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8-05.pub

Sunflower Electric Power Corporation
August, 2005
Tom Zerfas at x357 or a member of the Committee Also in this issue: Cost Cap Update An Ounce of Prevention.
Determining PPO
Heard It Through The
Savvier Car Buyers Than
Providers
Grapevine
Healthcare Consumers?
A recent study performed by
Wholesale prices for
What can we learn from Great-West Healthcare
brand-name drugs network. The spouse of this? As we have advised,
found that consumers de-
increased by an av-
vote more time researching
a car or refrigerator pur-
erage of 6.6% be-
company needed cancer provider of service is a chase than they do a doctor
tween 2004 and treatments and contacted
or health plan.
the Cancer Treatment It is important to ensure 2005, more than
twice the inflation cated in the Southwest with the service or prod-
Drug Marketing Tactics
The Center for Dis-
OK. As he should, the PPO. This includes institu- The FDA plans to announce
a review of direct-to-

ease Control recom-
consumer prescription drug
mends that children
advertisements. Many phy-
exercise one hour
sicians and consumers
Blue Cross of Oklahoma. medical equipment provid- over the course of
think drug ads exaggerate
each day. The exer-
benefits and do not ade-
quately disclose risks. The
cise doesn’t have to
review is typically the first
be in one continu-
step in setting new rules to
ous block, though,
govern advertising.
as children are more
they received were from viders have the flexibility of likely to be active in
the Center. During the using different profession- Generic Available
“fits and spurts.”
stay, the Cancer Center als or institutions for treat- • The top five proce-
Nexium (“the purple pill”)
dures performed in
cost our plan $109 per pre-
scription and $40 per em-
US hospitals in
ployee co-pay. Omeprazole,
2003: cesarean sec-
write off the additional the generic equivalent, cost
tion (C-section); up-
amounts that BCBSKS the plan just $39 and em-
per GI endoscopy Medical Center is not a won’t pay, verify it and try
ployees $10 per co-pay.
(to diagnose ulcers,
Be sure to ask if a generic is
stomach cancer,
right for you.it could save
etc.); heart catheteri-
you and the plan a lot of
zations; respiratory
intubation and artifi-
cial respiration; and
Got a HIPAA Concern?
angioplasty. The answered correctly to the the network by going to the
total charges for earlier question that it was
your Privacy Officer
these were $108 bil-
Tom Zerfas
(785) 623-3357
tzerfas@sunflower.net
H e a l th c a r e B e n e f i t C o st C o n tr o l Co m m i t te e Q u e s t i on s ? C o n t a c t T o m Z e r f a s a t x 3 5 7 Cost Cap, Claims, & Utilization Update
Cost Cap & Claims
Utilization Analysis
The utilization analysis is a helpful tool to track us- age and costs in certain areas. Below, we compare the first six months of 2005 to the same time in 2004. 2004 Avg 2005 Avg
% Inc/Dec
Contract Contract
Institutional Services
# of Inpatient Admissions
$168,908
$137,168
Inpatient Plan Paid
Inpatient Average Plain Paid/
$156,213
$176,045
Admission
# of Outpatient Claims
Outpatient Plan Paid
$154,248
$189,399
Outpt Avg Plan Paid/Claim
# of ER Claims
$479,369
$502,612
ER Plan Paid
ER Avg Plan Paid/Claim
Professional Services
Performance Update
# of Claims
For the first six months of the year, 64% of the claims were under $1,000 and 94% were under $5,000: this points out Plan Paid
how the majority of claims usually are small, but a minority Average Plan Paid/Claim
usually are larger-ticket items. We had an increase in the Drug Services
amount paid for professional services (some of this is due to the new $10 co-pay). Once again, the number of prescrip- # of Scripts
tions written for drugs has increased. A good sign is that we Plan Paid
are selecting generic equivalents more of the time (51% this Average Plan Paid/Script
Generic Potential
Generics Purchased
Your Healthcare Committee Members
Dental Services
If you have any questions regarding the performance of our # of Services
plan, contact Bill Washburn, Chad Dockter, Robert Staats, Plan Paid
Sandy Skipton, Chuck Fischer, Dale Livingston, Don Tull, or Del Kaps. Average Plan Paid/Service
Average Cost Per Contract 2005 (through July)

Source: http://www.sunflower.net/documents/8-05-Newsletter.pdf

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