City of Toledo

July – December 2010

 Financial Summary

Gross and Net Cost by Location

2
 Plan Summary

Courts Exec Admin Commanders Services Admin Police Maint. Judges

Jul - Dec Jul - Dec Jul - Dec Jul - Dec Jul - Dec Jul - Dec Jul - Dec HSB 2009
2010 2010 Jul - Dec 2010 2010 2010 2010 2010 2010 Index
# Employees 83 116 127 197 53 456 798 78
# Members 189 282 384 511 132 1,375 192 207

Gross Cost per EE $12,030 $12,242 $5,504 $8,059 $3,848 $6,631 $8,547 $7,130 $6,354
Net Cost per EE $9,049 $8,129 $5,504 $7,822 $3,848 $6,455 $7,479 $7,130

Number of Catastrophic Cases 2 2 0 2 0 2 15 0

Catastrophic Cases / 1,000 10.6 7.1 0.0 3.9 0.0 1.5 7.5 0.0 9.1
Avg. Catastrophic Case Paid $112,106 $169,085 $0 $61,633 $0 $70,127 $78,426 $0 $116,981
Cats as % of Gross Dollars 44.7% 47.7% 0.0% 15.6% 0.0% 9.3% 34.5% 0.0%
Catastrophic Threshold $50,000

Inpatient:
# of Admits 5 24 7 20 1 32 75 6
# of Patient Days 60 120 15 71 2 106 320 14
Paid per Admit $38,420 $14,032 $4,884 $14,427 $8,075 $8,430 $15,542 $10,290 $10,973
Paid per Day $3,202 $2,806 $2,279 $4,064 $4,037 $2,545 $3,643 $4,410 $2,849
Admits / 1,000 53 170 36 78 15 47 75 58 74
Days / 1,000 634 8851 78 278 30 154 321 135 287
Average LOS 12.0 5.0 2.1 3.6 2.0 3.3 4.3 2.3 3.9
Annualized Information

3
 Plan Summary cont.

Courts Exec Admin Commanders Services Admin Police Maint. Judges

Jul - Dec Jul - Dec Jul - Dec Jul - Dec Jul - Dec Jul - Dec Jul - Dec HSB 2009
2010 2010 Jul - Dec 2010 2010 2010 2010 2010 2010 Index

Cost Distribution -Paid Per Member $2,092 $2,569 $178 $1,237 $123 $358 $1,156 $596 $1,110
Hospital Inpatient $2,739 $1,954 $1,095 $1,422 $948 $1,359 $1,707 $1,505 $1,635
Facility Outpatient $468 $502 $551 $440 $474 $479 $562 $583 $524
Physician Office $5,299 $5,025 $1,824 $3,099 $1,545 $2,196 $3,425 $2,684 $3,269
Total:
Physician Office Visit Utilization 3.7 3.4 3.5 3.5 3.3 3.0 3.3 3.1 3.1
Physician Office Visit Avg. Paid $52 $53 $50 $51 $51 $51 $54 $56 $49
Total Physician Office Visit Paid $192 $180 $175 $179 $168 $153 $178 $174 $152

Physician DX&L Utilization 14.8 14.0 10.8 11.5 12.1 10.0 11.7 11.7 8.4
Physician DX&L Avg. Paid $69 $68 $70 $65 $57 $70 $72 $82 $65
Physician DX&L Total Paid $1,021 $952 $756 $748 $690 $700 $842 $959 $546

ER Patients 24 27 38 45 12 147 242 22

ER Visits 26 44 42 53 13 174 312 28
ER Admits 1 9 4 7 0 13 40 0
ER Visits Per Member 0.27 0.31 0.22 0.21 0.20 0.25 0.31 0.27 0.22
ER Average Paid per Visit $1,556 $1,311 $1,361 $1,210 $1,383 $1,206 $1,248 $967 $1,131
Annualized Information

4
 Courts
July – December 2010
 Cost Distribution - Courts

Paid Dollar Range # of Members % of Members # of Claims % of Claims Total Paid % of Paid
$100,000.01 Plus 1 0.53% 104 8.02% $165,933 33.10%
$50,000.01 - $100,000.00 1 0.53% 11 0.85% $58,279 11.63%
$25,000.01 - $50,000.00 2 1.06% 54 4.17% $64,500 12.87%
$10,000.01 - $25,000.00 2 1.06% 49 3.78% $33,258 6.64%
$5,000.01 - $10,000.00 10 5.29% 210 16.20% $59,844 11.94%
$2,500.01 - $5,000.00 11 5.81% 189 14.58% $44,099 8.80%
$0.01 - $2,500.00 106 56.04% 677 52.24% $75,328 15.03%
$0.00 56 29.69% 2 0.15% $0 0.00%
189 100.00% 1,296 100.00% $501,242 100.00%

6
 Demographics - Courts

Patient Patient # # # ER Inpatient Outpatient PCP Specialist Other Total

Type Relationship Members Patients Claims Visits Admits Billed Allowed Paid Paid Paid Paid Paid Paid
Child Child 63 38 236 9 0 $118,044 $48,434 $0 $28,101 $3,476 $12,426 $184 $44,187
63 38 236 9 0 $118,044 $48,434 $0 $28,101 $3,476 $12,426 $184 $44,187

Self Insured 83 77 973 14 5 $1,045,722 $446,202 $197,905 $110,077 $17,421 $54,586 $58,644 $438,632
83 77 973 14 5 $1,045,722 $446,202 $197,905 $110,077 $17,421 $54,586 $58,644 $438,632

Spouse Husband 41 23 155 3 0 $63,384 $37,523 $0 $9,942 $3,418 $4,553 $494 $18,407
Wife 3 1 1 0 0 $89 $89 $0 $0 $15 $0 $0 $15
44 24 156 3 0 $63,473 $37,612 $0 $9,942 $3,433 $4,553 $494 $18,422

Female 108 91 1,093 21 5 $1,089,876 $472,969 $197,905 $127,468 $19,165 $59,828 $58,828 $463,193
Male 82 48 272 5 0 $137,362 $59,279 $0 $20,652 $5,165 $11,737 $494 $38,049

Total: 190 139 1,365 26 5 $1,227,238 $532,248 $197,905 $148,120 $24,330 $71,565 $59,322 $501,242

7
 MDC Summary - Courts

Description # Patients # Claims Total Billed Total Eligible Total Paid % of Paid
(MDC 12) DISORDER OF DIGESTIVE 19 92 $473,066 $223,987 $223,606 44.61%
SYSTEM
(MDC 23) FRACTURES AND OTHER 22 74 $86,726 $54,476 $53,770 10.73%
INJURIES
(MDC 22) ILLDEFINED CONDITIONS 63 203 $112,220 $64,867 $48,042 9.58%
(MDC 03) ENDOCRINE, NUTRITIONAL, 22 71 $82,051 $32,416 $31,274 6.24%
METABOLIC,
(MDC IMMUNITY,
16) FEMALE DISORDERS
DISORDERS 20 68 $62,922 $26,612 $26,294 5.25%
(MDC 18) DISORDER OF 44 179 $43,111 $25,841 $22,571 4.50%
MUSCULOSKELETAL
(MDC SYSTEM
11) DISORDER OF RESPIRATORY 39 106 $68,669 $19,771 $18,307 3.65%
SYSTEM
(MDC 17) PREGNANCY / CHILDBIRTH 2 25 $30,337 $14,130 $14,046 2.80%
(MDC 25) FACTORS AFFECTING HEALTH 60 162 $32,462 $14,736 $13,562 2.71%
(MDC 13) OTHER DIGESTIVE DISORDERS 9 30 $60,192 $11,430 $11,282 2.25%
(MDC 02) NEOPLASMS 8 27 $20,940 $8,363 $7,875 1.57%
(MDC 19) DISORDER OF BREAST OR 30 55 $8,952 $5,805 $5,019 1.00%
SKIN
(MDC 05) PSYCHOTIC CONDITIONS 12 51 $8,491 $5,772 $4,813 0.96%
(MDC 08) DISORDER OF EYE / ADNEXA 13 21 $7,181 $5,513 $4,800 0.96%
(MDC 10) DISORDER OF CIRCULATORY 18 43 $10,181 $4,512 $4,355 0.87%
SYSTEM
(MDC 09) DISORDER OF EAR 9 17 $5,408 $3,899 $3,418 0.68%
(MDC 04) DISORDER OF BLOOD 3 6 $6,220 $2,152 $2,138 0.43%
(MDC 07) DISORDER OF NERVOUS 9 13 $4,603 $2,905 $1,709 0.34%
SYSTEM
(MDC 14) NEPHRITIS / NEPHROSIS 12 22 $3,236 $1,594 $1,505 0.30%
(MDC 01) INFECTIOUS / PARASITIC 13 19 $2,173 $1,442 $1,149 0.23%
DISEASE
(MDC 15) DISORDER OF MALE GENITAL 2 4 $1,516 $1,018 $1,008 0.20%
ORGANS
(MDC 20) CONGENITAL ANOMALIES 5 6 $988 $728 $540 0.11%
(MDC 21) PERINATAL PERIOD 2 2 $295 $277 $158 0.03%
CONDITIONS 436 1,296 $1,131,940 $532,248 $501,242 100.00%

