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INLAND EMPIRE HEALTH PLAN STANDARD MONTHLY REPORTS Board Report #288

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INLAND EMPIRE HEALTH PLAN STANDARD MONTHLY REPORTS Board Report #288 INLAND EMPIRE HEALTH PLAN STANDARD MONTHLY REPORTS Supplemental to: Board Report #288 March 11, 2019 Inland Empire Health Plan Supplemental to Board Report #288 March 11, 2019 ADMINISTRATION (Bradley P. Gilbert, M.D.) 1. Standard IEHP Monthly Reports a. IEHP Finance Reports 1) Income Statements 2) Capitation Income and Expense b. IEHP Operations Reports 1) Claims Summary Report 3) Claims Processing Turnaround Time 3) PCP Member Allocation Report 4) Member Services Telephone Activity Report 5) Provider Automated Eligibility Contact Report 6) Member Eligibility Verification Report c. IEHP Provider Reports 1) IPA Consolidated Membership Report 2) Hospital Consolidated Membership Report 3) New Enrollment Trend Report by Consolidated IPA d. IEHP Marketing Reports 1) All Medi-Cal Aid Codes Enrollment Report 2) Medi-Cal Mandatory – Families Aid Codes Enrollment Report 3) Medi-Cal Mandatory – Seniors & Persons with Disabilities (SPD) Aid Codes Enrollment Report 4) IEHP’s Medi-Cal Non-Mandatory Aid Codes Enrollment Report 5) IEHP’s Medi-Cal Expansion Aid Codes Enrollment Report 6) IEHP Medicare Enrollment Report 2 Inland Empire Health Plan Supplemental to Board Report #288 March 11, 2019 ADMINISTRATION (Dr. Gilbert) 1. Review of the Financial Monthly Reports a. Finance Reports 1) Income Statement for the Month Ended January 31, 2018 (in thousands) Organizational Medi-Cal Medicare Expenditures Grand Total Actual Budget Variance $ Actual Budget Variance $ Premium Revenue 328,642 319,162 9,481 36,240 34,486 1,753 - 364,882 Supplemental 35,487 26,276 9,210 - - - - 35,487 Other Revenue - - - 2,086 1,338 748 - 2,086 Net Revenue 364,129 345,438 18,691 38,325 35,824 2,501 - 402,454 Facility Claims 126,683 129,243 (2,560) 14,290 12,885 1,405 - 140,974 Capitation Expense 64,678 67,702 (3,025) 12,876 12,530 345 - 77,553 Professional 40,822 34,415 6,407 4,537 4,004 533 - 45,359 Pharmacy 60,440 62,580 (2,140) 4,691 5,776 (1,086) - 65,131 Incentives 5,102 5,435 (333) 171 349 (178) - 5,274 All Other Medical 25,877 21,607 4,270 3,185 2,204 981 - 29,062 Other Expenses 16,715 6,778 9,937 62 - 62 - 16,777 G & A Expenses - Medical - - - - - - 9,961 9,961 Medical Cost Allocations 7,770 8,933 (1,163) 2,191 2,265 (73) (9,961) - Total Medical Costs 348,088 336,695 11,394 42,003 40,014 1,990 - 390,092 Gross Margin 16,040 8,743 7,297 (3,678) (4,189) 512 - 12,363 3 Inland Empire Health Plan Supplemental to Board Report #288 March 11, 2019 ADMINISTRATION (Dr. Gilbert) 1. Review of the Financial Monthly Reports a. Finance Reports 1) Income Statement for the Month Ended January 31, 2018 (in thousands) (continued) Organizational Medi-Cal Medicare Expenditures Grand Total Actual Budget Variance $ Actual Budget Variance $ Operating Expenses Administration 1,773 1,954 (181) 138 156 (18) - 1,911 Finance 797 930 (132) 134 162 (27) - 931 Information Technology (IT) 5,634 4,633 1,001 133 113 20 - 5,767 Marketing 1,056 1,046 11 307 302 5 - 1,364 Health