This document shows summary statistics of the performance of contracts with a guaranteed minimum length. The filter is for contracts with an effective year greater than or equal to 2020, completed, abrogated or active. This was done to get a large enough dataset, knowing that there will likely be some deterioration of loss experience in the future.

The table below shows the performance of the Guaranteed LOC contracts

Effective Year Ultimate Projections Ultimate Price Contracts MLR Budget MLR
2020 8,866,621 12,340,303 6 71.9% 77.9%
2021 12,733,118 13,429,212 6 94.8% 79.5%
2022 28,200,861 30,925,826 16 91.2% 78.4%
2023 27,939,319 35,087,752 20 79.6% 75.7%
2024 32,783,722 42,631,565 20 76.9% 78.9%
2025 1,196,245 1,616,548 1 74.0% 74.0%

This experience compares unfavorably to the performance of the non-Guaranteed LOC contracts

Effective Year Ultimate Projections Ultimate Price Contracts MLR Budget MLR
2020 296,432,146 407,629,582 315 72.7% 75.7%
2021 350,101,051 465,984,325 319 75.1% 76.5%
2022 356,263,256 467,738,916 308 76.2% 76.9%
2023 375,718,724 528,412,482 362 71.1% 76.1%
2024 431,025,155 573,559,292 416 75.1% 75.9%
2025 8,789,491 11,935,991 11 73.6% 74.8%

The distribution of contracts is shown below and demonstrates a tendency for high severity contracts to require the guarantee. This may also account for the higher loss ratio for these contracts.

Diagnosis Type Contracts Ultimate Projections Ultimate Price MLR Budget MLR
ABI 57,461,233 67,433,962 36 85.2% 77.4%
Amputation 4,968,747 6,615,105 5 75.1% 74.5%
Burn Injury 525,353 628,558 1 83.6% 70.0%
Multiple Trauma 8,165,138 12,326,636 9 66.2% 75.4%
SCI 40,599,414 49,026,945 18 82.8% 79.8%
Case Complexity Contracts Ultimate Projections Ultimate Price MLR Budget MLR
2 173,808 230,971 1 75.3% 76.0%
4 9,925,350 12,535,458 12 79.2% 73.2%
5 41,927,518 51,728,797 29 81.1% 75.9%
6 59,693,209 71,535,980 27 83.4% 80.1%

Looking at 2023 in detail, we see that the elevated loss ratio is not due to large outliers

Patient Contract ID Ultimate Projections Ultimate Price Gain/Loss MLR
143338 2,365,375 2,106,516 -258,859 112.3%
143648 4,287,482 3,963,774 -323,708 108.2%
142563 1,223,406 2,241,917 1,018,511 54.6%
144318 577,194 728,727 151,533 79.2%
143887 863,598 1,028,927 165,329 83.9%
143110 670,730 837,399 166,669 80.1%
142710 2,401,144 2,573,175 172,031 93.3%
142586 796,987 978,175 181,188 81.5%
142830 756,301 1,032,352 276,051 73.3%
142939 703,495 999,014 295,519 70.4%
142575 1,687,763 2,028,152 340,389 83.2%
143127 1,514,319 1,996,151 481,832 75.9%
144040 1,011,653 1,499,746 488,093 67.5%
142569 1,637,776 2,166,971 529,195 75.6%
144333 871,675 1,406,286 534,611 62.0%
144401 852,278 1,416,148 563,870 60.2%
142910 1,244,682 1,886,767 642,085 66.0%
143821 1,979,370 2,045,247 65,877 96.8%
143523 1,313,519 1,993,279 679,760 65.9%
144130 1,180,571 2,159,029 978,458 54.7%

There were 4 contracts that were still admitted at the contract end date

PatientContractID Guaranteed MCL Effective Date Booking Date Target End Date Actual End Date Admit Date Discharge Date
137480 80 2020-05-19 2020-08-31 2021-12-01 2023-06-16 2020-12-02 2023-06-20
139565 66 2021-06-26 2021-09-30 2022-10-01 2023-06-29 2022-07-11 2023-06-30
140860 100 2022-03-09 2022-05-31 2024-02-07 2023-06-16 2022-08-04 2024-02-06
142126 106 2022-10-14 2022-12-31 2024-10-25 2024-10-22 2023-07-18 2024-12-05