8
 Inpatient Summary - Courts

Bed Avg Total Paid per Paid per % of % of

Hospital Admits Days LOS Total Billed Allowed Total Paid Admit Day Admits Paid
ST VINCENT MERCY MEDICAL CENTER 1 26 26 $247,349 $103,887 $103,887 $103,887 $3,996 0.58% 4.35%
SELECT SPECIALTY HOSPITAL 1 23 23 $60,494 $41,400 $41,400 $41,400 $1,800 0.58% 1.73%
ST ANNE MERCY HOSPITAL 1 6 6 $68,551 $25,332 $25,332 $25,332 $4,222 0.58% 1.06%
FLOWER HOSPITAL 1 2 2 $35,813 $14,443 $14,443 $14,443 $7,222 0.58% 0.60%
ST CHARLES HOSPITAL 1 3 3 $15,129 $7,038 $7,038 $7,038 $2,346 0.58% 0.29%
5 60 12 $427,335 $192,100 $192,100 $38,420 $3,202 2.91% 8.05%

Inpatient paid dollars accounts for 38.3% of the

Courts total paid dollars.

9
 Catastrophic Summary - Courts

Member ID Age Gender Relationship Diag Cd Diagnosis Description Total Paid

71777 58 F Insured 56081 INTESTINAL OR PERITONEAL ADHESIONS WITH OBSTRUCTION $165,933
(POSTOPERATIVE) (POSTINFECTION)

69121 28 F Insured 5560 ULCERATIVE (CHRONIC) ENTEROCOLITIS $58,279

$224,212

Catastrophic
Members account
for 44.7% of the
total paid dollars.

10
 Emergency Room Summary - Courts

Courts
Jul - Dec HSB 2009
2010 Index
# Patients 24
# Visits 26
ER Visits per Member* 0.27 0.22
Admits 1
ER Average Paid per Visit $1,556 $1,131
* Annualized data

Emergency Room Visits by Day of Week

6
6
5
5
4
4
3 4
3 3
2

2
1

0
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
11
 In vs Out of Network - Courts

Non-Network
$6,920
1%
In-Network
$494,322
99%

12
 In Network Medical Discounts - Courts

$450,000
54% 63% 48% 31%
$400,000

$350,000

$300,000

$250,000

$200,000

$150,000

$100,000

$50,000

$0
Inpatient Facility Outpatient Facility Physician Other

Eligible Allow ed PPO Discount Paid

13
 Employee Medical Cost Sharing - Courts

Em ployee
Paid
$11,552
Courts Paid
2%
$501,242
98%

Employee paid consists of Deductible, Co-Insurance and Co-Pay. It does not

contain premium dollars.
14
Executive Admin.
July – December 2010
 Cost Distribution – Exec Admin

Paid Dollar Range # of Members % of Members # of Claims % of Claims Total Paid % of Paid
$100,000.01 Plus 1 0.35% 274 12.94% $287,941 40.61%
$50,000.01 - $100,000.00 1 0.35% 99 4.67% $50,228 7.08%
$25,000.01 - $50,000.00 1 0.35% 14 0.66% $28,642 4.04%
$10,000.01 - $25,000.00 7 2.48% 186 8.78% $112,681 15.89%
$5,000.01 - $10,000.00 11 3.90% 178 8.40% $72,231 10.19%
$2,500.01 - $5,000.00 14 4.96% 261 12.32% $49,637 7.00%
$0.01 - $2,500.00 174 61.67% 1,099 51.89% $107,635 15.18%
$0.00 73 25.93% 7 0.33% $0 0.00%
282 100.00% 2,118 100.00% $708,995 100.00%

16
 Demographics – Executive Admin

Patient Patient # # # ER Inpatient Outpatient Specialist Other

Type Relationship Members Patients Claims Visits Admits Billed Allowed Paid Paid PCP Paid Paid Paid Total Paid
Child Child 102 72 528 20 7 $399,938 $164,293 $36,163 $33,765 $9,465 $22,870 $1,131 $103,394
Ineligible 0 2 3 0 0 $4,976 $0 $0 $0 $0 $0 $0 $0
Child
102 74 531 20 7 $404,914 $164,293 $36,163 $33,765 $9,465 $22,870 $1,131 $103,394

Self Insured 116 97 1,194 14 8 $1,306,645 $468,898 $273,891 $108,929 $21,020 $70,391 $4,236 $478,467
116 97 1,194 14 8 $1,306,645 $468,898 $273,891 $108,929 $21,020 $70,391 $4,236 $478,467

Spouse Husband 23 16 278 9 6 $381,099 $227,092 $37,022 $31,013 $6,613 $10,021 $0 $84,669
Wife 41 39 279 1 3 $140,052 $66,726 $15,381 $9,471 $4,460 $13,108 $43 $42,464
64 55 557 10 9 $521,151 $293,818 $52,404 $40,484 $11,073 $23,130 $43 $127,134

Female 144 130 1,207 20 11 $706,622 $308,159 $63,458 $74,559 $20,028 $56,248 $1,587 $215,880
Male 138 96 1,075 24 13 $1,526,089 $618,849 $299,000 $108,618 $21,531 $60,143 $3,823 $493,115

Total: 282 226 2,282 44 24 $2,232,711 $927,008 $362,458 $183,178 $41,558 $116,391 $5,410 $708,995

