january december 2016 2016 yearly operating report_v7… · an executive summary of...
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1
WSHIP
ADMINISTRATOR’S REPORT
January – December 2016
An Executive Summary of Administrator’s Yearly Operating Report and Pool Activities
YEARLY ENROLLMENT SUMMARY
Total Enrollment as of 12/31/16: 1,458 (decreased 6% from prior year)
Number/percentage sponsored by Third Party: 865 / 59%
Non-Medicare Enrolled: 421 / 29% (decreased 15% from prior year)
Sponsored by 3rd Party: 296 / 70% of non-Medicare enrollment
Number sponsored by EHIP: 253
Number sponsored by other: 43
Medicare Enrolled: 1,037 / 71% (decreased 2% from prior year)
Sponsored by 3rd Party: 597 / 58% of Medicare enrollment
Enrollment YTD: 214 Terminations YTD: 406
Plan Selection:
Non-Medicare: PPO – 29%, Standard – 3%, HSA – 1%, Limited A – 0%,
Medicare: Basic – 52%, Basic Plus – 15%
Age & Gender: Average age: 58 Gender: Female– 36%, Male– 64%
ANNUAL ENROLLMENT ACTIVITY (Non-Medicare enrollment is closed):
Number of applications received: 282
Number of applications approved: 242
Number of applications pended: 170
Number of applications denied: 28
Primary denial reason: Lack of response to request for missing information
Percent of applications submitted by agents: 18%
Percent of applications submitted by Third Party: 51% (Kidney Centers only)
Terminations in the reporting year: (34% of terminations were due to non-payment)
Medicare Terminations: 257
Non-Medicare Terminations: 120
2
YEARLY CLAIMS EXPENSE
Medical Claims Paid: $25,998,310
Medicare: $9,577,298
Non-Medicare: $16,421,010
Pharmacy Claims Paid: $15,476,969.00
Medicare: $1,233,905
Non-Medicare: $14,243,064
Total Claims Paid: $41,475,280
OTHER YEARLY ACTIVITY
Claims Activity:
Number of claims received: 81,265
Customer Service Telephone Calls and Website Visitors:
Average calls per day: 37
Average website visitors per day: 19
Appeals:
Number of appeals received related to eligibility: 119
First Level (Administrator) 109; Second Level (Grievance Committee) 10
Number of appeals received related to other: 63
First Level (Administrator) 63; Second Level (Grievance Committee) 0
Number of appeals adjudicated in favor of applicant/enrollee: 94
Number of appeals adjudicated and denied: 88
OIC Complaints:
Number of complaints received: 1
Monthly Operations Report
2016 Yearly Operating Report
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
1065
2333
2062
25322652
2889 30873266
3447 3397 3578
3923 3862
3675
4022
17371556 1458
Total Enrollment by Calendar Year1999 - 2016
NOTE: This chart depicts total enrollment within WSHIP at year end. In 2016 enrollment decreased 6.3% from 2015. Enrollment increased in 1999 when individual insurance products were no longer available in most Washington counties, and legislation allowed access to the Pool. The Standard Health Questionnaire was utilized from 2000-2013 to determine a threshold for coverage by carriers. The substantial decrease in WSHIP enrollment is due to increased access made available by the Affordable Care Act and the Washington Health Benefit Exchange.
Chart 1
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
918 1678 1378 1678 1544 1403 1872
596
0
50
100
150
200
250
300
350
400
450
500
550
600
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Num
ber o
f Enr
olle
es
Non-Medicare Policies in Force2007- 2016
$500 Standard Plan $1,000 Standard Plan $1,500 Standard Plan $500 PPO Plan $1,000 PPO Plan $2,500 PPO Plan $5,000 PPO Plan
NOTE: This chart depicts the change in enrollment by plans. The HSA Qualified PPO Plan and Limited PPO Plans A and B were added in January of 2008 and are not included in this chart. Beginning in 2014, Non-Medicare plans are no longer open to new enrollment if individual plans are offered in all counties.
Chart 2
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
160
332
241
332
526
674728
778813 829
408
505
571
505458
347304
276238
208
334
0
100
200
300
400
500
600
700
800
900
1,000
1,100
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Num
ber o
f Enr
olle
es
Medicare Policies in Force2007 - 2016
Basic Plan Basic Plus Plan Plan 2
NOTE: This chart depicts the change in enrollment by Medicare plans. Medicare Part D was introduced in 2006 causing a sharp decrease in WSHIP enrollment in Plan 2 as enrollees switched to either the Basic or Basic Plus plan options which were added in January of 2006. Effective January 2008, Plan 2 enrollees were required to switch to either Basic or Basic Plus plan options. Basic Plus was closed to new enrollment Dec. 31, 2008
Chart 3
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
14.3
%
7.6%
31.3
%
7.7%
7.8%
13.6
%
4.8%
12.9
%7.9%
3.0% 3.
