Pharr-San Juan-Alamo ISDFourth Year Annual Review2007-2008

“An ounce of prevention is worth a pound of cure.”- Benjamin Franklin

Good Health Comes First

Overview

• Utilization

• Top 5 Diagnosis

• Diagnosis Summary

• Top 5 Medications

• Top 5 Referrals

• Overall Satisfaction Survey

Results

• YTD Clinic Expense

• Total Paid Claims

• Primary Care

• Pharmacy

• 4 Year compensation

• Productivity Summary

• Employee Savings

• Overall Summary

PSJA 2008 Medical Clinic Summary

Utilization

• 2,465 Total patient records

• 3,843 Average monthly enrollment

• 64% of the population have visited the clinic at least once

PSJA 2008 Medical Clinic Summary

• Total Clinic Usage: 8,740

• Employee: 7,493

• Spouse: 717

• Dependent: 530

2006 - 2007

• Total Clinic Usage: 10,564

• Employee: 8,962

• Spouse: 820

• Dependent: 782

2007 - 2008

Top 5 Diagnosis

PSJA 2008 Medical Clinic Summary

2007-2008

High Cholesterol

22%

Bronchitis8%Diabetes

11%

High Blood Pressure

20%

Upper Respiratory

I nfection39%

2006-2007

Upper Respiratory

I nfection38%High Blood

Pressure18%

Diabetes12%

Urinary Tract I nfection

9%

High Cholesterol

23%

2005-2006

Upper Respiratory

I nfection29%

Cough6%

Diabetes14%

High Cholesterol

20%

High Blood Pressure

31%

A message from Free First Healthcare Clinic

Diagnosing and treating upper respiratory infection (URI), cough, or bronchitis quickly and effectively can prevent severe infections resulting in less time away from work. When left untreated, infection and inflammation of the larger airways of the lungs lead to chronic conditions such as asthma and bronchitis. Severe cases can eventually become pneumonia.

High Cholesterol is an excess level of fat in your blood. These fats can be triglycerides or cholesterol. Many people choose touse diet, exercise and weight loss as the initial step in treating the disorder. It does not bring the cholesterol or triglyceride

leveldown to a normal range. Medication is recommended to prevent cardiovascular damage. High cholesterol is often associatedwith increased risk of heart disease or stroke. There are genetic disorders that predispose people to high cholesterol so evenexercising and eating healthy is not preventive.

Heart disease is the leading killer of both men and women which is also your top diagnosis. Uncontrolled and/or undiagnosed

high blood pressure can lead to end stage organ damage, kidney or eye problems, early stroke and early heart attack. Diagnosing and treating high blood pressure early can prevent these problems and decrease the risk of end stage organ

damage while improving quality of life.

Diabetes, which is above normal blood glucose levels, can cause the blood to thicken and lead to end stage organ damage in

the kidneys, eyes, and circulation of the body if left untreated. Poor circulation can lead to increased risk of infections andamputation of the lower extremities.

Bronchitis is an inflammation of the mucus membrane of the bronchi. Bronchitis is usually viral in nature, but may occur from a bacterial infection. Often a person acquires Bronchitis after having a URI. Because Bronchitis is usually caused by a virus we are able to only treat the symptoms of bronchitis by drinking plenty of fluids and with cough suppressants.

Diagnosis Summary

PSJA 2008 Medical Clinic Summary

Top 5 Medications

PSJA 2008 Medical Clinic Summary

2006 - 2007

Amoxicillin 22%

Naproxen 18%

Benazepril 14%

Levothyroxine13%

Cephalexin33%

2005 - 2006

Amoxicillin29%

Ranitidine13%

Naproxen13%

Metformin HCL12%

Cephalexin33%

2007 - 2008

Amoxicillin20%

Cephalexin39%

Naproxen19%

Antipyrine/Benzocaine

11%

Metformin HCL11%

Medication TypeCephalexin AntibioticAmoxicillin AntibioticNaproxen Anti- inflammatoryAntipyrin/ Benzocain Pain relieverMetformin HCL Controls high blood sugar

Top 5 Referrals

PSJA 2008 Medical Clinic Summary

2006 - 2007

MRI16%

Mammography21%

Ultrasound27%

X-Ray34%

GI2%

2005 - 2006

EKG1%

X-Ray71%

MRI12%

Ultrasound8%

Mammography8%

2007 - 2008

X- Ray61%

Ultrasound13%

Mammography11%

MRI11%

Dermatology4%

Satisfaction Survey Results (Clinic)

Survey Questions

• Availability of Appointments?

• Wait Time?

• Physician Patient Care?

• Nurse Patient Care?

• Overall Satisfaction?

PSJA 2008 Medical Clinic Summary

Very Satisfied99%

Somewhat Satisfied

1%

604 Surveys

Satisfaction Survey Results (Medication)

Survey Questions

• Quickness of receiving medication?

• Availability of medication?

• Convenience of this program?