17
 MDC Summary – Executive Admin

Description # Patients # Claims Total Billed Total Eligible Total Paid % of Paid
(MDC 23) FRACTURES AND OTHER INJURIES 33 124 $225,296 $114,816 $134,709 19.00%
(MDC 25) FACTORS AFFECTING HEALTH 105 317 $212,047 $114,765 $100,557 14.18%
(MDC 10) DISORDER OF CIRCULATORY SYSTEM 48 197 $205,500 $93,275 $91,426 12.90%
(MDC 02) NEOPLASMS 18 153 $312,228 $187,920 $85,559 12.07%
(MDC 22) ILLDEFINED CONDITIONS 78 265 $127,645 $67,820 $62,673 8.84%
(MDC 03) ENDOCRINE, NUTRITIONAL, METABOLIC, IMMUNITY, 48 154 $134,777 $59,295 $57,326 8.09%
DISORDERS
(MDC 18) DISORDER OF MUSCULOSKELETAL SYSTEM 63 299 $153,187 $65,606 $55,946 7.89%
(MDC 11) DISORDER OF RESPIRATORY SYSTEM 46 129 $60,971 $24,825 $23,262 3.28%
(MDC 16) FEMALE DISORDERS 17 52 $68,374 $22,436 $21,839 3.08%
(MDC 07) DISORDER OF NERVOUS SYSTEM 16 48 $47,074 $18,406 $18,014 2.54%
(MDC 17) PREGNANCY / CHILDBIRTH 7 35 $90,529 $72,533 $17,997 2.54%
(MDC 05) PSYCHOTIC CONDITIONS 22 88 $18,417 $12,498 $10,524 1.48%
(MDC 19) DISORDER OF BREAST OR SKIN 44 71 $14,867 $8,478 $7,424 1.05%
(MDC 14) NEPHRITIS / NEPHROSIS 9 39 $43,220 $41,641 $4,269 0.60%
(MDC 08) DISORDER OF EYE / ADNEXA 29 42 $8,762 $6,068 $4,117 0.58%
(MDC 12) DISORDER OF DIGESTIVE SYSTEM 15 26 $11,439 $5,183 $4,017 0.57%
(MDC 01) INFECTIOUS / PARASITIC DISEASE 18 30 $5,034 $3,038 $2,299 0.32%
(MDC 13) OTHER DIGESTIVE DISORDERS 3 9 $4,241 $1,817 $1,797 0.25%
(MDC 15) DISORDER OF MALE GENITAL ORGANS 8 11 $3,362 $1,848 $1,729 0.24%
(MDC 20) CONGENITAL ANOMALIES 3 4 $3,817 $1,704 $1,588 0.22%
(MDC 04) DISORDER OF BLOOD 7 10 $2,882 $1,669 $972 0.14%
(MDC 09) DISORDER OF EAR 8 12 $1,856 $1,098 $951 0.13%
(MDC 21) PERINATAL PERIOD CONDITIONS 2 3 $269 $269 $0 0.00%
647 2,118 $1,755,794 $927,008 $708,995 100.00%

18
 Inpatient Summary – Executive Admin.

Hospital Admits Bed Avg Total Billed Total Total Paid Paid per Paid per % of % of
Days LOS Allowed Admit Day Admits Paid
THE TOLEDO HOSPITAL 12 44 3.7 $283,071 $165,498 $78,823 $6,569 $1,791 6.98% 3.30%
UNIVERSITY OF TOLEDO MEDICAL 3 50 16.7 $269,444 $133,322 $133,322 $44,441 $2,666 1.74% 5.58%
CENTER
ST VINCENT MERCY MEDICAL CENTER 3 13 4.3 $242,467 $142,370 $54,636 $18,212 $4,203 1.74% 2.29%
CLEVELAND CLINIC FOUNDATION 1 3 3 $11,694 $11,694 $37,222 $37,222 $12,407 0.58% 1.56%
NORTHWESTERN MEMORIAL HOSPITAL 1 1 1 $15,326 $13,487 $13,487 $13,487 $13,487 0.58% 0.56%
ST LUKES HOSPITAL 1 2 2 $29,037 $10,047 $10,047 $10,047 $5,023 0.58% 0.42%
ST CHARLES HOSPITAL O 1 3 3 $9,555 $3,835 $3,835 $3,835 $1,278 0.58% 0.16%
TALLAHASSEE MEMORIAL HOSPITAL 1 2 2 $13,980 $13,980 $2,978 $2,978 $1,489 0.58% 0.12%
ST RITAS MEDICAL CENTER WESTSIDE - 1 2 2 $3,668 $2,421 $2,421 $2,421 $1,210 0.58% 0.10%
LUKE URGENT CARE 24 120 5 $878,241 $496,653 $336,770 $14,032 $2,806 13.95% 14.10%

Inpatient paid dollars accounts for 47.5% of the

Executive Admin. total paid dollars.

19
 Catastrophic Summary – Executive Admin.

Member ID Age Gender Relationship Diag Cd Diagnosis Description Total Paid

89766 55 M Insured 99709 OTHER NERVOUS SYSTEM COMPLICATIONS $287,941
103887 62 M Husband 2761 HYPOSMOLALITY AND/OR HYPONATREMIA $50,228
$338,169

Catastrophic
Members account
for 47.7% of the
total paid dollars.

20
 Emergency Room Summary – Exec. Admin.

Executive Administration
Jul - Dec HSB 2009
2010 Index
# Patients 44
# Visits 27
ER Visits per Member* 0.31 0.22
Admits 9
ER Average Paid per Visit $1,311 $1,131
* Annualized data

Emergency Room Visits by Day of Week

12

12
10

6 8
6
4 5 6
4
2 3
0
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
21
 In vs Out of Network – Exec. Admin.

In-Network
$36,800
5% In-Network
$672,195
95%

22
 In Network Discounts – Exec. Admin.

$800,000

$700,000 57% 57% 49% 25%

$600,000

$500,000

$400,000

$300,000

$200,000

$100,000

$0
Inpatient Facility Outpatient Facility Physician Other

Eligible Allow ed PPO Discount Paid

23
 Employee Medical Cost Sharing – Exec. Admin.

Em ployee
Paid Exec. Adm in
$21,450 Paid
3% $708,995
97%

Employee paid consists of Deductible, Co-Insurance and Co-Pay. It does not

contain premium dollars.
24
 Commanders
July – December 2010
 Cost Distribution – Commanders

Paid Dollar Range # of Members % of Members # of Claims % of Claims Total Paid % of Paid
$10,000.01 - $25,000.00 5 1.30% 162 7.30% $61,378 17.52%
$5,000.01 - $10,000.00 14 3.64% 319 14.37% $99,766 28.47%
$2,500.01 - $5,000.00 15 3.90% 272 12.25% $54,792 15.64%
$0.01 - $2,500.00 255 66.38% 1,447 65.18% $134,465 38.37%
$0.00 95 24.77% 20 0.90% $0 0.00%
384 100.00% 2,220 100.00% $350,400 100.00%

26
 Demographics – Commanders

Patient Patient # # # ER Inpatient Outpatient PCP Specialist Other Total

Type Relationship Members Patients Claims Visits Admits Billed Allowed Paid Paid Paid Paid Paid Paid
Child Child 167 120 644 16 2 $191,695 $89,515 $6,905 $30,756 $13,012 $22,224 $1,192 $74,089
167 120 644 16 2 $191,695 $89,515 $6,905 $30,756 $13,012 $22,224 $1,192 $74,089

Self Insured 127 111 943 18 3 $454,763 $192,107 $16,022 $88,572 $16,634 $53,550 $6,073 $180,851
127 111 943 18 3 $454,763 $192,107 $16,022 $88,572 $16,634 $53,550 $6,073 $180,851

Spouse Husband 9 8 84 0 1 $67,145 $28,007 $5,862 $1,737 $13,258 $5,135 $661 $26,653
Wife 81 66 695 8 1 $279,324 $186,632 $5,399 $28,191 $6,482 $25,763 $2,972 $68,807
90 74 779 8 2 $346,469 $214,640 $11,261 $29,929 $19,740 $30,898 $3,633 $95,460

Female 187 149 1,359 27 5 $516,426 $299,040 $22,623 $71,855 $16,501 $52,818 $4,879 $168,675
Male 197 156 1,007 15 2 $476,501 $197,222 $11,565 $77,401 $32,885 $53,855 $6,019 $181,725

Total: 384 305 2,366 42 7 $992,927 $496,262 $34,188 $149,256 $49,386 $106,673 $10,898 $350,400

