACY


0.93%0.90% 0.87%

0.81%

0.99% 0.93%0.85%

1.08% 0.95%0.94%

0.82%

0.6%0.7%0.8%0.9%1.0%1.1%1.2%

Q22016

Q32016

Q42016

Q12017

SpecialtyU5liza5onRate#ofRxClaims


39.3%38.1% 36.8% 36.6%

43.8%41.0% 37.8% 40.0%

49.6%43.4% 42.4%

50.2%

25%30%35%40%45%50%55%

Q22016

Q32016

Q42016

Q12017

SpecialtyU,liza,onRate$ofRxClaims



PrescriptionDrugs

PHARMACY


$2.9 $2.9 $3.1 $3.0

$4.9 $5.1 $5.3 $4.5

$6.1 $5.6 $5.2$5.0

$0

$2

$4

$6

$8

$10

$12

$14

$16

Q22016

Q32016

Q42016

Q12017

Millions

QuarterlyDrugSpendingbyDrugCategory

Generic Brand Specialty


DakotaWellnessProgram

MONTHLY WELLNESS THEMESMonthly themes keep the wellness program fresh throughout the year and keepsmembers engaged in their individual wellness pursuit. Newsletters, e-blasts andworksite posters are used to introduce themes.

SVHP-1960 2/17

Dakota Wellness Program

ESTABLISH HEALTHY EATING IN KIDS Research shows that children build food acceptance through repeated tastings and sensory experiences. Try these tips to make trying new foods a positive experience.

Schedule Set a specific schedule for meals and snacks. This gives structure to the day and your child will know what to expect. If your child declines to eat, explain that they will be able to eat again in “x” amount of time.

Proportion Focus meals on proportion, variety and moderation. Help your child judge their fullness by asking them, “Are you hungry, or are you full?”

Adventure Let your child play detective and analyze new food. Have a conversation by using prompt questions that ask about the size, shape, color, texture and look of the food.

SVHP-1912 12/16


TAKE STOCK IN YOU THIS NEW YEAR If your New Year’s goals are usually tossed aside by January 31, you deserve a better approach. What need does meeting your goal help fulfill? Know your needs, enjoy the change process and 2017 can be your year to shine!

Ask yourself:

• Which two needs drive much of what I do every day?

• How will the process of working toward my goal help meet my top two needs?

Wellness Activities

Monthly Book Club: The Three Marriages: Reimagining Work, Self and Relationship by David Whyte

Certainty The perception of safety & security

VarietyNew and exciting experiences

Significance A sense of importanceand meaning

GrowthStretching our limitstoward improvement

Love & ConnectionPart of an accepting group

ContributionServing, protecting and giving to a cause larger than ourselves

SVHP-1936 1/17


HOW IS YOUR HEALTH? LOOK INSIDE YOUR MOUTH According to the Academy of General Dentistry, new research shows that the health of your mouth mirrors the condition of your body as a whole. Without proper oral hygiene, bacteria can reach levels that may lead to oral infections that can lead to intestinal failure, irritable bowel syndrome and other digestive disorders.

The American Dental Association provides these recommendations to help reduce your risk of oral complications:

Brush twice a day for at least two minutes, using fluoridated toothpaste.

Floss daily to remove plaque from places your toothbrush can’t reach.

Eat a healthy diet to provide the nutrients necessary (vitamins A and C, in particular) to prevent gum disease.

Avoid cigarettes and smokeless tobacco, which are known to contribute to gum disease and oral cancer.

Visit the dentist regularly for cleanings and exams. This is one of the most effective ways to detect the early signs of gum disease.



TOP 10 ONLINE WELLNESS ACTIVITIESThese are the top 10 online Novu activities that were selected and completedby NDPERS members.

NUTRITION

CARDIO

BALANCE &MOBILITY

SLEEP HEALTH

HEALTHY WEIGHT

STRENGTH

STRESS

YOGA & RELAXATION

PURPOSE

DAILY HYDRATION CHALLENGE

#1 #6

#2 #7

#3 #8

#4 #9

#5 #10



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EVENT ATTENDANCE BY AGENCYThe Sanford Health Plan NDPERS wellness team engages members both offline

and online. Wellness educators travel across the state to support agency wellness

coordinators and provide worksite education and activities. This map shows where

they’ve been over the last quarter.

