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HomeMy WebLinkAboutRFP - 7512 ON-SITE EMPLOYEE WELLNESS CLINICADDENDUM NO. 1 SPECIFICATIONS AND CONTRACT DOCUMENTS Description of BID 7512: On-Site Employee Wellness Clinic OPENING DATE: 3:00 PM (Our Clock) June 7, 2013 To all prospective bidders under the specifications and contract documents described above, the following changes/additions are hereby made and detailed in the following sections of this addendum: Exhibit 1 – Questions & Answers Exhibit 2 – Utilization & Cost by Service Category Data Exhibit 3 – Prescription Data Exhibit 4 – Demographics Please contact David Carey, CPPB, Buyer at (970) 416-2191 with any questions regarding this addendum. RECEIPT OF THIS ADDENDUM MUST BE ACKNOWLEDGED BY A WRITTEN STATEMENT ENCLOSED WITH THE BID/QUOTE STATING THAT THIS ADDENDUM HAS BEEN RECEIVED. Financial Services Purchasing Division 215 N. Mason St. 2nd Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707 fcgov.com/purchasing Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 1 of 21 EXHIBIT 1 – QUESTIONS & ANSWERS 1. What are your preferred business hours of operation for the clinic? Unknown 2. Do you have existing space identified for the clinic? If so, what is the total square footage? Please provide address. Unknown 3. Do you offer a Health Savings Account (HSA) as part of a high deductible health plan? If so, what is the total number of clinic-eligible employees on the HSA? No, we do not offer a HSA 4. Do you offer a Health Reimbursement Account (HRA) as part of a high deductible health plan? If so, what is the total number of clinic-eligible employees on the HRA? No, we do not offer a HRA 5. Is the total number of dependents included in the 1,495 current city enrollment number? If so, can you please provide a breakout of the dependents and their age ranges? No, dependents are not included in the 1,495 number. This is City enrollment only. The City also offers medical coverage to Poudre Fire Authority and the Library District. Following are the number current enrollment on our medical plan – does not include those employees who waive coverage: Child(ren) = 1344 Spouse = 757 Domestic Partner = 4 Employee = 1515 TOTAL = 3620 6. Are employees located in more than one location? If so, please provide an employee count by location (please provide address). Employees are all located in Fort Collins, CO 7. Since the City of Fort Collins (the City) intends to offer onsite pharmacy dispensing, please provide a list of your top 50 utilized medications. Please refer to the attached file entitled “Top RX 2012”. 8. In order to estimate clinic costs and claims savings, can you please provide the information below based on the claims data for the prior year or three years if able: a. Number of PRIMARY CARE visits per eligible participant Unknown Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 2 of 21 b. Number of SPECIALIST visits per eligible participant Unknown c. Number of LAB visits per eligible participant Please refer to the attached file entitled “Utilization and Cost by Service Category” d. Number of EMERGENT visits per eligible participant Please refer to the attached file entitled “Utilization and Cost by Service Category” e. What is the average cost per office visit? Please refer to the attached file entitled “Utilization and Cost by Service Category” f. What is the average insurance co-pay for visits outside of the clinic? Unknown g. What is the average cost per office Primary Care visit? Unknown h. What is the average cost per SPECIALIST visit? Unknown i. What is the average cost per LAB visit? Please refer to the attached file entitled “Utilization and Cost by Service Category” j. What is the average cost per EMERGENT visit? Please refer to the attached file entitled “Utilization and Cost by Service Category” 9. To calculate anticipated productivity and absenteeism savings, what is the average hourly wage for employees? $30.53 10. Is your goal to encourage employees to consider the onsite provider as their primary care physician? No, seen more as preventative services rather than replace primary care physician. 11. How will the City incentivize employees and dependents to leverage the clinic? Unknown 12. Are you currently providing biometric screenings to all employees? If so, are these conducted on an individual basis or via group screening events? Who is the City’s screening partner? Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 3 of 21 Biometric screenings are held annually via group screening events. The last few years we have used Health Promotion Management Inc to conduct our screenings. Some of the biometrics we do in-house – BP, weight, body composition. 