27
 MDC Summary – Commanders

Description # Patients # Claims Total Billed Total Eligible Total Paid % of Paid
(MDC 22) ILLDEFINED CONDITIONS 104 290 $159,291 $100,990 $69,988 19.97%
(MDC 18) DISORDER OF MUSCULOSKELETAL SYSTEM 75 337 $146,185 $66,658 $56,008 15.98%
(MDC 11) DISORDER OF RESPIRATORY SYSTEM 77 224 $124,304 $66,699 $29,899 8.53%
(MDC 10) DISORDER OF CIRCULATORY SYSTEM 48 135 $59,441 $30,747 $28,938 8.26%
(MDC 05) PSYCHOTIC CONDITIONS 45 180 $53,823 $32,397 $27,433 7.83%
(MDC 23) FRACTURES AND OTHER INJURIES 37 103 $73,541 $24,677 $22,039 6.29%
(MDC 25) FACTORS AFFECTING HEALTH 133 292 $72,750 $34,819 $21,902 6.25%
(MDC 07) DISORDER OF NERVOUS SYSTEM 26 90 $54,368 $22,181 $19,321 5.51%
(MDC 02) NEOPLASMS 22 65 $26,104 $13,507 $12,789 3.65%
(MDC 16) FEMALE DISORDERS 24 53 $19,727 $12,211 $9,577 2.73%
(MDC 03) ENDOCRINE, NUTRITIONAL, METABOLIC, IMMUNITY, 52 121 $35,478 $17,968 $9,233 2.63%
DISORDERS
(MDC 12) DISORDER OF DIGESTIVE SYSTEM 20 39 $22,112 $12,402 $8,351 2.38%
(MDC 17) PREGNANCY / CHILDBIRTH 2 16 $13,490 $13,066 $8,149 2.33%
(MDC 19) DISORDER OF BREAST OR SKIN 43 76 $12,687 $9,753 $5,780 1.65%
(MDC 14) NEPHRITIS / NEPHROSIS 18 52 $18,429 $11,831 $5,740 1.64%
(MDC 13) OTHER DIGESTIVE DISORDERS 6 20 $16,167 $4,982 $4,600 1.31%
(MDC 09) DISORDER OF EAR 17 37 $5,878 $3,519 $2,716 0.78%
(MDC 01) INFECTIOUS / PARASITIC DISEASE 22 31 $12,792 $11,659 $2,550 0.73%
(MDC 08) DISORDER OF EYE / ADNEXA 19 33 $4,305 $3,059 $2,450 0.70%
(MDC 04) DISORDER OF BLOOD 4 16 $2,712 $1,489 $1,340 0.38%
(MDC 15) DISORDER OF MALE GENITAL ORGANS 5 7 $1,825 $1,231 $1,193 0.34%
(MDC 20) CONGENITAL ANOMALIES 1 1 $1,100 $307 $307 0.09%
(MDC 24) BURNS / ACCIDENTS BY FIRE 1 1 $115 $90 $80 0.02%
(MDC 21) PERINATAL PERIOD CONDITIONS 1 1 $20 $20 $16 0.00%
802 2,220 $936,646 $496,262 $350,400 100.00%

28
 Inpatient Summary – Commanders

Hospital Admits Bed Avg Total Billed Total Total Paid Paid per Paid per % of % of
Days LOS Allowed Admit Day Admits Paid
ST LUKES HOSPITAL 2 3 1.5 $7,498 $5,070 $5,070 $2,535 $1,690 1.16% 0.21%
CENTENE CORP OH 1 1 1 $7,855 $7,855 $6,284 $6,284 $6,284 0.58% 0.26%
THE TOLEDO HOSPITAL 1 5 5 $13,938 $5,870 $5,870 $5,870 $1,174 0.58% 0.25%
UNIVERSITY OF TOLEDO MEDICAL 1 3 3 $15,434 $5,862 $5,862 $5,862 $1,954 0.58% 0.25%
CENTER HOSPITAL
FLOWER 1 2 2 $15,170 $5,703 $5,703 $5,703 $2,852 0.58% 0.24%
ST VINCENT MERCY MEDICAL CENTER 1 1 1 $5,213 $5,213 $5,399 $5,399 $5,399 0.58% 0.23%
7 15 2.1 $65,108 $35,573 $34,188 $4,884 $2,279 4.07% 1.43%

Inpatient paid dollars accounts for 9% of the

Commanders total paid dollars.

29
 Catastrophic Summary – Commanders

There are no members for

this division that have
exceeded the $50,000
threshold

30
 Emergency Room Summary – Commanders

Commanders
Jul - Dec HSB 2009
2010 Index
# Patients 38
# Visits 42
ER Visits per Member* 0.22 0.22
Admits 4
ER Average Paid per Visit $1,361 $1,131
* Annualized data

Emergency Room Visits by Day of Week

8
8
7
7
6 7 7
5

4 5
3 4 4
2

0
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
31
 In vs Out of Network – Commanders

Non-Network
$31,706 In-Network
9% $318,694
91%

32
 In Network Discounts – Commanders

$400,000

$350,000 52% 64% 47% 37%

$300,000

$250,000

$200,000

$150,000

$100,000

$50,000

$0
Inpatient Facility Outpatient Facility Physician Other

Eligible Allow ed PPO Discount Paid

33
 Employee Medical Cost Sharing - Commanders

Em ployee
Paid Com m anders
$30,175 Paid
8% $350,400
92%

Employee paid consists of Deductible, Co-Insurance and Co-Pay. It does not

contain premium dollars.
34
 Services
July – December 2010
 Cost Distribution – Services

Paid Dollar Range # of Members % of Members # of Claims % of Claims Total Paid % of Paid
$50,000.01 - $100,000.00 2 0.39% 44 1.39% $123,266 15.57%
$25,000.01 - $50,000.00 6 1.17% 221 6.99% $202,705 25.60%
$10,000.01 - $25,000.00 10 1.96% 377 11.93% $135,310 17.09%
$5,000.01 - $10,000.00 8 1.57% 172 5.44% $59,615 7.53%
$2,500.01 - $5,000.00 26 5.09% 477 15.09% $92,309 11.66%
$0.01 - $2,500.00 326 63.78% 1,860 58.86% $178,579 22.55%
$0.00 133 26.05% 9 0.28% $0 0.00%
511 100.00% 3,160 100.00% $791,783 100.00%

36
 Demographics – Services

Patient Patient # # # ER Inpatient Outpatient PCP Specialist Other

Type Relationship Members Patients Claims Visits Admits Billed Allowed Paid Paid Paid Paid Paid Total Paid
Child Child 189 132 691 18 6 $453,971 $189,128 $63,682 $49,180 $17,586 $31,415 $328 $162,191
Full Time 1 0 0 0 0 $0 $0 $0 $0 $0 $0 $0 $0
Student
Incapacitated 1 1 19 0 0 $2,844 $1,704 $0 $0 $50 $14 $1,261 $1,325
Child
191 133 710 18 6 $456,815 $190,832 $63,682 $49,180 $17,636 $31,429 $1,589 $163,517

Self Insured 197 169 1,678 22 9 $1,092,312 $434,842 $161,020 $128,951 $29,324 $84,474 $8,083 $411,853
197 169 1,678 22 9 $1,092,312 $434,842 $161,020 $128,951 $29,324 $84,474 $8,083 $411,853

Spouse Husband 34 26 383 2 0 $89,462 $47,944 $0 $12,653 $5,108 $8,042 $2,669 $28,472
Wife 90 77 643 11 5 $538,924 $273,050 $91,362 $47,618 $6,756 $40,511 $1,694 $187,942
123 103 1,026 13 5 $628,386 $320,993 $91,362 $60,271 $11,864 $48,554 $4,363 $216,414

Female 250 209 1,819 28 10 $1,234,925 $561,936 $185,099 $136,830 $25,475 $97,800 $8,406 $453,609
Male 261 196 1,595 25 10 $942,589 $384,731 $130,964 $101,574 $33,349 $66,657 $5,630 $338,174

Total: 511 405 3,414 53 20 $2,177,513 $946,667 $316,063 $238,403 $58,824 $164,456 $14,036 $791,783