7%
6.1%
8.5%
2.1%
4.1%
11.4
%
4.6%
31.3
%
3.1%
12.4
%
4.4%
1.4%
13.8
%
24.3
%
11.8
%
5.6%
29.9
%
20.1
%
3.9%
1.6% 2.6%
34.4
%
18.1
%
19.1
%
2.8%
19.1
%
4.6%
0.7%
1.1%
0
100
200
300
400
500
Non-Payment Death Other Coverage Moved Out ofState
Insured Request Medicare Financial Hardship Loss of 3rd PartyPayor
Num
ber o
f Enr
olle
es
Terminations by Reason(for all 2012 - 2016 terminations)
2012 2013 2014 2015 2016
NOTE: This chart depicts the reasons coverage was terminated for enrollees. "Insured Request" indicates those who did not state a reason for terminating. "Non-Payment" reflects enrollees who did not respond to queries regarding reasons for non-pay.
64.6
%
Chart 4
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
HSA Qual PPO Plan Limited PPO A Basic Plan Basic Plus Plan
Age $500 $1,000 $1,500 Age $500 $1,000 $2,500 $5,000 Age $3,000* $1,500* Age0-18 4 0 0 0-18 11 2 0 1 0-18 0 0 0-18 0 019-29 4 0 2 19-29 9 4 5 0 19-29 0 0 19-29 8 030-34 1 0 1 30-34 32 5 1 0 30-34 0 0 30-34 15 135-39 3 0 0 35-39 51 1 2 1 35-39 0 0 35-39 25 040-44 4 0 0 40-44 59 2 4 2 40-44 2 0 40-44 49 345-49 1 1 1 45-49 55 0 9 2 45-49 2 0 45-49 71 450-54 6 2 2 50-54 35 3 5 1 50-54 0 0 50-54 105 1755-59 0 0 0 55-59 20 1 8 3 55-59 4 0 55-59 147 2960-64 1 1 1 60-64 12 4 11 5 60-64 5 0 60-64 180 4265-69 0 0 1 65-69 2 0 0 0 65-69 0 0 65-69 105 3670-74 2 0 0 70-74 1 0 0 0 70-74 0 0 70-74 70 3675-79 0 0 0 75-79 0 0 1 0 75-79 0 0 75-79 29 2280-84 0 0 0 80-84 0 0 0 0 80-84 0 0 80-84 19 1585+ 0 0 0 85+ 0 0 0 0 85+ 0 0 85+ 6 3Total 26 4 8 Total 287 22 46 15 Total 13 0 Total 829 208
* Began enrolling on January 1, 2008.
TOTAL ENROLLMENT: 1,458
Plan & Age Distribution Summary as of December 31, 2016
Standard Plan PPO Plan
Total STD Plan Enrollment= 38 Total PPO Plan Enrollment = 383 Total Medicare Enrollment = 1,037
NOTE: This chart depicts the enrollment of WSHIP by plan within each of the illustrated age bands. The Limited PPO Plan B was closed in May 2014.
26 4 8
287
22 46 15 13
829
208
0100200300400500600700800900
$500Standard
Plan
$1,000Standard
Plan
$1,500Standard
Plan
$500 PPO Plan
$1,000 PPO Plan
$2,500PPOPlan
$5,000PPOPlan
HSAQualified
HDHP
BasicPlan
BasicPlusPlan
Num
ber o
f Enr
olle
es
Chart 5
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
0 25 50 75 100 125 150 175 200
0 - 1 Year
1 - 2 Years
2 - 3 Years
3 - 4 Years
4 - 5 Years
5 - 6 Years
6 - 7 Years
7 - 8 Years
8 - 9 Years
9 - 10 Years
10 - 15 Years
15 + Years
# of Enrollees
Time Policyholders Enrolled in WSHIP
Basic Plus Plan Basic Plan HSA Qualified Preferred Preferred Plan Standard Plan
NOTE: This chart depicts the duration of time enrollees with non-Medicare and Medicare polices are enrolled with WSHIP as of December 31, 2016.