13. Is there outreach currently being provided to high risk individuals? If so, please describe the current method. Who is the City’s coaching vendor? High risk individuals are identified through our health assessment and telephonic coaching is provided through Mayo Clinic. Disease Management is also offered through our TPA – UMR. 14. What is the participation level in the current wellness programs (e.g., HRA and coaching)? Participation in the Health Assessment was 87% in 2012. For coaching 66% of our population who took the HA were eligible for coaching, 36% of those eligible accepted the coaching invitation. 15. What level of integration will be required regarding the Mayo Clinic and their HRA? We would like to continue to Mayo Clinic for our health assessment. Integrating the HA data into coaching and other intervention opportunities at or through the clinic would be preferred. We would also like to use the clinic setting to help drive employees to the resources available on our portal hosted by Mayo Clinic. We are willing to review other HRA vendors / services as an integral part of the clinic if you have a service/program to offer. 16. Could you please clarify the first bullet point regarding the individual health plans for each employee and their established “clinic” goals on page 15 of the RFP? The intention of the City is to identify a baseline “risk score” for each employee based on their HRA, biometric data, chronic conditions, etc. Once the risk score has been established, there will be a set of goals stratified by risk. These goals will include measurable progress in biometrics (i.e. blood pressure, cholesterol, etc.), return visits to the clinics, and possibly participation in relevant classes/programs provided by the City’s Health and Wellness Program. 17. Who is eligible for current wellness services and who will be eligible for participation in wellness programs provided by the new vendor? All City and Library employees with the exception of Police Services and Poudre Fire Authority. 18. How does the City intend to leverage the claim information provided by UMR for clinic use? For risk profiling? The City intends to have the clinic integrate UMR’s data into an electronic medical record to provide a total health picture for each member. It is the City’s hope that this total health picture/risk profile will be used to address chronic conditions, disease management, and general health maintenance with the members when they visit the clinic. Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 4 of 21 Wellness & Disease Management Questions 19. Is the City willing to share pricing information on disease management services and the current HRA? No, this is proprietary Information 20. Is it expected that we would provide behavioral/lifestyle coaching? Unknown but probably not 21. Please describe how UMR currently coordinates with the City’s wellness coordinator regarding disease management. Program solely through UMR. UMR provides participation reports to Wellness Coordinator. Wellness Coordinator may provide some classes related to disease management categories but participation is voluntary. 22. Does the City plan to continue to utilize this UMR service or is it the expectation that these disease management services will be provided fully by the vendor managing the onsite clinic? Unknown 23. If this service will no longer be provided by UMR, can the City reallocate that current line item expense to the employee clinic? Unknown Clinic Questions 24. What incentives or encouragement for staff and dependents to use the Employee Health Clinic will the City provide? Unknown 25. What is the premium rate reduction mentioned for meeting the clinic goal? Misprint- Well Days are the incentive for clinic goals 26. For sports physicals: is the City willing to consider making these scheduled appointments rather than walk-in? Unknown 27. Is the City asking that this clinic manage chronic conditions and medication compliance? (The PCP typically manages these) No 28. What labs do you expect to be included in the CAP rate? We have recognized the labs drawn during the HRA process; however, this question is in reference to all other acute care management labs. Please include all standard labs for acute care either in the CAP rate or as a pass through. If a pass through, please include approximate costs if possible. Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 5 of 21 29. How many Primary Care & Urgent Care visits did the City have last year for all employees? How many for benefited dependents? Unknown 30. Will the City let hourly employees utilize the clinic without clocking out? Unknown 31. Will the City require employees and eligible spouses to attend an introductory meeting outlining the services prior to usage? Unknown 32. Can you provide clarification on the 32-36 clinic hours requested? Are standard8-12 and 1-5 M-F hours desired and acceptable? (40 hours per week). If not, what day(s) of the week does the City want fewer than 8 hours? Is there any interest in having extended hours such as 5-7 PM hours, or Saturday hours? Please outline your standard hours for groups with a comparable number of eligible participants. Indicate the hourly rate for the staff so that the City may draw comparisons to other vendors with different hours. 