Services 2,011 1,836 175 553 507 46 - 2,564 Network Development 53 55 (2) 178 183 (5) - 231 Operations 4,949 5,084 (134) 869 836 33 - 5,818 Total Operating Expenses 16,273 15,537 737 2,313 2,259 54 - 18,586 Operating Surplus (Deficit) (233) (6,794) 6,561 (5,991) (6,449) 458 - (6,223) Total AB85 2,051 2,048 3 - - - - 2,051 Total IHSS (2,200) - (2,200) - - - - (2,200) Total Sales Tax (77) - (77) - - - - (77) Other Income (Expense) - - - - - - 936 936 Property Management Income (Expense) - - - - - - 82 82 Total Non Operating Income (Expense) (226) 2,048 (2,274) - - - 1,018 793 Net Surplus (Deficit) (459) (4,746) 4,287 (5,991) (6,449) 458 1,018 (5,431) 4 Inland Empire Health Plan Supplemental to Board Report #288 March 11, 2019 ADMINISTRATION (Dr. Gilbert) 1. Review of the Financial Monthly Reports a. Finance Reports 1) Year-To-Date Income Statement for the One Month Ended January 31, 2018 (in thousands) Organizational Medi-Cal Medicare Expenditures Grand Total Actual Budget Variance $ Actual Budget Variance $ Premium Revenue 2,304,215 2,226,600 77,615 244,967 236,265 8,702 - 2,549,181 Supplemental 242,482 175,815 66,666 - - - - 242,482 Other Revenue 0 - 0 4,929 7,540 (2,612) - 4,929 Net Revenue 2,546,696 2,402,415 144,281 249,896 243,805 6,091 - 2,796,592 Facility Claims 901,182 866,740 34,442 95,829 86,118 9,711 - 997,011 Capitation Expense 461,983 478,039 (16,056) 91,311 85,237 6,075 - 553,295 Professional 266,397 229,889 36,508 33,063 26,748 6,315 - 299,460 Pharmacy 402,486 396,501 5,985 19,864 25,863 (5,999) - 422,350 Incentives 26,877 38,045 (11,169) 1,749 1,004 745 - 28,626 All Other Medical 163,471 144,751 18,720 18,110 14,719 3,391 - 181,581 Other Expenses 113,611 50,394 63,217 (118) - (118) - 113,493 G & A Expenses - Medical - - - - - - 62,273 62,273 Medical Cost Allocations 48,823 59,274 (10,451) 13,450 15,225 (1,775) (62,273) - Total Medical Costs 2,384,831 2,263,633 121,198 273,258 254,914 18,344 - 2,658,089 Gross Margin 161,866 138,782 23,083 (23,362) (11,110) (12,253) - 138,503 5 Inland Empire Health Plan Supplemental to Board Report #288 March 11, 2018 ADMINISTRATION (Dr. Gilbert) 1. Review of the Financial Monthly Reports a. Finance Reports 1) Year-To-Date Income Statement for the One Month Ended January 31, 2018 (in thousands) (Continued) Organizational Medi-Cal Medicare Expenditures Grand Total Actual Budget Variance $ Actual Budget Variance $ Operating Expenses Administration 12,760 13,936 (1,176) 1,054 1,058 (4) - 13,814 Finance 5,108 5,828 (720) 847 970 (124) - 5,955 Information Technology (IT) 38,533 32,237 6,296 898 764 134 - 39,431 Marketing 6,149 7,696 (1,547) 2,061 2,146 (85) - 8,209 Health Services 11,188 12,847 (1,658) 3,024 3,577 (552) - 14,213 Network Development 500 361 139 1,187 1,207 (20) - 1,687 Operations 33,007 34,727 (1,720) 5,861 5,806 55 - 38,868 Total Operating Expenses 107,245 107,632 (387) 14,931 15,529 (598) - 122,177 Operating Surplus (Deficit) 54,621 31,151 23,470 (38,294) (26,639) (11,655) - 16,327 Total AB85 14,354 14,334 20 - - - - 14,354 Total ACA 0 - 0 - - - - 0 Total IHSS (16,648) - (16,648) - - - - (16,648) Total Sales Tax 331 - 331 - - - - 331 Other Income (Expense) - - - - - - 2,570 2,570 