Chart 6
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
0 25 50 75 100 125 150 175 200
0 - 1 Year
1 - 2 Years
2 - 3 Years
3 - 4 Years
4 - 5 Years
5 - 6 Years
6 - 7 Years
7 - 8 Years
8 - 9 Years
9 - 10 Years
10 - 15 Years
15 + Years
# of Enrollees
Time Enrolled in WSHIPMedicare Policies
Basic Plus Plan Basic Plan
NOTE: This chart depicts the duration of time enrollees with Medicare policies were enrolled with WSHIP as of December 31, 2016. Basic and Basic Plus plans have been available for eight years. However, the activity beyond eight years illustrates enrollees who at one point had Plan 2 coverage and then changed to either the Basic or the Basic Plus plans. As of January 2008, all Plan 2 enrollees were required to either terminate coverage or move to the Basic or the Basic Plus plans.
Chart 7
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
0255075
100125150175200225250
AD
AMS
ASO
TIN
BEN
TON
CH
ELA
N
CLA
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CLA
RK
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BIA
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WLI
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GR
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WAH
KIA
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LA W
ALL
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WH
ATC
OM
WH
ITM
AN
YAK
IMA
County
2016 Enrollment By CountyN
umbe
r of E
nrol
lees
4471
0.00%
0.01%
0.02%
0.03%
0.04%
0.05%
0.06%
AD
AMS
ASO
TIN
BEN
TON
CH
ELA
N
CLA
LLAM
CLA
RK
CO
LUM
BIA
CO
WLI
TZ
DO
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LAS
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RY
FRA
NKL
IN
GAR
FIEL
D
GR
AN
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GR
AYS
…
ISLA
ND
JEFF
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KIN
G
KIT
SAP
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LN
MA
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N
OKA
NO
GAN
PAC
IFIC
PEN
D…
PIE
RC
E
SAN
JU
AN
SKA
GIT
SN
OH
OM
ISH
SPO
KAN
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STE
VEN
S
THU
RS
TON
WAH
KIA
KUM
WAL
LA W
ALL
A
WH
ATC
OM
WH
ITM
AN
YAK
IMAEn
rollm
ent P
erce
nt
County
2016 Enrollment by % of Total County Population0.18%
Chart 8
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
$0
$341
$1,658
$3,218
$7,555
$11,754
$20,148
$36,592
$60,667
$85,628
$121,265
$407,953
$0
$418
$1,714
$3,632
$7,621
$12,090
$18,029
$34,815
$54,147
$82,368
$125,184
$208,652
0 50 100 150 200 250 300 350 400
$0
$1-$1000
$1,001-$2,500
$2,501-$5,000
$5,001-$10,000
$10,001-$15,000
$15,001-$25,000
$25,001-$50,000
$50,001-$75,000
$75,001-$100,000
$100,001-$150,000
> $150,000
Number of Claimants
Distribution of Total Allowed* Medical and Pharmacy Claims 2016
Medicare
Non-Medicare
NOTE: This chart depicts the total allowable charges for all medical and pharmacy claims processed in 2016 for all enrollees. The allowable claim costs have been banded as illustrated below. The average allowed medical and pharmacy cost per member per year (PMPY) is $20,180. At the end of each bar is the total average PMPY cost for the corresponding dollar band. 1.6% of the Non-Medicare enrollees drove 50% of total Non-Medicare costs. 12.5% of the Medicare enrollees drove 50% of total Medicare costs.
* Allowed: The dollar amount after deducting discounts and/or what other insurance has already paid.
Chart 9
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
Note: This chart illustrates the loss ratio and expense ratio for the calendar year for all WSHIP plans. Medicare and Non-Medicare totals are reflected in the green bars at the right side of each chart.
0%100%200%300%400%500%600%700%800%900%
1000%1100%1200%1300%1400%
HSAQualified
$500PPO
$1000PPO
$2500PPO
$5000PPO
$500Standard
$1000Standard
$1500Standard
Basic BasicPlus
MedicareTotal
Non-Medicare
Total
2016 Expense Ratio by Plan
0%100%200%300%400%500%600%700%800%900%
1000%1100%1200%1300%1400%
HSAQualified
$500PPO
$1000PPO
$2500PPO
$5000PPO
$500Standard
$1000Standard
$1500Standard
Basic BasicPlus
MedicareTotal
Non-Medicare
Total
2016 Total Loss Ratio by Plan
Chart 10
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
NOTE: This chart illustrates medical, pharmacy and total claims paid by plan. Medicare and Non-Medicare totals are reflected in the green bars at the right side of each chart. In 2016, WSHIP paid $26,883,191 in medical claims and $15,636,497 in pharmacy claims, for a total of $42,519,688.