33. The RFP indicates that the clinic will have a blood work-up lab. Can you provide clarity as to what “blood work-up” would be required to be performed on-site? Vendor preference is to provide standard outpatient labs for CLIA waived testing (urine analysis, rapid strep testing, Influenza rapid antigen testing, urine pregnancy tests, finger stick hemoglobin testing, finger stick blood sugar testing), and to have a blood draw station. All serum blood testing would be sent out to hospital-based lab since quality is better. Does the City have a list of labs that should be included in the price quote? Vendor preference is acceptable. The City would allow the vendor to use its preferred external lab for serum blood testing. Please list any preferred labs in the RFP response. 34. RFP indicates that a space will be made available for secure medical records. Vendor’s preference would be to have all medical records stored electronically using the EPIC EMR utilized by all UCH facilities and AFM. Is this acceptable? Yes. 35. DME supplies. Are supplies such as crutches, commercial air casts, commercial splints, etc. to be included at no cost to the employee as part of clinic visits? Or are DME supplies excluded? All DME is available to participants at no cost. 36. Where does the City plan to build the clinic? What is parking like in this area? Unknown 37. As the clinic will be staffed by a PA or NP, many injuries such as fractures, complex or facial lacerations, etc. would be out of the scope of the services provided by these Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 6 of 21 providers. Vendor assumption is that any such injuries that were referred to an outside facility would be charged to the insurance payor as usual. Is this correct? Correct 38. Is the City interested in potential existing off-site clinic locations rather than building a dedicated on-site clinic? This would involve shared space and shared costs, while performance guarantees remain. Unknown Other Questions 39. Does the City expect vendor to provide educational outreach and marketing of services? If so, do they expect the cost of this to be included in the RFP as a separate item or in the CAP rate? Yes. 40. In “Other Questions”, re: question #10, which reads “Describe how you manage and deliver a program for multiple clients to a single location.“ Please clarify. What kind of programs and which clients participate (i.e. employee only or dependents, etc.)? The City would like to understand your capacity and protocol to open a clinic in which other employers/groups in the area may join at a later time. 41. Does the City anticipate the number of employees to remain relatively constant? Or is there a seasonal fluctuation in eligible employees? Remain pretty constant Demographics 42. Can you please provide a detailed breakdown of the clinic eligible membership:  What is the number of clinic eligible employees? 1515  What is the number of clinic eligible spouses? 757  What is the number of clinic eligible dependent children? 1344  Are there any clinic eligible retirees? If yes, please describe. NA  Are there any other members, contractors and / or partners who would be eligible to utilize services within the health center? If yes, please provide details: Domestic Partners = 4 The above numbers are for City, Poudre Fire Authority, and Library District employees.  What is the average employee age? Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 7 of 21 47  What % of the employee population is male? 64.3%  What is the average employee turnover % annually? 6.14%  What is the average hourly wage equivalent for employees? $30.53  Do you know the number of work loss days per 100 employees? unknown  In terms of the current self-funded plan design, do you presently offer a High Deductible Health Plan? No  If yes, is there an HSA (Health Savings Acct.) or HRA (Health Reimbursement Acct.) tied to the HDHP? NA – do not offer HSA or HRA.  