PSJA 2008 Medical Clinic Summary

Very Satisfied99%

Somewhat Satisfied

1%

747 Surveys

YTD Clinic Expense

PSJA 2008 Medical Clinic Summary

Clinic Services Supplies Lab ServicesStock

Pharmacy Prescriptions

Medical Assistant Fee

TOTAL

September 34,770.00$ 13,410.59$ 4,388.97$ 2,305.44$ 21,452.51$ -$ 76,327.51$ October 42,090.00$ 1,044.96$ 6,598.25$ 3,597.34$ 18,702.56$ -$ 72,033.11$ November 36,600.00$ 3,754.19$ 6,342.84$ 3,754.19$ 19,128.12$ -$ 69,579.34$ December 27,450.00$ 1,785.68$ 3,840.00$ 3,074.52$ 18,363.07$ -$ 54,513.27$ J anuary 40,260.00$ 3,792.56$ 5,809.79$ 4,328.29$ 17,815.64$ -$ 72,006.28$ February 38,430.00$ 1,028.44$ 6,720.00$ 3,948.13$ 28,795.49$ -$ 78,922.06$ March 38,430.00$ 2,464.87$ 6,240.00$ 5,541.30$ 18,761.72$ 3,378.20$ 74,816.09$ April 40,260.00$ 1,304.52$ 8,160.00$ 3,768.44$ 20,038.99$ 3,484.60$ 77,016.55$ May 38,430.00$ 814.62$ 4,380.00$ 4,796.09$ 29,805.18$ 3,378.20$ 81,604.09$ J une 38,430.00$ 3,941.17$ 6,780.00$ 4,839.68$ 24,819.30$ 3,378.20$ 82,188.35$ J uly 31,110.00$ 965.62$ 6,300.00$ 2,231.59$ 18,596.86$ 1,808.80$ 61,012.87$ August 39,345.00$ 461.44$ 5,560.91$ 799.12$ 23,109.01$ 2,234.40$ 71,509.87$

TOTAL 445,605.00$ 34,768.66$ 71,120.76$ 42,984.13$ 259,388.45$ 17,662.40$ 871,529.39$

Total Paid Claims

• $421,899.74 Annual Savings

• $23.28 Reduction in PEPM

PSJA 2008 Medical Clinic Summary

2004-2005 Trend 10% 2005-2006 Trend 10% 2006-2007 Trend 10% 2007-2008

Total less specTotal Claims

$16

,815

,332

.34

$18

,496

,865

.57

$18

,511

,490

.80

$20

,362

,639

.88

$17

,937

,987

.88

$19

,731

,786

.67

$19

,549

,886

.93

$16

,215

,332

.34

$16

,215

,332

.34

$17

,836

,865

.57

$18

,712

,639

.88

$17

,337

,987

.88

$19

,071

,786

.67

$18

,649

,886

.93

Total Plan Savings

• Primary Care Annual Savings $667,288.18

PSJA 2008 Medical Clinic Summary

2004/2005 2005/2006 2006/2007 2007/2008

Total Amount Paid

Total Paid Without Clinic

$1,7

51,33

0.20

$1,8

11,12

2.30

$2,0

99,66

4.40

$2,2

89,62

0.75

$1,5

58,32

2.41

$1,4

30,94

4.53

$1,6

20,48

4.69

$1,6

22,33

2.57

$0.00

$500,000.00

$1,000,000.00

$1,500,000.00

$2,000,000.00

$2,500,000.00

Pharmacy

• 49% Overall savings

• $239,571.36 Total cost savings

• 96% Generic utilization

PSJA 2008 Medical Clinic Summary

Clinic Cost, $248,143.62

Without Clinic Cost,

$487,675.39

$-

$50,000.00$100,000.00$150,000.00$200,000.00$250,000.00$300,000.00

$350,000.00$400,000.00$450,000.00$500,000.00

Approximate employee wage $14.50 per hourNumber of employee office visits 8960 visitsApproximate time off to see physician in traditional setting 180 minutesApproximate work value lost $42.00 per visitTotal estimated work value lost

$376,320.00

Approximate patient wait time 20 minutesApproximate patient time with physician 25 minutesTotal approximate time off to see physician 45 minutesApproximate work value lost $10.75 per visitTotal estimated work value lost $96,320.00

Average work time gained 2.25 hours

Total estimated work value gained $280,000.00

Productivity Summary

PSJA 2008 Medical Clinic Summary

Employee Savings

• Office copay:

$15.00

• Total clinic visits:

10,564

Employee Savings: $158,460.00

• *Generic copay: $9.25

• Total Generic Rx: 9,876

• *Brand copay: $20.77

• Total Brand Rx: 394

Employee Savings: $91,353.00

Employee Savings: $8,183.38

Total Savings: $257,996.38

*Prescription medication co-payments are an average of retail and mail order co-payments provided by PBM.

PSJA 2008 Medical Clinic Summary

• Primary Care Savings: $667,281.80• Total Pharmacy Savings: $239,571.36• Productivity Savings: $280,000.00• Total Savings:

$1,186,853.16

• YTD Cost: (Minus Pharmacy Cost) $612,140.94• Total Clinic Savings Minus Expenses:

$574,712.22• Clinic Savings (less productivity):

$294,712.22

Overall Summary

PSJA 2008 Medical Clinic Summary

Thank you