1.3%
14.8%
3.3% 4.0% 1.5%
14.2%
0.1% 1.5%
19.7%
2.9%
22.6%
40.6%
$-
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
$30,000,000
HSAQualified
$500PPO
$1000PPO
$2500PPO
$5000PPO
$500Standard
$1000Standard
$1500Standard
Basic BasicPlus
MedicareTotal
Non-Medicare
Total
2016 Medical Claims Paid by Plan
0.3%
27.3%
3.5% 1.2% 0.0% 1.0% 0.1% 0.4% 0.1%2.8%
36.8%33.9%
$-
$5,000,000
$10,000,000
$15,000,000
$20,000,000
HSAQualified
$500PPO
$1000PPO
$2500PPO
$5000PPO
$500Standard
$1000Standard
$1500Standard
Basic BasicPlus
MedicareTotal
Non-Medicare
Total
2016 Pharmacy Claims Paid by Plan
1.6%
42.0%
6.7% 5.3% 1.5%15.2%
0.2% 1.9%19.8%
5.7%25.5%
74.5%
$-
$10,000,000
$20,000,000
$30,000,000
$40,000,000
$50,000,000
HSAQualified
$500PPO
$1000PPO
$2500PPO
$5000PPO
$500Standard
$1000Standard
$1500Standard
Basic BasicPlus
MedicareTotal
Non-Medicare
Total
2016 Total Claims Paid by Plan
Chart 11
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
$-
$5,000
$10,000
$15,000
$20,000
HSAQualified
$500PPO
$1000PPO
$2500PPO
$5000PPO
$500Standard
$1000Standard
$1500Standard
Basic BasicPlus
MedicareTotal
Non-Medicare
Total
2016 Medical Claims Paid Per Member Per Month (PMPM) by Plan
$-
$1,000
$2,000
$3,000
$4,000
HSAQualified
$500PPO
$1000PPO
$2500PPO
$5000PPO
$500Standard
$1000Standard
$1500Standard
Basic BasicPlus
MedicareTotal
Non-Medicare
Total
2016 Pharmacy Claims Paid Per Member Per Month (PMPM) by Plan
$-
$5,000
$10,000
$15,000
$20,000
$25,000
HSAQualified
$500PPO
$1000PPO
$2500PPO
$5000PPO
$500Standard
$1000Standard
$1500Standard
Basic BasicPlus
MedicareTotal
Non-Medicare
Total
2016 Total Paid Claims Per Member Per Month (PMPM) by Plan
Chart 12
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
Enrollment Plan CostsMembers Months Total Premiums Total Out-of-Pocket Total Plan Paid Member Costs Plan Costs
Standard Plans 480 738,358$ 45,199$ 7,384,390$ 1,632 15,384$ Preferred Provider Plan 4,558 5,359,417$ 507,597$ 23,614,937$ 1,287$ 5,181$
HSA Qualified Plan 156 130,392$ 62,926$ 660,621$ 1,239$ 4,235$ Total Non-Medicare 5,194 6,228,167 615,721 31,659,948 1,318$ 6,095$
Basic Plus 2,642 1,409,519$ 8,005$ 2,439,169$ 537$ 923$ Basic 9,824 3,428,869$ 15,308$ 8,420,667$ 351$ 857$
Total Medicare 12,466 4,838,388 23,314 10,859,835 390$ 871$ Total All Plans 17,660 11,066,554 639,035 42,519,783 663$ 2,408$
Member Costs PMPMAnnual Totals
2016 Cost Sharing on a Per Member Per Month (PMPM) BasisNOTE: This chart illustrates the cost sharing on a per member per month (PMPM) basis. Enrollees' totals include all out-of-pocket related health plan costs (co-pays, deductibles, coinsurance) in addition to the annual premium.
Chart 13
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
2012
2012
2012
2012
2012
2013
2013
2013
2013
2013
2014
2014
2014
2014
2014
2015
2015
2015
2015
201520
16
2016
2016
2016
2016
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Hospital Inpatient Hospital Outpatient Office Outpatient Drugs Other
Perc
ent o
f Tot
al
Distribution of Claim Payments by Place of Service 2012 - 2016NOTE: This chart depicts the annual paid medical and pharmacy claims cost for each place of service as a percent of the total annual cost. "Other" is a total of services not within the defined labels below, such as Ambulance, Community Mental Health Center, Home Health / Hospice, and Substance Abuse Treatment Center.