If yes, how many employees are on the HSA? NA  How many spouses are on the HSA? NA  How many dependent children are on the HSA? NA  Is it expected / desired that HSA enrollment will continue to increase? If yes, what is your goal? NA  If yes, how many employees are on the HRA? NA  How many spouses are on the HRA? NA  How many dependent children are on the HRA? NA  Is it expected / desired that HRA enrollment will continue to increase? If yes, what is your goal? NA Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 8 of 21  If possible, please provide an eligibility file for spouses / dependent children and retirees detailing residential zip codes. This will enable us to assess geographic impact on utilization for non-employees (assuming they will be eligible). Unavailable  What is the physical address (if known) where the clinic will be located? Unknown Medical Plan Utilization / Unit Cost Experience 43. Please provide the following medical plan utilization data if possible  No. of hospital admissions per 1,000 population See attached “Utilization and Cost by Service Category” report  Average unit cost per hospital admission See attached “Utilization and Cost by Service Category” report  No. of outpatient services per 1,000 population See attached “Utilization and Cost by Service Category” report  Average unit cost per outpatient service See attached “Utilization and Cost by Service Category” report  No. of primary care visits PPPY Unknown  Average unit cost per PCP visit Unknown  No. of specialty care visits PPPY unknown  Average unit cost per specialty care visit unknown  No. of lab tests per 1,000 population See attached “Utilization and Cost by Service Category” report  Average unit cost per lab visit See attached “Utilization and Cost by Service Category” report  No. of physical therapy visits per 1,000 population See attached “Utilization and Cost by Service Category” report  Average unit cost per physical therapy visit See attached “Utilization and Cost by Service Category” report  No. of radiology exams per 1,000 population See attached “Utilization and Cost by Service Category” report Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 9 of 21  Average unit cost per radiology exam See attached “Utilization and Cost by Service Category” report  No. of ER visits per 1,000 population See attached “Utilization and Cost by Service Category” report  Average unit cost per ER visit See attached “Utilization and Cost by Service Category” report  No. of Urgent Care visits per 1,000 population unknown  Average unit cost per UC visit unknown  No. of Prescriptions PPPY See attached “All RX 2012” report  Average unit cost per Rx See attached “All RX 2012” report Occupational Health Services 44. Are occupational health services requested? I note the solicitation states that Physical Therapy may be added. Should occupational health services be included in our staffing and cost model? If yes, please provide data on those services which should be included below: No, occupational health services should not be included. Drug / Alcohol Screening  Average No. of Random Drug Screens PEPY  Cost per screening  Average No. of New Hire Drug Screens PEPY  Cost per screening  Average No. of Post Injury Drug Screens PEPY  Cost per screening  Is Breath Alcohol Testing required as part of your drug screen protocol? If yes:  Average No. of Random BAT Screens PEPY  Cost per screening  Average No. of New Hire BAT Screens PEPY  Cost per screening  Average No. of Post Injury BAT Screens PEPY  Cost per screening Work Related Injury Treatment  On average, how many work related injuries do you experience PEPY  Total Work Comp Paid  Do you desire that the vendor will provider Occupational / Work Comp Case Management as part of the service delivery? Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 10 of 21 Work Related / Occupational Health Services  Average No. of New Hire / Pre Employment Physicals PEPY  Average unit cost per New Hire / Pre Employment physicals  Average No. of NFPA (Police / Fire) physicals conducted annually  Average unit cost per NFPA phsyical  Are NFPA physicals conducted during a specific time period? Please describe.  Average No. of DOT physicals PEPY  Average unit cost per DOT physical  Are DOT physicals conducted during a specific time period? Please describe.  Average No. of PFT physicals PEPY (Quantitative/Qualitative)  Average unit cost per physical therapy visit  Are PFT physicals conducted during a specific time period? Please describe.  Average No. of work comp related physical therapy visits PEPY  Average unit cost per physical therapy visit  Average No. of audiometric screenings PEPY  Average unit cost per audiometric screening  Are audiometric screenings conducted during a specific time period? Please describe.  Average No. of PPD tests PEPY  Total Paid  Are there any other occupational health services that we should include in the quoted solution for the City? 45. Will selected vendor be required to track/manage the Well Day Incentive Program (e.g., track who has completed HRA)? No, this will be managed internally. 