37
 MDC Summary – Services

Description # Patients # Claims Total Billed Total Eligible Total Paid % of Paid
(MDC 18) DISORDER OF MUSCULOSKELETAL SYSTEM 106 419 $367,669 $168,671 $146,247 18.47%
(MDC 10) DISORDER OF CIRCULATORY SYSTEM 79 234 $325,571 $137,118 $133,635 16.88%
(MDC 25) FACTORS AFFECTING HEALTH 178 479 $312,329 $127,888 $111,129 14.04%
(MDC 22) ILLDEFINED CONDITIONS 134 409 $207,508 $121,774 $92,527 11.69%
(MDC 23) FRACTURES AND OTHER INJURIES 69 209 $132,484 $74,813 $53,607 6.77%
(MDC 03) ENDOCRINE, NUTRITIONAL, METABOLIC, IMMUNITY, 88 242 $108,343 $52,403 $44,400 5.61%
DISORDERS
(MDC 14) NEPHRITIS / NEPHROSIS 24 82 $105,666 $52,327 $36,612 4.62%
(MDC 11) DISORDER OF RESPIRATORY SYSTEM 86 282 $96,299 $35,081 $32,703 4.13%
(MDC 17) PREGNANCY / CHILDBIRTH 7 40 $73,744 $35,650 $25,794 3.26%
(MDC 05) PSYCHOTIC CONDITIONS 37 158 $50,938 $27,167 $23,750 3.00%
(MDC 07) DISORDER OF NERVOUS SYSTEM 30 99 $36,043 $22,483 $20,163 2.55%
(MDC 12) DISORDER OF DIGESTIVE SYSTEM 27 50 $28,057 $16,962 $15,482 1.96%
(MDC 16) FEMALE DISORDERS 29 86 $48,995 $22,214 $13,101 1.65%
(MDC 19) DISORDER OF BREAST OR SKIN 64 120 $33,399 $15,385 $12,000 1.52%
(MDC 09) DISORDER OF EAR 28 50 $15,069 $7,162 $6,243 0.79%
(MDC 02) NEOPLASMS 22 49 $13,067 $8,020 $6,192 0.78%
(MDC 01) INFECTIOUS / PARASITIC DISEASE 32 49 $6,340 $4,629 $3,648 0.46%
(MDC 08) DISORDER OF EYE / ADNEXA 29 38 $5,827 $4,197 $2,996 0.38%
(MDC 15) DISORDER OF MALE GENITAL ORGANS 8 22 $5,387 $3,397 $2,995 0.38%
(MDC 21) PERINATAL PERIOD CONDITIONS 3 8 $5,528 $2,762 $2,752 0.35%
(MDC 20) CONGENITAL ANOMALIES 8 14 $12,348 $2,763 $2,267 0.29%
(MDC 13) OTHER DIGESTIVE DISORDERS 5 10 $4,912 $2,118 $2,098 0.26%
(MDC 04) DISORDER OF BLOOD 8 11 $3,937 $1,684 $1,442 0.18%
1,101 3,160 $1,999,459 $946,667 $791,783 100.00%

38
 Inpatient Summary – Services

Hospital Admits Bed Avg Total Billed Total Total Paid Paid per Paid per % of % of
Days LOS Allowed Admit Day Admits Paid
THE TOLEDO HOSPITAL 7 39 5.6 $543,434 $205,180 $203,388 $29,055 $5,215 4.07% 8.52%
FLOWER HOSPITAL 4 11 2.8 $35,184 $15,023 $12,435 $3,109 $1,130 2.33% 0.52%
BAY PARK COMMUNITY HOSPITAL 3 7 2.3 $42,839 $22,667 $13,630 $4,543 $1,947 1.74% 0.57%
ST LUKES HOSPITAL 2 2 1 $26,263 $11,529 $11,529 $5,765 $5,765 1.16% 0.48%
ST VINCENT MERCY MEDICAL CENTER 1 3 3 $74,585 $31,326 $31,326 $31,326 $10,442 0.58% 1.31%
ST CHARLES HOSPITAL O 1 1 1 $19,371 $6,768 $6,768 $6,768 $6,768 0.58% 0.28%
ST ANNE MERCY HOSPITAL 1 1 1 $6,508 $5,333 $5,333 $5,333 $5,333 0.58% 0.22%
ARROWHEAD BEHAVIORAL HEALTH LLC 1 7 7 $9,100 $4,125 $4,125 $4,125 $589 0.58% 0.17%
20 71 3.6 $757,284 $301,951 $288,534 $14,427 $4,064 11.63% 12.08%

Inpatient paid dollars accounts for 36.4% of the

Services total paid dollars.

39
 Catastrophic Summary – Services

Member ID Age Gender Relationship Diag Cd Diagnosis Description Total Paid

69999 43 F Wife 4241 AORTIC VALVE DISORDERS $69,343
129403 0 F Child V3001 SINGLE LIVEBORN BORN IN HOSPITAL DELIVERED BY CESAREAN SECTION $53,923
$123,266

Catastrophic
Members account
for 15.6% of the
total paid dollars.

40
 Emergency Room Summary – Services

Services
Jul - Dec HSB 2009
2010 Index
# Patients 45
# Visits 53
ER Visits per Member* 0.21 0.22
Admits 7
ER Average Paid per Visit $1,210 $1,131
* Annualized data

Emergency Room Visits by Day of Week

14
14
12

10

8
9
8
6
7
4 5 6
4
2

0 41
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
 In vs Out of Network – Services

Non-Network
$25,786
3%
In-Network
$765,997
97%

42
 In Network Discounts – Services

$900,000
$800,000 61% 59% 47% 29%

$700,000
$600,000

$500,000
$400,000

$300,000
$200,000

$100,000

$0
Inpatient Facility Outpatient Facility Physician Other

Eligible Allow ed PPO Discount Paid

43
 Employee Medical Cost Sharing - Services

Em ployee
Paid Services Paid
$31,259 $791,783
4% 96%

Employee paid consists of Deductible, Co-Insurance and Co-Pay. It does not

contain premium dollars.
44
 Administrative
July – December 2010
 Cost Distribution – Administrative

Paid Dollar Range # of Members % of Members # of Claims % of Claims Total Paid % of Paid
$10,000.01 - $25,000.00 1 0.76% 19 2.45% $11,982 11.79%
$5,000.01 - $10,000.00 3 2.28% 102 13.14% $19,780 19.46%
$2,500.01 - $5,000.00 9 6.84% 185 23.84% $31,868 31.35%
$0.01 - $2,500.00 87 66.08% 459 59.15% $38,008 37.40%
$0.00 32 24.05% 11 1.42% $0 0.00%
132 100.00% 776 100.00% $101,639 100.00%

46
 Demographics – Administrative

Patient Patient # # # ER Inpatient Outpatient PCP Specialist Other

Type Relationship Members Patients Claims Visits Admits Billed Allowed Paid Paid Paid Paid Paid Total Paid
Child Child 47 41 177 6 0 $46,893 $23,387 $0 $7,954 $3,262 $5,701 $335 $17,252
47 41 177 6 0 $46,893 $23,387 $0 $7,954 $3,262 $5,701 $335 $17,252

Self Insured 53 47 338 4 0 $139,599 $39,993 $0 $15,488 $7,908 $11,628 $1,686 $36,711
53 47 338 4 0 $139,599 $39,993 $0 $15,488 $7,908 $11,628 $1,686 $36,711

Spouse Husband 7 5 42 0 0 $13,395 $5,147 $0 $806 $152 $3,594 $0 $4,552

Wife 25 22 306 3 1 $119,179 $56,739 $8,075 $12,502 $4,621 $15,096 $2,830 $43,124
32 27 348 3 1 $132,574 $61,886 $8,075 $13,308 $4,773 $18,690 $2,830 $47,676

Female 67 60 522 8 1 $221,217 $86,122 $8,075 $23,455 $8,763 $23,480 $3,143 $66,916
Male 65 55 341 5 0 $97,849 $39,145 $0 $13,295 $7,180 $12,539 $1,709 $34,723