Chart 14
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$18,000
$20,000
2010 2011 2012 2013 2014 2015 2016
Preferred Provider Plans Standard Plans
NOTE: This chart depicts network discounts for both the Standard and Preferred Provider Plans on a PMPM basis for 2010 through 2016. In 2016, the network savings as a percent of total in-network charges for Standard Plans was 62% and for Preferred Provider Plans was 38.3%. The total combined network savings was 49.7%.
Network Savings on a Per Member Per Month (PMPM) Paid Basis for 2010 - 2016
Chart 15
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
Percent of Claims Dollars Paid Percent of Dollars PaidIn-Net Out-of-Net In-Net Out-of-Net In-Net Out-of-Net
PPO Plans 89% 11% 9,398,459$ 945,628$ 91% 9%STD Plans 94% 6% 6,692,995$ 61,727$ 99% 1%
In-Network versus Out-of-Network Utilization 2016
NOTE: This chart illustrates the utilization of in-network providers versus out-of-network providers. For enrollees within the Preferred Provider Plans, 89% of the time they were utilizing an in-network provider which resulted in 91% of the total dollars paid. For enrollees within the Standard plans, 94% of the time they were utlizing an in-network provider which resulted in 99% of the total dollars paid.
Chart 16
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
Service Code Analysis 2016 Paid Medical Claims
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
$900,000
$1,000,000
$1,100,000
$1,200,000
$1,300,000
$1,400,000
$1,500,000
$1,600,000
$1,700,000
$1,800,000
$1,900,000
$2,000,000
NOTE: This chart depicts the total paid medical claims per each service code or benefit category with total charges $100,000 and up. As a percentage of total claims paid, ancillary charges accounted for 53.6% , injections represented 10.2% and diagnostic testing equaled 10%. The top three ancillary charges billed were Ancillary Charges ($13.6 million) Injections ($2.6 million) and Diagnostic Testing ($2.5 million).
Chart 17
Washington State Health Insurance Pool 2016 Yearly Operating Report March 9, 2016
$0.00
$1,000,000.00
$2,000,000.00
$3,000,000.00
$4,000,000.00
$5,000,000.00
$6,000,000.00
Top 10 Ancillary Services 2016
Chart 18
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
22%
24%
26%
28%
30%
Perc
ent o
f Tot
al M
edic
al C
laim
s
Major Diagnostic Categories by % of Total Medical Claims Paid in 2016
Total Medicare Non-Medicare
NOTE: This chart depicts the paid medical claims based upon Major Diagnosis Categories for all plans. The % of WSHIP claims billed under the Kidney and Urinary Tract Disease Diagnosis Cateory in 2016 was: non-Medicare - 52.95%, Medicare - 77.80% and Total - 61.56%.
Chart 19
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
Provider Name Paid AmountPercent of Total
Medical Claims Paid FCHN Provider? Total Renal Care 3,913,147.50 15.1% YesNorthwest Bethany 2,943,250.57 11.4% YesNorthwest Kidney Centers 1,246,398.29 4.8% YesPuget Sound Blood Center 1,201,729.68 4.6% YesProvidence Health & Services 1,027,136.09 4.0% YesHarborview Medical Center 903,460.53 3.5% YesVirginia Mason Center 640,875.37 2.5% YesThe Regional Hospital for Respiratory & Complex Care 632,850.19 2.4% YesVGM Group Inc 614,267.59 2.4% YesPuget Sound Kidney Centers 574,759.94 2.2% YesKadlec Regional Medical Center 538,437.82 2.1% YesSeattle Childrens Hospital 528,243.31 2.0% YesSt Joseph Medical Center 477,969.18 1.8% YesCentral Washington Hospital 398,633.42 1.5% YesBirth and Family Clinic 395,863.92 1.5% YesUniversity of Washington 390,516.44 1.5% YesProvidence Everett Medical Labs 378,328.88 1.5% YesInland Northwest Renal Care Group 318,363.32 1.2% YesKennewick Public Hospital District 292,647.80 1.1% YesOption Care Enterprises Inc 287,388.47 1.1% YesNorth Spokane Renal Services 279,351.18 1.1% YesProvidence Health & Services 274,480.33 1.1% YesMulticare Health Systems 269,365.32 1.0% YesSwedish Health Services 261,539.35 1.0% YesAssociation of University Physicians 255,971.69 1.0% YesTotal of all other providers 6,843,805$ 73.6%
Top 25 Providers by 2016 Medical Claims PaidNOTE: This chart depicts the top 25 providers in 2016 by medical claims paid. The top 25 providers account for approximately 74% of claim dollars paid in 2016.
