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Dashboard shows concentrated costs and COVID-related suppression; plans offer partial premium credits
Summary
SFHSS data show 2% of active/early-retiree population accounts for roughly 40% of costs; COVID-19 suppressed visits early in 2020 but claims rebounded in June/July. Several plans offered premium/admin credits, including a $1,005,650 refund from UHC Medicare Advantage and Delta Dental credits affecting retiree rates.
Marina Coleridge (Ryn), enterprise systems and analytics manager, presented the Q2 cost, utilization and quality dashboard derived from the SFHSS all-payer claims database (incurred Apr. 2019'Mar. 2020, paid through June 2020). She reported that high-cost claimants continue to grow and that 2% of the active/early-retiree population account for about 40% of costs. Specialty drugs dominate the top-cost categories; top drivers include facility inpatient/outpatient charges and specialty therapies.
Coleridge said many utilization metrics show a dip in spring 2020 likely caused by COVID-related suppression of care. "We may be seeing some claims suppression, it's definitely not quantified yet," she said, noting that some declines in chronic-condition prevalence on the dashboard likely reflect delayed care rather than true health improvements.
Mike Clark of Aon followed with a COVID-19 financial update that cataloged refunds and credits from health and dental plans in response to suppressed claims. Clark said the UnitedHealthcare Medicare Advantage PPO returned $1,005,650 as a partial premium refund that will be applied in September invoices. Delta Dental offered a 25% administrative fee service credit for its active PPO and a 25% premium credit for August/September to be paid in January 2021; Clark said SFHSS proposes applying retiree-plan refunds to 2021 retiree premiums rather than issuing thousands of checks.
Board members asked how the system would address deferred care and target interventions to avoid future acute episodes. Coleridge recommended focusing on medication adherence, preventive visits and steering members to lower-cost settings in partnership with health plans. Clark said claims levels began returning toward normal in June and July, suggesting some suppressed services have restarted.