Property Management Income (Expense) - - - - - - 853 853 Total Non Operating Income (Expense) (1,962) 14,334 (16,296) - - - 3,423 1,461 Net Surplus (Deficit) 52,659 45,485 7,174 (38,294) (26,639) (11,655) 3,423 17,788 6 Inland Empire Health Plan Supplemental to Board Report #288 March 11, 2018 ADMINISTRATION (Dr. Gilbert) 1. Review of the Standard IEHP Monthly Reports a. Finance Reports 2) Capitation Income and Expense for the Period Ended January 31, 2018 January Year-to-Date Riverside SB Total Riverside SB Total Membership: Medi-Cal 607,439 607,260 1,214,699 4,253,864 4,282,774 8,536,638 CMC 13,653 13,220 26,873 95,105 92,165 187,270 Total Members: 621,092 620,480 1,241,572 4,348,969 4,374,939 8,723,908 Revenue: Medi-Cal 179,186,222 179,273,290 358,459,512 1,250,755,057 1,258,738,080 2,509,493,137 CMC 22,714,867 21,279,950 43,994,816 146,071,139 141,027,763 287,098,902 Net Revenue: $201,901,089 $200,553,240 $402,454,329 $1,396,826,196 $1,399,765,843 $2,796,592,039 Medical Costs: Medi-Cal 167,860,556 178,111,773 345,972,329 1,255,643,844 1,113,364,736 2,369,008,579 CMC 20,951,095 23,168,216 44,119,311 152,674,084 136,405,967 289,080,051 Total Medical Costs: $188,811,652 $201,279,989 $390,091,641 $1,408,317,928 $1,249,770,702 $2,658,088,631 Gross Margin: $13,089,437 $(726,750) $12,362,688 $(11,491,732) $149,995,141 $138,503,408 7 Inland Empire Health Plan Supplemental to Board Report #288 March 11, 2019 ADMINISTRATION 1. Review of The Standard IEHP Monthly Reports b. Operations Reports 1) Claims Summary Report Claims Inventory Report Month End January 2019 Claims Beginning Claims Claims Claims Claims Ending Category Inventory Received Paid Denied Capitated Inventory Professional IEHP Responsible 3,276 129,897 92,181 31,663 1,845 7,484 IEHP Direct 27,739 397,466 299,239 27,805 37,583 60,578 Per Diem Hospital Contract 37,616 101,052 101,275 11,252 1,052 25,089 Vision 3,372 20,120 18,584 984 2 3,922 Pay For Performance (P4P) 695 2,513 1,681 119 - 1,408 Mental Health 6,662 10,030 8,038 706 13 7,935 Member Reimbursement 6 - - - 6 Redirected 780 35,132 48 34,545 316 1,003 Decaps - - - - - - No Category - - - - - - Professional Subtotal 80,146 696,210 521,046 107,074 40,811 107,425 Institutional IEHP Responsible 16,354 54,087 41,515 9,893 564 1 IEHP Direct 19,820 66,076 55,048 3,193 3,956 23,699 Per Diem Hospital Contract 2,477 23,858 20,780 2,129 2,176 1,250 Vision 1 - - - - 1 Pay For Performance (P4P) - - - - - - Mental Health 336 183 180 24 15 300 Member Reimbursement - - - - - - Redirected 5,465 3,893 246 3,728 - 5,384 Decaps - - - - - - No Category - - - - - - 44,453 148,097 117,769 18,967 6,711 49,103 Total Claims in Diamond 124,599 844,307 638,815 126,041 47,522 156,528 November Production Days 21 Delayed Receipts (included in Claims Received Column) 0 Paid, Denied and Capitated Claims 812,378 Claims aw aiting Check Write 145,541 Claims aw aiting adjudication 10,987 Auto-Adjudicated Claims 663,607 Auto-Adjudication Rate 82% Average Claims Worked per Day 38,685 Average # of Days Claims are in Inventory 1 8 Inland Empire Health Plan Supplemental to Board Report #288 March 11, 2019 ADMINISTRATION 1.
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