The following tables show how the actual length of contract compares to both the target length and the guaranteed length

The table below compares actual to budget for effective years 2021 and 2022, showing higher reforecasts for inpatient and outpatient/day treatment

Summary Service Code Code Description Budget Reforecast
9000 In-Patient Hospitalization 23,269,352 24,818,013
9100 Out-Patient/Day Treatment 3,349,562 5,585,742
9300 Management Services 101,000 180,000
9400 Physician & Professional Fees 827,025 647,194
9500 Personal Care Attendant Fees 1,226,035 1,215,053
9600 Transportation 652,829 633,631

The service detail for in and outpatient is shown below

Inpatient
Detail Service Code Code Description Budget Reforecast
9002 ICU 4,123,333 4,585,898
9003 Med/Surg 4,651,333 4,885,428
9004 Acute Rehab 9,468,017 10,610,902
9005 Emergency Room 57,121 13,532
9006 Subacute 3,425,875 2,630,932
9007 Skilled Nursing Facility 556,000 1,023,718
9008 Long Term Residential Placement 987,675 1,067,602
Outpatient/Day Treatment
Detail Service Code Code Description Budget Reforecast
9101 Day Treatment 547,350 134,128
9102 Post Acute Residential 1,019,370 2,075,198
9105 Out Patient Surgical Facility Visit 320,162 176,922
9110 Nursing Services & RN Visits 1,357,766 3,163,925
9120 Physical Therapy-Outpatient 23,040 1,200
9130 Occupational Therapy-Outpatient 23,040 245
9140 Speech/Language Therapy-Outpatient 23,040 2,880
9170 Medical Supplies-Outpatient 31,660 15,044
9180 Medications-Outpatient 3,000 16,000
9186 Home Evaluation-Outpatient 1,133 200

The bulk of the rehab overage came from 2 patients, so does not appear to be a systemic problem in pricing

Acute Rehab by Patient
PatientContractID Budget Reforecast
137295 354,997 270,000
137480 849,792 629,935
137800 26,522 27,902
138036 361,493 0
138567 35,700 124,900
138796 777,032 842,816
138812 308,406 257,320
139565 150,500 328,000
140406 249,480 444,498
140450 245,000 246,878
140860 399,000 521,521
140965 189,280 268,806
141077 47,014 102,310
141299 559,350 496,800
141823 276,701 211,150
141838 133,024 129,780
141932 429,772 354,519
142057 409,500 226,992
142126 533,039 384,491
142259 1,025,578 1,503,446
142261 338,245 861,164
142269 122,500 119,820
142325 892,218 1,180,828
142401 628,126 805,115
142685 125,748 271,911

For Nursing and Post Acute Residential, the overrages make up a greater portion of total patients, though fewer patients incur these services.

## Adding missing grouping variables: `effectiveyear`
Nursing Services by Patient
PatientContractID Effective Year Diagnosis Type Case Complexity Budget Reforecast
138796 2021 SCI 6 521,902 1,514,976
140860 2022 ABI 5 13,300 0
142259 2022 SCI 6 489,060 1,484,249
142325 2022 ABI 4 333,504 164,700

Post acute residential overages are driven by underestimation of days

## Adding missing grouping variables: `effectiveyear`
Post Acute Residential by Patient
PatientContractID Effective Year Diagnosis Type Case Complexity Budget Reforecast
137295 2020 ABI 6 216,295 301,290
140406 2021 ABI 5 234,540 746,691
140450 2021 ABI 6 71,000 58,000
140860 2022 ABI 5 76,875 303,150
142057 2022 ABI 6 241,560 537,700
142259 2022 SCI 6 73,500 0
142685 2022 ABI 4 105,600 128,367