46. Will HRA vendor and Disease Management vendor be able and willing to electronically feed selected vendor’s EMR with appropriate data? Yes, we believe so but will need to do further review once we know what systems will be used 47. Will PBM vendor be able and willing to electronically feed selected vendor’s EMR with appropriate data? Yes. The vendor that the City uses is OptumRX and we will request that they submit a monthly file feed to the clinic. 48. In the RFP it states that the vendor must have the capabilities to maintain claims information provided by UMR in the individual patient health record. Is the City able to clarify what is meant by “claims information provided by UMR,” is this raw claims information or specific utilization points, i.e. provider visits per year? A raw data file for medical and rx will be requested monthly. 49. Is the City interested in potentially offering occupational health services in the future? Not at this time Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 11 of 21 50. Does the City plan to transition HRA and/or Biometric services to the chosen clinic vendor? The City has yet to determine whether they will terminate their current contract with Mayo Clinic. Should the City decide to maintain their current contract for HRA/Biometrics, please let us know whether you can integrate outside vendor HRA/biometric data into your EMR. 51. Does the City want vendors to include pricing for HRA and Biometric services in the RFP? Yes 52. Are vendors allowed to follow up with additional questions once we receive exhibits C, D and E? Yes 53. What is the City’s long-term vision/goal as it pertains to this new program? Provide more Wellness/Disease Management options of care for employees. Provide employees with a centralized place to receive preventative care services. Reduce costs. 54. Has the City identified space for the on-site clinic? If yes, what is the approximate square footage? Will the City provide a floor plan? Unknown 55. Will the City accept alternative staffing models? Yes 56. Will the City consider alternative operating hours for the on-site clinic? Yes 57. Does the City manage its own wellness program? Yes 58. What other third party vendors does the City currently partner with to provide wellness services (i.e., biometric screenings)? Health Promotion Management Inc 59. Who is the City’s PBM? Optum Rx 60. Will the City provide more detailed information on the role of its Wellness Coordinator? Yes Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 12 of 21 61. What specific wellness offerings/classes are included as part of the City’s existing wellness program? Various behavioral change/enhancement classes…..too many to list. 62. What is the current participation rate for wellness services (i.e., HRA participation, screenings, etc.)? Participation in the Health Assessment was 87% in 2012 63. Will the City provide a breakdown of eligible participants by age group? See the attached “Employee Demographics” and “Spouse and Dependent Demographics” reports. 64. Page 15 – The City notes that the selected vendor must maintain an individual health record for all employees visiting the clinic including but not limited to claim information provided by UMR. Will the City provide additional details regarding this requirement? The City would like the vendor to have an electronic medical record (EMR) for each clinic participant that integrates information from clinic visits, medical/rx claim data from UMR, and HRA/Biometric data. 65. Page 15 – The City notes that it expects the selected vendor to provide the staffing and medical and prescription drug supplies needed to open and maintain the clinic. Is it accurate to assume that the City will maintain financial responsibility for medical and pharmaceutical supplies? Yes. Please outline whether the costs will be pass through, approximate costs, and any preferred vendors. 66. Page 15 – The City references possible expansion for physical therapy or exercise. What is the City’s anticipated timeframe for implementing these additional services? Unknown. 67. Page 16 – The City references musculoskeletal consultation as part of the on-site clinic’s scope of services. Please provide additional details regarding this requirement. Capability to assess acute musculoskeletal conditions and either treat or refer the patient to in-network facilities/physicians to treat the issues. If the City decides to incorporate physical therapy/exercise areas into the clinic, the clinician will be expected to refer/utilize these services within the clinic to address participants with musculoskeletal issues. 68. Page 16 – The City desires performance guarantees on “City satisfaction.” Please provide more information regarding this metric. Please provide any standard performance guarantees that you provide to existing clients. City satisfaction references satisfaction with the implementation, ongoing account management, and any level of service they receive from the vendor that has not been otherwise outlined. Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 13 of 21 69. Page 24, Questions 10 and 14 – Based on the questions posed, is the City considering a near-site clinic as a possible option? Has the City identified other vendors with which to share the clinic space? The City would like to understand how you would administer a clinic with multiple clients in terms of billing, decision making, staffing, etc. Please outline any experience that you’ve had with shared clinics or how you would address this situation. 70. Page 25 – The City desires pricing for two assumptions: (1) employees only (2) employees and dependents. If bidders propose alternate staffing options, does the City require that the bidder price both assumptions for each staffing option? Yes Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 14 of 21 Medical Services Services % Services Mbrs % Mbrs Svcs/Mbr Billed Charge Plan Paid % Paid Avg Charge Avg Paid Paid/Mbr Mbr Pd Avg Mbr Pd % Mbr Pd Total 24,862 100.00% 1,295 100.00% 19.2 $8,641,491.44 $5,417,941.82 100.00% $347.58 $217.92 $4,183.74 $749,091.07 $30.13 12.15% 01. Inpatient Hospital Admission 62 0.25% 51 3.94% 1.22 $2,098,485.33 $1,685,138.70 31.10% $33,846.54 $27,179.66 $33,041.94 $82,192.83 $1,325.69 4.65% 02. Outpatient Hospital Encounter 1,052 4.23% 421 32.51% 2.5 $2,231,895.97 $1,499,561.25 27.68% $2,121.57 $1,425.44 $3,561.90 $194,162.69 $184.57 11.46% 03. Emergency Room Visit 155 0.62% 117 9.03% 1.32 $514,602.26 $437,711.04 8.08% $3,320.01 $2,823.94 $3,741.12 $26,472.50 $170.79 5.70% 04. Inpatient Surgery 90 0.36% 40 3.09% 2.25 $190,999.40 $98,679.15 1.82% $2,122.22 $1,096.44 $2,466.98 $15,136.09 $168.18 13.30% 05. Outpatient Surgery 1,183 4.76% 478 36.91% 2.47 $625,830.77 $316,359.34 5.84% $529.02 $267.42 $661.84 $39,154.42 $33.10 11.01% 06. Physician Office Visit 3,974 15.98% 1,111 85.79% 3.58 $513,478.00 $277,526.00 5.12% $129.21 $69.84 $249.80 $121,635.94 $30.61 30.47% 07. Mental Health Visit 470 1.89% 66 5.10% 7.12 $54,469.50 $18,252.55 0.34% $115.89 $38.84 $276.55 $19,183.53 $40.82 51.24% 08. Chiropractic Encounter 1,136 4.57% 171 13.20% 6.64 $82,205.61 $16,006.91 0.30% $72.36 $14.09 $93.61 $30,614.66 $26.95 65.67% 09. Physical Therapy 2,271 9.13% 266 20.54% 8.54 $220,584.31 $68,427.77 1.26% $97.13 $30.13 $257.25 $66,943.13 $29.48 49.45% 10. Wellness/Routine Visit 566 2.28% 554 42.78% 1.02 $109,072.70 $83,781.99 1.55% $192.71 $148.02 $151.23 $0.00 $0.00 0.00% 11. Radiology Services 1,658 6.67% 581 44.86% 2.85 $421,417.90 $174,693.30 3.22% $254.17 $105.36 $300.68 $52,451.48 $31.64 23.09% 12. Laboratory Services 5,888 23.68% 883 68.19% 6.67 $467,774.26 $135,677.26 2.50% $79.45 $23.04 $153.65 $9,567.34 $1.62 6.59% 13. Other Services 6,357 25.57% 1,026 79.23% 6.2 $1,110,675.43 $606,126.56 11.19% $174.72 $95.35 $590.77 $91,576.46 $14.41 13.13% City of Fort Collins January 2012 through December 2012, Incurred Claims Medical Services Sliced by: Relationship on Employee EXHIBIT 2 – UTILIZATION BY COST & SERVICE CATEGORY DATA Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 15 of 21 # All Claims CITY OF FORT COLLINS None (76411027) Patient Cnt Claim Cnt Service Cnt Billed Amt Allowed Amt Paid Amt Claim Summary Service Dates: All Paid Dates: 01/01/2012 - 12/31/2012 Benefit Type: Prescription Drug Patients Claims Services Billed Allowed Paid CITY OF FORT COLLINS 2,519 56,162 33,575 $2,623,235.93 $2,623,235.93 $2,100,771.37 REPORT TOTALS: 1 Distinct Group: 2,519 56,162 33,575 $2,623,235.93 $2,623,235.93 $2,100,771.37 CRITERIA: Claim Summary (Standard) Date Range: Filters: Service Dates: All; Paid Dates: 01/01/2012 - 12/31/2012 None Group: City of Fort Collins Benefit Type: Prescrip. Drugs Summarize By: None Thresholds: Display Options: None - Claim Expenses Included in Dollar Totals Produced by UMR InfoPort℠ on 05/29/2013 Claim Summary 5/29/2013 Page 1 of 1 EXHIBIT 3 - PRESCRIPTION DATA Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 16 of 21 # Drug Name CITY OF FORT COLLINS None (76411027) Claims Rx Count Generic Cnt Allowed Patient Resp Paid Rx Summary by Drug Name Top 50 Distinct Groups by Prescription Count Service Dates: All Paid Dates: 01/01/2012 - 12/31/2012 Benefit Type: Prescription Drug # Drug Name Claims Rx Count Generic Cnt Allowed Patient Resp Paid 1 LEVOTHYROXIN TA 1,436 1,314 1,314 $8,562.69 $8,315.10 $247.59 2 LISINOPRIL TA 1,115 1,071 1,071 $6,537.09 $6,254.12 $282.97 3 HYDROCO/APAP TA 894 808 808 $8,311.09 $5,223.88 $3,087.21 4 CITALOPRAM TA 799 743 743 $3,630.50 $3,393.96 $236.54 5 ZOLPIDEM TA 755 563 563 $9,793.53 $5,832.08 $3,961.45 6 SIMVASTATIN TA 943 557 557 $13,610.67 $9,661.55 $3,949.12 7 TRAZODONE TA 531 527 527 $1,657.92 $1,655.88 $2.04 8 METFORMIN TA 696 486 486 $5,156.04 $3,967.32 $1,188.72 9 ATORVASTATIN TA 917 401 401 $50,747.80 $7,310.99 $43,436.81 10 CLONAZEPAM TA 432 388 388 $3,113.64 $2,230.74 $882.90 11 CYCLOBENZAPR TA 412 386 386 $1,642.09 $1,497.46 $144.63 12 LAMOTRIGINE TA 513 383 383 $3,547.25 $3,086.83 $460.42 13 OMEPRAZOLE CA 996 382 382 $25,994.30 $5,706.92 $20,287.38 14 FLUOXETINE CA 416 376 376 $2,681.80 $1,953.55 $728.25 15 AZITHROMYCIN TA 469 369 369 $9,584.81 $3,690.00 $5,894.81 16 OXYCOD/APAP TA 374 350 350 $8,438.99 $2,187.99 $6,251.00 17 SYNTHROID TA 496 336 0 $7,048.80 $5,977.72 $1,071.08 18 ALPRAZOLAM TA 363 335 335 $2,177.78 $1,855.84 $321.94 19 ESCITALOPRAM TA 880 332 332 $30,208.93 $4,507.52 $25,701.41 20 LEVOXYL TA 321 317 317 $1,328.84 $1,326.14 $2.70 20 PREDNISONE TA 321 317 317 $794.13 $727.30 $66.83 21 FLUTICASONE SP 446 294 294 $14,259.10 $3,145.00 $11,114.10 22 AMOXICILLIN CA 292 288 288 $1,234.51 $1,212.18 $22.33 23 AMITRIPTYLIN TA 284 284 284 $654.64 $654.64 $0.00 24 LISINOP/HCTZ TA 342 278 278 $3,916.97 $3,168.58 $748.39 25 SERTRALINE TA 397 271 271 $5,445.89 $3,767.98 $1,677.91 26 LORAZEPAM TA 301 253 253 $3,452.94 $1,812.61 $1,640.33 27 CEPHALEXIN CA 251 237 237 $1,692.82 $1,487.75 $205.07 28 ALLOPURINOL TA 233 231 231 $1,334.22 $1,334.22 $0.00 29 AMLODIPINE TA 410 228 228 $6,883.63 $3,505.04 $3,378.59 30 BUPROPN HCL TA 433 225 225 $22,021.37 $2,960.30 $19,061.07 31 TRAMADOL HCL TA 288 220 220 $2,637.15 $1,566.65 $1,070.50 32 VITAMIN D CA 217 217 217 $878.12 $838.24 $39.88 33 PROAIR HFA AE 362 212 0 $11,480.56 $4,539.38 $6,941.18 34 METOPROLOL TA 373 205 205 $11,267.35 $3,520.00 $7,747.35 35 TRIAMT/HCTZ TA 203 203 203 $678.99 $678.99 $0.00 Produced by UMR InfoPort℠ on 05/29/2013 Rx Summary 5/29/2013 Page 1 of 3 Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 17 of 21 CITY OF FORT COLLINS (76411027) Rx Summary by Drug Name Top 50 Distinct Groups by Prescription Count Service Dates: All Paid Dates: 01/01/2012 - 12/31/2012 Benefit Type: Prescription Drug # Drug Name Claims Rx Count Generic Cnt Allowed Patient Resp Paid 36 METOPROL TAR TA 201 201 201 $566.72 $566.72 $0.00 37 MELOXICAM TA 214 194 194 $1,170.41 $1,085.99 $84.42 38 DIAZEPAM TA 188 188 188 $613.85 $613.85 $0.00 39 NEXIUM CA 445 185 0 $49,426.41 $8,219.76 $41,206.65 40 HYDROCHLOROT TA 211 175 175 $821.50 $699.03 $122.47 41 275 174 136 $9,858.29 $2,765.26 $7,064.26 42 AMOX/K CLAV TA 207 173 173 $7,763.41 $1,732.97 $6,030.44 43 VIVELLE-DOT DI 320 158 0 $11,780.25 $5,450.00 $6,330.25 44 HYDROCHLOROT CA 158 156 156 $548.76 $532.37 $16.39 45 BUPROPION TA 307 155 155 $11,207.98 $1,950.86 $9,257.12 46 PANTOPRAZOLE TA 633 153 153 $8,723.39 $2,645.00 $6,078.39 47 NASONEX SP 559 151 0 $21,035.15 $4,103.87 $16,931.28 48 SPIRONOLACT TA 223 149 149 $2,170.41 $1,093.98 $1,076.43 49 LOSARTAN/HCT TA 439 147 147 $5,837.41 $2,640.00 $3,197.41 50 VALACYCLOVIR TA 193 141 141 $27,275.05 $2,766.59 $24,508.46 Totals for Prescription Drug: 51 Distinct Groups: 23,484.00 16,887.00 15,807.00 $451,205.94 $157,420.70 $293,756.47 Produced by UMR InfoPort℠ on 05/29/2013 Rx Summary 5/29/2013 Page 2 of 3 Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 18 of 21 CITY OF FORT COLLINS (76411027) Rx Summary by Drug Name Top 50 Distinct Groups by Prescription Count Service Dates: All Paid Dates: 01/01/2012 - 12/31/2012 Benefit Type: Prescription Drug Claims Rx Count Generic Cnt Allowed Patient Resp Paid Totals for Top 50 Distinct Groups by Prescription Count: 51 Distinct Groups: 23,484 16,887 15,807 $451,205.94 $157,420.70 $293,756.47 REPORT TOTALS (Includes Distinct Groups out of Threshold): 1,025 Distinct Groups: 56,162 33,575 27,244 $2,623,235.93 $521,667.07 $2,100,771.37 CRITERIA: Claim Summary (Standard) Date Range: Filters: Service Dates: All; Paid Dates: 01/01/2012 - 12/31/2012 None Group: City of Fort Collins Benefit Type: Prescription Drug Summarize By: 1. Drug Name Thresholds: Display the Top 50 Distinct Groups by Prescription Count Produced by UMR InfoPort℠ on 05/29/2013 Rx Summary 5/29/2013 Page 3 of 3 Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 19 of 21 City of Fort Collins January 2012 through December 2012, Incurred Claims Demographic Sliced by: Relationship on Employee Demographic Services % Services Mbrs % Mbrs Svcs/Mbr Billed Charge Plan Paid % Paid Avg Charge Avg Paid Paid/Mbr Mbr Pd Avg Mbr Pd % Mbr Pd Total 24,862 100% 1,295 100% 19.2 $8,641,491 $5,417,942 100% $348 $218 $4,184 $749,091 $30 12.1% Female 11,487 46.2% 506 39.1% 22.7 $3,764,676 $2,384,309 44% $328 $208 $4,712 $327,567 $29 12.1% 20 to 39 2,884 11.6% 148 11.4% 19.5 $704,299 $431,001 8% $244 $149 $2,912 $93,603 $32 17.8% 20 to 29 490 2% 39 3% 12.6 $158,270 $102,112 1.9% $323 $208 $2,618 $23,228 $47 18.5% 30 to 39 2,394 9.6% 116 9% 20.6 $546,029 $328,889 6.1% $228 $137 $2,835 $70,375 $29 17.6% 40 to 59 6,389 25.7% 300 23.2% 21.3 $2,166,737 $1,406,076 26% $339 $220 $4,687 $177,455 $28 11.2% 40 to 49 2,284 9.2% 