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LEADING FOR WELLNESSIn the first quarter of 2017, the Dakota Wellness Program focused on agency leader wellness training and offered two-hour Leading for Wellness sessions in Bismarck, Minot, Fargo and Grand Forks with over 100 agency leaders attending.

Leading for Wellness recognizes organizational culture can serve as an accelerator or barrier to employee well-being. This leadership development training reveals how supervisors, managers, directors and executives can use employee engagement to drive wellness. The following survey responses were collected after the training sessions.

1. As a result of the Leading for Wellness presentation, I am more knowledgeable about the connection between employee engagement and employee well-being, with career well-being as the primary driver of overall well-being. 97% of Participants Agreed or Strongly Agreed

2. As a leader, I am now more aware of how I can change organizational culture by influencing the six dimensions of well-being with my employees. 92% of Participants Agreed or Strongly Agreed

3. I will apply the leadership competencies I learned in the presentation to increase the well-being of my employees. 90% of Participants Agreed or Strongly Agreed

4. Which technique(s) resonated the most with you, and which ones do you plan to focus on first? (responses unduplicated)• Physical, social, emotional and career well-being• Finding out what creates stress for our employees and addressing it• Improved sleep• Career well-being: strengths, autonomy, positive feedback• Stress in the workplace• Community well-being• Acknowledging achievements and good work of employees• Employee engagement• Getting more department heads on board with the dimensions

of well-being

5. Additional Comments: (responses unduplicated)• Loved this training! Very insightful. Related a lot to the speaker’s examples

and discussion.• Excellent two hours spent. Well done!• Great session! A lot of new information, enjoyed the presentation and

examples.• Thanks! Worth my time!• Really liked the piece on positive reinforcement.• Great ideas. I’m anxious to implement them. Thank you!• I am not the administrator of our department. Our management sees the

need, but does not realize how important wellness is and is “too busy” to assist in any program we try to complete.

• We will try to restart the in-office concession stand with healthy options.• I will apply to the extent my CEO permits.


MEASURE GOAL OUTCOME REPORTING DATES OUTCOME

COST MANAGEMENT:

Health Risk Assessment 10% Dec. 31, 2015 17.9%

HEALTH OUTCOMES:

Medical Home Enrollment 30% July 1, 2016 36.5%

Breast Cancer Screening Rates 80% June 30, 2017 –

Cervical Cancer Screening Rates 85% June 30, 2017 –

Colorectal Cancer Screening Rates 60% June 30, 2017 –

PROVIDER NETWORK/CONTRACTING:

NDPERS PPO network - in-state hospitals, MDs and DOs that participate in the Company’s Par Network.

Hospital = 85%MDs & DOs = 85% Dec. 31, 2015

Hospital = 94%

MDs & DOs = 87%

Minimum provider discount from in-network providers

30% for Non-Medicare

contracts June 30, 2017 –

Claims Financial Accuracy 99% June 30, 2017 –

Claims Payment Incidence Accuracy 97% June 30, 2017 –

Claim Timeliness 99% June 30, 2017 –

Average Speed of Answer 45 seconds June 30, 2017 –

Call Abandoned Rate 7% or less June 30, 2017 –

ANCILLARY ITEMS:

The interest rate utilized currently is based on the US Treasury Notes quoted by the Wall Street Journal

verification June 30, 2017 –

Rx rebates passed-through to NDPERS 100% June 30, 2017 –

HRA WELLNESS SCORE:

HRA Wellness Score 5% point increase Dec. 31, 2016 N/A

bWell Participation 10% Dec. 31, 2015 10.8%

Health Club Credit Goal = 1,950 July 1, 2016 1,879

PerformanceStandards &Guarantees


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SVHP-2059 7/17

ndpers executive summary executive summary | 2 contents 3 summary 6 ... poli;cal subs med. re;rees...

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