Chart 20
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
20 Total PPO Plan = 276 597296
893
Third Party Sponsors Members Plan & Age Distribution Summary as of December 31, 2016
Standard Plan PPO Plan HSA Qual PPO Plan Basic Plus Plan
0-18 1 0 0 0-18 0$3,000Age
Basic PlanAge$500 $1,000 $1,500 Age $5000-18
$1,000 $2,500 $5,000 Age1 0 1 0
19-29 3 0 1 19-29 70-18 0 0
19-29 0 719-29 00 2 00 11
35-39 3 0 0 35-39 481
35-39 0 2135-39 030-34 1 30-34 0 30-34
0 0 00 0 30-34 31 0 0
0 0 5845-49 10 391
00 1 40-44 0
45-4940-44
240-44 2 0 0 40-44 57
50-54 4 0 0 50-54 3345-49 1 0 0 45-49 53
50-540 50-54 0 4 8455-59 0 0 0 55-59 19
0 055-59 2 10455-59 20 3 0
65-69 0 0 0 65-69 20
65-69 665-69 060-64 1
0 0 01 0 60-64 9 60-64 40 0
75-79 0 0 0 75-79 00 0 070-74 2 0 0 70-74 10 0 0
1 60-64
80-84 085+ 0 285+ 0
70-74 0 4270-74 075-79 0 1775-79 0
11670
0 0 85+ 00 0 080-84 0 0 0 80-84 00 0 0
NOTE: Third party sponsors accounted for 61.2% of the total WSHIP population. At the end of 2016, EHIP had 253 enrollees, DSHS had 5, and Kidney Organization Sponsors had 607.
TOTAL ENROLLMENT:
Total 17 580Total Standard Plan = Total Medicare =
3 7 3 Total 3Total 18 1 1 Total 260
Total Non-Medicare =
80-84 1 985+ 0
18 1 1
260
3 7 3 3 17
580
0100200300400500600700
$500Standard
Plan
$1000Standard
Plan
$1,500Standard
Plan
$500PPOPlan
$1,000PPOPlan
$1,500PPOPlan
$2,500PPOPlan
HSAQualified
HDHP
BasicPlusPlan
BasicPlan
Num
ber o
f Enr
olle
es
Chart 21
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
NOTE: This chart depicts the paid medical and pharmacy claims on a per member per month (PMPM) basis for each of the three primary third party sponsors and how each compares to WSHIP in total. The percentages on each bar graph represent the medical and pharmacy costs of each primary third party sponsor as a percentage of the total WSHIP medical and pharmacy costs. In 2016, third party sponsor claims represent 61% of the total annual claim costs for WSHIP.
11.8%
54.8%
27.6%
51.1%
2.8%
33.3%
0.2%0.4%
0.2%
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
$4,500
Medical Pharmacy Total
EHIP Kidney DSHS Total
2016 Claims Paid Per Member Per Month (PMPM): WSHIP -vs- Third Party Sponsors
300%
486%
152%
384%
0%
100%
200%
300%
400%
500%
600%
EHIP KIDNEY DSHS WSHIP (total)
2016 Loss Ratio: WSHIP -vs- Third Party Payors
Chart 22
Washington State Health Insurance Pool 2016 Yearly Operating Report March 8, 2017
2014 2015 20169,560 5,952 5,278 Total number of unique visitors
26 16 14 Average daily number of unique visitors
Health Reform
1,003 Medicare Benefits1,508 Contact Us1,694
For Board of Directors
330 Yearly Reports
821 Provider Network
324 Assessment Form
2,918 Medicare Eligibility
WSHIP Web Site Statisticswww.wship.org
2013 through 2016 Comparison
Interesting Facts
Page NameNumber of SessionsTop 10 Pages Most Frequently Accessed
326
Monthly Premiums
575 About WSHIP652
0 100 200 300 400 500 600 700 800 900 1,000 1,100 1,200
11-30 sec
31-60 sec
1-3 min
3-10 min
10-30 min
30+ min
# of Unique Visitors
Average Length of Visit
201620152014
Chart 23