129 10% 17.7 $537,645 $325,888 6% $235 $143 $2,526 $57,697 $25 15% 50 to 59 4,105 16.5% 184 14.2% 22.3 $1,629,092 $1,080,188 19.9% $397 $263 $5,871 $119,758 $29 10% 60 and Over 2,214 8.9% 81 6.2% 27.3 $893,640 $547,231 10.1% $404 $247 $6,756 $56,509 $26 9.4% 60 to 64 1,561 6.3% 67 5.2% 23.3 $406,553 $258,312 4.8% $260 $165 $3,855 $34,158 $22 11.7% 65 Plus 653 2.6% 21 1.6% 31.1 $487,086 $288,919 5.3% $746 $442 $13,758 $22,351 $34 7.2% Male 13,375 53.8% 789 60.9% 17 $4,876,815 $3,033,633 56% $365 $227 $3,845 $421,524 $32 12.2% 20 to 39 2,327 9.4% 233 18% 10 $490,855 $286,211 5.3% $211 $123 $1,228 $72,945 $31 20.3% 20 to 29 520 2.1% 63 4.9% 8.3 $123,956 $76,074 1.4% $238 $146 $1,208 $16,308 $31 17.7% 30 to 39 1,807 7.3% 176 13.6% 10.3 $366,899 $210,136 3.9% $203 $116 $1,194 $56,637 $31 21.2% 40 to 59 7,482 30.1% 443 34.2% 16.9 $2,702,770 $1,627,023 30% $361 $217 $3,673 $229,625 $31 12.4% 40 to 49 2,614 10.5% 202 15.6% 12.9 $807,424 $367,379 6.8% $309 $141 $1,819 $83,204 $32 18.5% 50 to 59 4,868 19.6% 252 19.5% 19.3 $1,895,346 $1,259,644 23.2% $389 $259 $4,999 $146,421 $30 10.4% 60 and Over 3,566 14.3% 142 11% 25.1 $1,683,191 $1,120,400 20.7% $472 $314 $7,890 $118,954 $33 9.6% 60 to 64 2,622 10.5% 119 9.2% 22 $1,041,564 $727,752 13.4% $397 $278 $6,116 $77,017 $29 9.6% 65 Plus 944 3.8% 38 2.9% 24.8 $641,627 $392,647 7.2% $680 $416 $10,333 $41,938 $44 9.7% HPI - Analytics ©2013 PlanIT, Incorporated. Subject to the Terms of Use. All rights are reserved. Page 1 EXHIBIT 4 - DEMOGRAPHICS Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 20 of 21 City of Fort Collins January 2012 through December 2012, Incurred Claims Demographic Sliced by: Relationship on Spouse and Dependent Demographic Services % Services Mbrs % Mbrs Svcs/Mbr Billed Charge Plan Paid % Paid Avg Charge Avg Paid Paid/Mbr Mbr Pd Avg Mbr Pd % Mbr Pd Total 30,161 100% 1,871 100% 16.1 $9,997,471 $6,004,755 100% $331 $199 $3,209 $832,828 $28 12.2% Female 19,733 65.4% 1,145 61.2% 17.2 $6,684,971 $3,963,778 66% $339 $201 $3,462 $569,053 $29 12.6% 00 to 19 6,043 20% 484 25.9% 12.5 $1,045,384 $625,090 10.4% $173 $103 $1,292 $126,224 $21 16.8% 00 to 02 1,711 5.7% 98 5.2% 17.5 $228,510 $141,442 2.4% $134 $83 $1,443 $22,811 $13 13.9% 03 to 05 743 2.5% 98 5.2% 7.6 $120,043 $71,607 1.2% $162 $96 $731 $12,365 $17 14.7% 06 to 09 885 2.9% 96 5.1% 9.2 $166,156 $89,535 1.5% $188 $101 $933 $27,178 $31 23.3% 10 to 19 2,704 9% 236 12.6% 11.5 $530,675 $322,505 5.4% $196 $119 $1,367 $63,871 $24 16.5% 20 to 39 5,303 17.6% 315 16.8% 16.8 $2,328,816 $1,496,905 24.9% $439 $282 $4,752 $195,441 $37 11.5% 20 to 29 2,601 8.6% 169 9% 15.4 $1,402,149 $870,171 14.5% $539 $335 $5,149 $103,444 $40 10.6% 30 to 39 2,702 9% 150 8% 18 $926,666 $626,734 10.4% $343 $232 $4,178 $91,997 $34 12.8% 40 to 59 7,304 24.2% 323 17.3% 22.6 $2,507,989 $1,608,972 26.8% $343 $220 $4,981 $215,753 $30 11.8% 40 to 49 3,407 11.3% 158 8.4% 21.6 $1,200,230 $753,110 12.5% $352 $221 $4,767 $112,265 $33 13% 50 to 59 3,897 12.9% 180 9.6% 21.6 $1,307,759 $855,862 14.3% $336 $220 $4,755 $103,488 $27 10.8% 60 and Over 1,083 3.6% 48 2.6% 22.6 $802,782 $232,811 3.9% $741 $215 $4,850 $31,634 $29 12% 60 to 64 849 2.8% 39 2.1% 21.8 $276,552 $197,109 3.3% $326 $232 $5,054 $21,595 $25 9.9% 65 Plus 234 0.8% 11 0.6% 21.3 $526,230 $35,702 0.6% $2,249 $153 $3,246 $10,040 $43 21.9% Male 10,428 34.6% 726 38.8% 14.4 $3,312,500 $2,040,977 34% $318 $196 $2,811 $263,776 $25 11.4% 00 to 19 4,974 16.5% 451 24.1% 11 $901,550 $549,129 9.1% $181 $110 $1,218 $114,495 $23 17.3% 00 to 02 1,556 5.2% 91 4.9% 17.1 $238,651 $152,666 2.5% $153 $98 $1,678 $22,293 $14 12.7% 03 to 05 616 2% 83 4.4% 7.4 $93,988 $54,746 0.9% $153 $89 $660 $15,931 $26 22.5% 06 to 09 706 2.3% 94 5% 7.5 $84,269 $44,358 0.7% $119 $63 $472 $17,080 $24 27.8% 10 to 19 2,096 6.9% 221 11.8% 9.5 $484,641 $297,359 5% $231 $142 $1,346 $59,190 $28 16.6% 20 to 39 1,994 6.6% 135 7.2% 14.8 $1,480,458 $939,012 15.6% $742 $471 $6,956 $51,322 $26 5.2% 20 to 29 1,575 5.2% 104 5.6% 15.1 $1,310,774 $828,089 13.8% $832 $526 $7,962 $32,445 $21 3.8% 30 to 39 419 1.4% 32 1.7% 13.1 $169,683 $110,923 1.8% $405 $265 $3,466 $18,877 $45 14.5% 40 to 59 1,781 5.9% 99 5.3% 18 $407,400 $220,028 3.7% $229 $124 $2,223 $56,739 $32 20.5% 40 to 49 725 2.4% 48 2.6% 15.1 $147,532 $72,206 1.2% $203 $100 $1,504 $22,062 $30 23.4% 50 to 59 1,056 3.5% 54 2.9% 19.6 $259,868 $147,822 2.5% $246 $140 $2,737 $34,677 $33 19% 60 and Over 1,679 5.6% 55 2.9% 30.5 $523,093 $332,808 5.5% $312 $198 $6,051 $41,220 $25 11% 60 to 64 1,364 4.5% 44 2.4% 31 $404,107 $261,033 4.3% $296 $191 $5,933 $29,979 $22 10.3% 65 Plus 315 1% 15 0.8% 21 $118,986 $71,775 1.2% $378 $228 $4,785 $11,241 $36 13.5% HPI - Analytics ©2013 PlanIT, Incorporated. Subject to the Terms of Use. All rights are reserved. Page 1 Addendum 1 - 7512 On-Site Employee Wellness Clinic Page 21 of 21