Total: 132 115 863 13 1 $319,066 $125,267 $8,075 $36,750 $15,943 $36,019 $4,852 $101,639

47
 MDC Summary – Administrative

Description # Patients # Claims Total Billed Total Eligible Total Paid % of Paid
(MDC 22) ILLDEFINED CONDITIONS 36 100 $33,936 $18,964 $16,506 16.24%
(MDC 23) FRACTURES AND OTHER INJURIES 15 53 $28,890 $16,659 $15,534 15.28%
(MDC 25) FACTORS AFFECTING HEALTH 54 114 $25,437 $12,396 $10,650 10.48%
(MDC 03) ENDOCRINE, NUTRITIONAL, METABOLIC, IMMUNITY, 22 91 $17,730 $11,150 $8,925 8.78%
DISORDERS
(MDC 18) DISORDER OF MUSCULOSKELETAL SYSTEM 26 87 $21,786 $11,814 $8,256 8.12%
(MDC 02) NEOPLASMS 7 26 $11,483 $6,677 $6,532 6.43%
(MDC 14) NEPHRITIS / NEPHROSIS 13 29 $11,825 $7,761 $5,540 5.45%
(MDC 08) DISORDER OF EYE / ADNEXA 11 23 $30,582 $5,913 $5,536 5.45%
(MDC 07) DISORDER OF NERVOUS SYSTEM 10 20 $14,662 $8,930 $5,432 5.34%
(MDC 19) DISORDER OF BREAST OR SKIN 17 30 $15,648 $5,163 $4,803 4.73%
(MDC 10) DISORDER OF CIRCULATORY SYSTEM 21 48 $7,606 $3,911 $3,348 3.29%
(MDC 11) DISORDER OF RESPIRATORY SYSTEM 26 66 $6,487 $4,234 $3,220 3.17%
(MDC 16) FEMALE DISORDERS 6 19 $8,046 $3,308 $3,176 3.12%
(MDC 01) INFECTIOUS / PARASITIC DISEASE 11 16 $1,594 $1,165 $844 0.83%
(MDC 12) DISORDER OF DIGESTIVE SYSTEM 5 7 $3,068 $2,947 $834 0.82%
(MDC 17) PREGNANCY / CHILDBIRTH 2 6 $1,264 $746 $724 0.71%
(MDC 15) DISORDER OF MALE GENITAL ORGANS 7 15 $1,333 $742 $702 0.69%
(MDC 05) PSYCHOTIC CONDITIONS 6 14 $2,191 $1,953 $520 0.51%
(MDC 09) DISORDER OF EAR 7 8 $760 $584 $359 0.35%
(MDC 04) DISORDER OF BLOOD 1 3 $256 $158 $118 0.12%
(MDC 13) OTHER DIGESTIVE DISORDERS 1 1 $111 $90 $80 0.08%
304 776 $244,697 $125,267 $101,639 100.00%

48
 Inpatient Summary – Administrative

Hospital Admits Bed Avg Total Billed Total Total Paid Paid per Paid per % of % of
Days LOS Allowed Admit Day Admits Paid
ST LUKES HOSPITAL 1 2 2 $13,147 $8,075 $8,075 $8,075 $4,038 0.58% 0.34%
1 2 2 $13,147 $8,075 $8,075 $8,075 $4,038 0.58% 0.34%

Inpatient paid dollars accounts for 8% of the

Administrative total paid dollars.

49
 Catastrophic Summary – Administrative

There are no members in

the Administrative division
that have exceeded the
catastrophic threshold of
$50,000.

50
 Emergency Room Summary – Administrative

Administrative
Jul - Dec HSB 2009
2010 Index
# Patients 12
# Visits 13
ER Visits per Member* 0.20 0.22
Admits 0
ER Average Paid per Visit $1,383 $1,131
* Annualized data

Emergency Room Visits by Day of Week

5
4.5 5
4
3.5
3
2.5 3
2
1.5
2
1
1 1 1 0
0.5
0
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
51
 In vs Out of Network – Services

Non-Network
$3,979
4%
In-Network
$97,660
96%

52
 In Network Discounts – Administrative

$120,000

$100,000 39% 62% 46% 24%

$80,000

$60,000

$40,000

$20,000

$0
Inpatient Facility Outpatient Facility Physician Other

Eligible Allow ed PPO Discount Paid

53
 Employee Medical Cost Sharing - Administrative

Emp l o y e e P a id A d mi ni s t ra t i v e
$8 ,753 P aid
8% $ 10 1, 6 3 9
92%

Employee paid consists of Deductible, Co-Insurance and Co-Pay. It does not

contain premium dollars.
54
 Police
July – December 2010
 Cost Distribution – Police

Paid Dollar Range # of Members % of Members # of Claims % of Claims Total Paid % of Paid
$50,000.01 - $100,000.00 2 0.15% 137 1.79% $140,253 9.29%
$25,000.01 - $50,000.00 5 0.36% 178 2.32% $175,560 11.62%
$10,000.01 - $25,000.00 14 1.02% 312 4.07% $196,381 13.00%
$5,000.01 - $10,000.00 38 2.76% 787 10.26% $260,786 17.27%
$2,500.01 - $5,000.00 83 6.04% 1,307 17.04% $284,499 18.84%
$0.01 - $2,500.00 856 62.25% 4,875 63.58% $452,826 29.99%
$0.00 377 27.43% 72 0.94% $0 0.00%
1,375 100.00% 7,668 100.00% $1,510,305 100.00%

56
 Demographics – Police

Patient Patient # # ER Inpatient Outpatient PCP Specialist Other

Type Relationship Members Patients # Claims Visits Admits Billed Allowed Paid Paid Paid Paid Paid Total Paid
Child Child 625 465 2,499 80 11 $908,818 $433,528 $34,176 $136,790 $53,619 $96,909 $9,303 $330,797
Full Time 1 1 1 0 0 $66 $66 $0 $0 $0 $0 $53 $53
Student
Incapacitated 2 3 31 1 0 $4,542 $2,505 $0 $365 $212 $1,634 $0 $2,210
Child
Ineligible Child 0 1 1 0 0 $54 $0 $0 $0 $0 $0 $0 $0

628 470 2,532 81 11 $913,480 $436,099 $34,176 $137,155 $53,831 $98,543 $9,355 $333,060

Self Insured 456 350 3,321 54 7 $2,223,346 $806,801 $128,590 $325,707 $70,897 $217,471 $24,284 $766,949
456 350 3,321 54 7 $2,223,346 $806,801 $128,590 $325,707 $70,897 $217,471 $24,284 $766,949

Spouse Ex-Spouse 1 2 10 0 0 $2,753 $0 $0 $0 $0 $0 $0 $0

Husband 28 25 201 3 1 $117,680 $46,846 $12,900 $9,772 $2,733 $16,214 $792 $42,411
Wife 263 224 2,180 36 13 $1,463,308 $800,569 $70,831 $170,427 $22,955 $98,103 $5,569 $367,885
292 251 2,391 39 14 $1,583,741 $847,415 $83,731 $180,199 $25,688 $114,316 $6,361 $410,295

Female 660 543 4,345 80 19 $2,609,131 $1,158,285 $116,996 $296,372 $64,336 $187,082 $14,694 $679,480
Male 716 528 3,899 94 13 $2,111,437 $932,031 $129,501 $346,689 $86,080 $243,248 $25,306 $830,824

Total: 1,376 1,071 8,244 174 32 $4,720,567 $2,090,315 $246,497 $643,061 $150,416 $430,331 $40,000 $1,510,305

