Mohave County trustees hear medical-claims review showing few high-cost members drive plan costs

Meritaine Health account director Rick Siphalmo told Mohave County trustees that calendar‑year 2024 produced mixed results: membership slipped 1.3 percent and employer per‑member‑per‑month costs were about 2.5 percent lower year‑over‑year, but claims utilization rose and a small number of very costly members continue to drive the plan’s expenses. "You had about 19 members that had claims over $100,000 which represents about 33 percent" of the plan’s medical spend, Siphalmo said.

The report compared two 12‑month periods rather than the county plan year to show trend. Siphalmo said the trust’s retrospective risk score was about 1.06 and the prospective score 1.01, a signal that overall risk was roughly stable. He also highlighted a notable increase in spouse costs: average spouse cost per month rose from roughly $768 to $970, a 26 percent increase from the prior year.

Trustees were shown a breakdown by diagnostic category. Endocrine, nutritional and metabolic conditions (including thyroid disorders and diabetes) increased and were identified as a key driver; three high‑cost claimants remained on the top‑10 list from 2023 into 2024 and are expected to continue driving costs. Musculoskeletal claims declined 24 percent, a change Siphalmo credited in part to Hinge Health, the county’s virtual musculoskeletal program. Digestive conditions rose, with hernias cited as a leading cause. He also flagged a roughly 12 percent drop in preventive services utilization, which he called “not a good thing” because preventive care can reduce long‑term costs.

Siphalmo told trustees the Aetna RAP and network negotiations produced strong average discounts (reported later in the meeting by Blue Cross Blue Shield), and that claims‑negotiation successes included a $372,000 refund tied to an orthopedic post‑acute adjustment that went to the stop‑loss carrier and should help moderate next year’s stop‑loss renewal.

Trustees asked about whether on‑site wellness fairs account for preventive screening volume; the presenter said those participation numbers live with the wellness staff and would be addressed in the wellness presentation. The trustees discussed the concentration of costs and options for encouraging preventive care but did not take formal policy action on those items during this session.

Ending: Trustees kept the focus on the two findings from the Meritaine presentation: a small number of members generate a disproportionate share of costs, and preventive service use has fallen. Both items were folded into later budget and wellness discussions at the meeting.