57
 Inpatient Summary – Police

Hospital Admits Bed Avg Total Billed Total Total Paid Paid per Paid per % of % of
Days LOS Allowed Admit Day Admits Paid
THE TOLEDO HOSPITAL 14 39 2.8 $392,768 $197,273 $132,736 $9,481 $3,403 8.14% 5.56%
ST ANNE MERCY HOSPITAL 4 13 3.3 $69,782 $25,926 $25,926 $6,481 $1,994 2.33% 1.09%
FLOWER HOSPITAL 3 21 7 $131,184 $58,828 $58,828 $19,609 $2,801 1.74% 2.46%
UNIVERSITY OF TOLEDO MEDICAL 3 10 3.3 $46,863 $46,367 $9,784 $3,261 $978 1.74% 0.41%
CENTER
ST LUKES HOSPITAL 3 7 2.3 $45,294 $41,337 $8,173 $2,724 $1,168 1.74% 0.34%
ST VINCENT MERCY MEDICAL CENTER 2 7 3.5 $82,790 $34,848 $24,726 $12,363 $3,532 1.16% 1.04%
BAY PARK COMMUNITY HOSPITAL 2 4 2 $16,721 $6,472 $6,472 $3,236 $1,618 1.16% 0.27%
GLENBEIGH 1 5 5 $5,958 $3,125 $3,125 $3,125 $625 0.58% 0.13%
32 106 3.3 $791,361 $414,175 $269,769 $8,430 $2,545 18.60% 11.30%

Inpatient paid dollars accounts for 17.8% of the

Police total paid dollars.

58
 Catastrophic Summary – Police

Member ID Age Gender Relationship Diag Cd Diagnosis Description Total Paid

69890 70 M Insured V5811 ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY $77,531
69749 42 M Insured 25063 DIABETES WITH NEUROLOGICAL MANIFESTATIONS TYPE I [JUVENILE TYPE] $62,722
UNCONTROLLED

$140,253

Catastrophic
Members account
for 9.3% of the total
paid dollars.

59
 Emergency Room Summary – Police

Police
Jul - Dec HSB 2009
2010 Index
# Patients 147
# Visits 174
ER Visits per Member* 0.25 0.22
Admits 13
ER Average Paid per Visit $1,206 $1,131
* Annualized data

Emergency Room Visits by Day of Week

35

30
32
25
26 29
20 25
21 22
15
19

10

0
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
60
 In vs Out of Network – Police

Non-Network
$25,786
3%
In-Network
$765,997
97%

61
 In Network Discounts – Police

$1,800,000
$1,600,000 58% 61% 47% 30%

$1,400,000
$1,200,000

$1,000,000
$800,000

$600,000
$400,000

$200,000
$0
Inpatient Facility Outpatient Facility Physician Other

Eligible Allow ed PPO Discount Paid

62
 Employee Medical Cost Sharing - Police

Em ployee
Paid Police Paid
$84,849 $1,510,305
5% 95%

Employee paid consists of Deductible, Co-Insurance and Co-Pay. It does not

contain premium dollars.
63
 Maintenance
July – December 2010
 Cost Distribution – Maintenance

Paid Dollar Range # of Members % of Members # of Claims % of Claims Total Paid % of Paid
$100,000.01 Plus 3 0.15% 182 1.58% $421,546 12.36%
$50,000.01 - $100,000.00 12 0.60% 724 6.29% $754,840 22.13%
$25,000.01 - $50,000.00 8 0.40% 199 1.73% $282,312 8.28%
$10,000.01 - $25,000.00 34 1.71% 793 6.89% $460,492 13.50%
$5,000.01 - $10,000.00 67 3.36% 1,324 11.50% $466,350 13.67%
$2,500.01 - $5,000.00 115 5.77% 1,675 14.55% $399,274 11.71%
$0.01 - $2,500.00 1,176 59.05% 6,504 56.51% $625,570 18.34%
$0.00 577 28.95% 109 0.95% $0 0.00%
1,992 100.00% 11,510 100.00% $3,410,384 100.00%

65
 Demographics – Maintenance

Patient Patient # # # ER Inpatient Outpatient Specialis Other

Type Relationship Members Patients Claims Visits Admits Billed Allowed Paid Paid PCP Paid t Paid Paid Total Paid
Child Child 768 552 2,954 132 23 $2,127,441 $669,970 $159,888 $209,325 $58,588 $127,791 $12,354 $567,946
Full Time 2 1 11 0 0 $1,672 $951 $0 $0 $494 $371 $0 $865
Student
Incapacitated 2 1 83 0 0 $83,519 $752 $0 $0 $0 $580 $0 $580
Child
Ineligible 0 2 10 0 0 $6,837 $0 $0 $0 $0 $0 $0 $0
Child
772 556 3,058 132 23 $2,219,469 $671,673 $159,888 $209,325 $59,082 $128,741 $12,354 $569,390

Self Insured 798 672 6,490 119 35 $5,212,625 $2,027,124 $646,818 $643,457 $146,746 $480,202 $53,912 $1,971,135
798 672 6,490 119 35 $5,212,625 $2,027,124 $646,818 $643,457 $146,746 $480,202 $53,912 $1,971,135

Spouse Husband 99 74 701 12 3 $1,133,254 $383,766 $105,589 $116,514 $9,414 $30,393 $11,586 $273,496
Wife 324 272 2,540 49 14 $1,816,176 $907,986 $239,152 $187,369 $37,229 $120,262 $12,352 $596,362
423 346 3,241 61 17 $2,949,430 $1,291,752 $344,741 $303,882 $46,643 $150,654 $23,938 $869,858

Female 966 826 7,051 161 35 $5,051,078 $1,922,169 $460,740 $485,132 $135,566 $408,468 $31,186 $1,521,093
Male 1,027 748 5,738 151 40 $5,330,446 $2,068,380 $690,707 $671,532 $116,904 $351,129 $59,019 $1,889,291

Total: 1,992 1,574 12,789 312 75 $10,381,524 $3,990,549 $1,151,447 $1,156,664 $252,470 $759,597 $90,204 $3,410,384

66
 Inpatient Summary – Maintenance

Hospital Admits Bed Avg Total Billed Total Total Paid Paid per Paid per % of % of
Days LOS Allowed Admit Day Admits Paid
THE TOLEDO HOSPITAL 22 73 3.3 $565,446 $270,124 $220,012 $10,001 $3,014 12.79% 9.21%
ST VINCENT MERCY MEDICAL CENTER 16 78 4.9 $1,311,001 $512,784 $473,447 $29,590 $6,070 9.30% 19.83%
ST LUKES HOSPITAL 9 33 3.7 $231,044 $111,676 $103,130 $11,459 $3,125 5.23% 4.32%
ST ANNE MERCY HOSPITAL 5 19 3.8 $328,381 $119,758 $119,758 $23,952 $6,303 2.91% 5.02%
FLOWER HOSPITAL 5 31 6.2 $182,998 $91,253 $67,615 $13,523 $2,181 2.91% 2.83%
UNIVERSITY OF TOLEDO MEDICAL 3 8 2.7 $64,804 $25,709 $25,709 $8,570 $3,214 1.74% 1.08%
CENTER
WOOD COUNTY HOSPITAL ASSN 3 10 3.3 $31,669 $25,336 $25,336 $8,445 $2,534 1.74% 1.06%
ODJFS 2 2 1 $9,134 $9,134 $7,307 $3,653 $3,653 1.16% 0.31%
ARROWHEAD BEHAVIORAL HEALTH LLC 2 10 5 $13,000 $6,250 $6,250 $3,125 $625 1.16% 0.26%
CLEVELAND CLINIC FOUNDATION 1 12 12 $57,879 $48,896 $48,896 $48,896 $4,075 0.58% 2.05%
UNIV OF MICHIGAN HOSPITAL 1 4 4 $30,220 $24,478 $24,478 $24,478 $6,120 0.58% 1.03%
ST CHARLES HOSPITAL O 1 4 4 $37,116 $14,104 $14,104 $14,104 $3,526 0.58% 0.59%
GLENBEIGH HLTH SOURCES 1 27 27 $28,515 $13,500 $13,500 $13,500 $500 0.58% 0.57%
BEACHWOOD
MANATEE MEMORIAL HOSPITAL 1 5 5 $11,565 $8,674 $6,939 $6,939 $1,388 0.58% 0.29%
BAY PARK COMMUNITY HOSPITAL 1 1 1 $13,715 $6,172 $6,172 $6,172 $6,172 0.58% 0.26%
TEXAS MEDICAID TMHP 1 1 1 $3,751 $3,751 $3,001 $3,001 $3,001 0.58% 0.13%
SUMMA HEALTH SYSTEM 1 2 2 $2,998 $2,998 $0 $0 $0 0.58% 0.00%
75 320 4.3 $2,923,236 $1,294,596 $1,165,654 $15,542 $3,643 43.60% 48.82%

Inpatient paid dollars accounts for 34% of the

Maintenance total paid dollars.

67
 Catastrophic Summary – Maintenance

Member ID Age Gender Relationship Diag Cd Diagnosis Description Total Paid

71372 46 M Insured 3570 ACUTE INFECTIVE POLYNEURITIS $200,317
103232 49 M Husband 28731 IMMUNE THROMBOCYTOPENIC PURPURA $120,573
70308 57 F Wife 41071 SUBENDOCARDIAL INFARCTION INITIAL EPISODE OF CARE $100,655
72150 57 F Insured V5789 CARE INVOLVING OTHER SPECIFIED REHABILITATION PROCEDURE $90,123
71031 66 F Wife 2894 HYPERSPLENISM $83,747
69276 55 F Insured 1744 MALIGNANT NEOPLASM OF UPPER-OUTER QUADRANT OF FEMALE BREAST $78,826
127207 65 M Husband 4280 CONGESTIVE HEART FAILURE UNSPECIFIED $65,972
70752 15 M Child 9694 POISONING BY BENZODIAZEPINE-BASED TRANQUILIZERS $62,618
73215 60 M Insured 1541 MALIGNANT NEOPLASM OF RECTUM $58,737
71252 53 M Insured 41401 CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY $54,999
121268 19 F Child 49392 ASTHMA UNSPECIFIED WITH (ACUTE) EXACERBATION $53,387
72035 39 M Insured 5739 UNSPECIFIED DISORDER OF LIVER $52,692
72273 71 M Insured 9961 MECHANICAL COMPLICATION OF OTHER VASCULAR DEVICE IMPLANT AND GRAFT $52,270
105363 47 F Insured 41051 ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL, INITIAL EPISODE OF CARE $51,128
130134 54 M Wife V552 ATTENTION TO ILEOSTOMY $50,341
$1,176,386

Catastrophic
Members account
for 34.5% of the
total paid dollars.

68
 Emergency Room Summary – Maintenance

Maintenance
Jul - Dec HSB 2009
2010 Index
# Patients 242
# Visits 312
ER Visits per Member* 0.31 0.22
Admits 40
ER Average Paid per Visit $1,248 $1,131
* Annualized data

Emergency Room Visits by Day of Week

60

50 52
49 51
40 45
44 40
30
31
20

10

0
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
69
 In vs Out of Network – Maintenance

Non-Network
$138,645
4%
In-Network
$3,271,738
96%

70
 In Network Discounts – Maintenance

$3,000,000 59% 59% 46% 32%

$2,500,000

$2,000,000

$1,500,000

$1,000,000

$500,000

$0
Inpatient Facility Outpatient Facility Physician Other

Eligible Allow ed PPO Discount Paid

71
 Employee Medical Cost Sharing - Maintenance

Em ployee
Paid
$138,033 Maint. Paid
4% $3,410,384
96%

Employee paid consists of Deductible, Co-Insurance and Co-Pay. It does not

contain premium dollars.
72
 Judges
July – December 2010
 Cost Distribution – Judges

Paid Dollar Range # of Members % of Members # of Claims % of Claims Total Paid % of Paid
$25,000.01 - $50,000.00 1 0.48% 35 2.73% $30,931 11.12%
$10,000.01 - $25,000.00 4 1.93% 117 9.13% $70,435 25.33%
$5,000.01 - $10,000.00 9 4.34% 159 12.41% $63,573 22.86%
$2,500.01 - $5,000.00 12 5.79% 171 13.35% $40,438 14.54%
$0.01 - $2,500.00 122 58.89% 786 61.36% $72,689 26.14%
$0.00 59 28.56% 13 1.01% $0 0.00%
207 100.00% 1,281 100.00% $278,066 100.00%

74
 Demographics – Judges

Patient Patient # # # ER Inpatient Outpatient PCP Specialist Other Total

Type Relations Members Patients Claims Visits Admits Billed Allowed Paid Paid Paid Paid Paid Paid
Child Child 79 55 312 19 2 $153,465 $74,452 $22,548 $21,333 $5,531 $15,651 $1,089 $66,151
79 55 312 19 2 $153,465 $74,452 $22,548 $21,333 $5,531 $15,651 $1,089 $66,151

Self Insured 78 74 692 7 1 $392,320 $143,084 $11,870 $57,288 $12,669 $53,758 $1,550 $137,135
78 74 692 7 1 $392,320 $143,084 $11,870 $57,288 $12,669 $53,758 $1,550 $137,135

Spouse Husband 26 17 178 1 1 $143,105 $54,073 $21,717 $11,583 $1,106 $15,540 $1,088 $51,035
Wife 24 19 166 1 2 $110,944 $49,426 $5,603 $9,353 $1,916 $6,874 $0 $23,746
50 36 344 2 3 $254,049 $103,499 $27,320 $20,936 $3,022 $22,415 $1,088 $74,780

Female 105 93 702 6 3 $421,207 $153,206 $17,473 $45,647 $10,773 $48,178 $461 $122,532
Male 102 72 646 22 3 $378,627 $167,830 $44,265 $53,910 $10,449 $43,646 $3,265 $155,534

Total: 207 165 1,348 28 6 $799,834 $321,036 $61,738 $99,557 $21,222 $91,823 $3,726 $278,066

75
 Inpatient Summary – Judges

Hospital Admits Bed Avg Total Total Total Paid per Paid per % of % of
Days LOS Billed Allowed Paid Admit Day Admits Paid
THE TOLEDO HOSPITAL 3 7 2.3 $27,080 $17,215 $6,668 $2,223 $953 1.74% 0.28%
ST VINCENT MERCY MEDICAL CENTER 2 5 2.5 $92,144 $33,587 $33,587 $16,794 $6,717 1.16% 1.41%
ST ANNE MERCY HOSPITAL 1 2 2 $59,398 $21,483 $21,483 $21,483 $10,741 0.58% 0.90%
6 14 2.3 $178,622 $72,284 $61,738 $10,290 $4,410 3.49% 2.59%

Inpatient paid dollars accounts for 22% of the Judges

total paid dollars.

76
 Catastrophic Summary – Judges

There are no members

that have exceeded the
catastrophic threshold of
$50,000.

77
 Emergency Room Summary – Judges

Judges
Jul - Dec HSB 2009
2010 Index
# Patients 22
# Visits 28
ER Visits per Member* 0.27 0.22
Admits 0
ER Average Paid per Visit $967 $1,131
* Annualized data

Emergency Room Visits by Day of Week

7
7
6
6
5
5
4
4
3

2 3
2
1 1
0
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
78
 In vs Out of Network – Judges

Non-Network
$10,042
4%
In-Network
$268,025
96%

79
 In Network Discounts – Judges

$300,000 63% 64% 49% 27%

$250,000

$200,000

$150,000

$100,000

$50,000

$0
Inpatient Facility Outpatient Facility Physician Other

Eligible Allow ed PPO Discount Paid

80
 Employee Medical Cost Sharing - Judges

Em ployee
Paid
Judges Paid
$13,094
$278,066
4%
96%

Employee paid consists of Deductible, Co-Insurance and Co-Pay. It does not

contain premium dollars.
81