ABC Company Claims Review

2020-2021 CLAIMS REVIEW

2020-2021 CLAIMS PERFORMANCE Capitation $600,000 250 Capitation Claims Rx Claims 3% Rx Claims 3% 2020 2021 11% 14% $500,000 200 2020 2021 $400,000 150 $300,000 Medical Claims Medical 86% Claims 83% 100 $200,000 High Cost High Cost Claimant Claimant Spend (>$50K) Spend (>$50K) 50 39% 25% $100,000 2020 2021 $0 0 All Other All Other Spend Spend Medical Claims Rx Claims Capitation Claims Premium Total Contracts 61% 75% [ 2 ]

HIGH COSTCLAIMANTS Encrypted Member ID Group ID Product Line Relationship Member Status Most Recent Medical Pharmacy Total Pooled Var. to Prior DOS Paid Paid Paid Month 2620974413088255581 002354873 BLUE CARE ELECT $2000 DEDUCTIBLE Dependent ACTIVE 12/28/2021 $125,617 $25 $125,642 $25,642 $1,615 1337529694658139434 002354873 BLUE CARE ELECT $2000 DEDUCTIBLE Subscriber ACTIVE 12/25/2021 $121,705 $721 $122,426 $22,426 $10,492 5752228905898884128 002354873 BLUE CARE ELECT $2000 DEDUCTIBLE Subscriber ACTIVE 12/31/2021 $102,077 $1,620 $103,697 $3,697 -$640 4114939063587695124 002354873 BLUE CARE ELECT $2000 DEDUCTIBLE Subscriber ACTIVE 12/20/2021 $79,314 $2 $79,316 NEW 8816351387601068106 004068168 HMO BLUE NE PREMIER VALUE Spouse ACTIVE 12/27/2021 $56,255 $13,325 $69,580 NEW 2976124683996996472 002354873 BLUE CARE ELECT $2000 DEDUCTIBLE Subscriber ACTIVE 12/29/2021 $45,614 $16,130 $61,744 $4,354 2511864468795196981 004068168 HMO BLUE NE PREMIER VALUE Subscriber ACTIVE 12/30/2021 $27,879 $26,945 $54,824 NEW 4952019859519145306 004068168 HMO BLUE NE PREMIER VALUE Spouse ACTIVE 12/27/2021 $54,473 $9 $54,482 $1,954 $612,934 $58,777 $671,710 $51,764 -39% -36% -39% -87% PRIOR ROLLING 12 Encrypted Member ID Group ID Product Line Relationship Member Status Most Recent Medical Pharmacy Total Pooled DOS Paid Paid Paid 1337529694658139434 002354873 BLUE CARE ELECT $2000 DEDUCTIBLE Subscriber ACTIVE 12/21/2020 $370,680 $5,295 $375,975 $275,975 9081164538480431134 002354873 BLUE CARE ELECT $2000 DEDUCTIBLE Dependent CANCELLED 11/30/2020 $230,339 $290 $230,629 $130,629 8417164670189283097 004023728 HMO BLUE NE $2000 DEDUCTIBLE Subscriber ACTIVE 12/22/2020 $98,119 $170 $98,288 6085902688542653469 002354873 BLUE CARE ELECT $2000 DEDUCTIBLE Dependent CANCELLED 12/25/2020 $53,242 $20,055 $73,297 4430605701715264929 002354873 BLUE CARE ELECT $2000 DEDUCTIBLE Subscriber ACTIVE 12/21/2020 $71,843 $9 $71,852 3896046506495496401 004068168 HMO BLUE NE PREMIER VALUE Subscriber ACTIVE 12/01/2020 $2,582 $63,481 $66,063 2260362067240808555 004023728 HMO BLUE NE $2000 DEDUCTIBLE Subscriber CANCELLED 12/22/2020 $58,940 $2,053 $60,993 5835849420894148445 002354873 BLUE CARE ELECT $2000 DEDUCTIBLE Subscriber ACTIVE 12/31/2020 $58,784 $124 $58,908 7338279881020529462 004023728 HMO BLUE NE $2000 DEDUCTIBLE Dependent CANCELLED 12/31/2020 $56,462 $610 $57,072 $1,000,991 $92,086 $1,093,076 $406,603 • HCC spend is 39% lower in 2021 than it was in 2020. • HCC spend accounts for 25% of total plan spend, where the norm is around 40%. • Rx accounts for 11% of HCC spend, where we are seeing it reach as high as 30-40% due to the increase in utilization of specialty drugs across the board. [ 3 ]

DEMOGRAPHICS MEMBERSHIP DISTRIBUTION MEMBER AGE M F • 28% of those covered on Dependent the plan are under the age 65+ Subscriber 36% 41% of 19 60 - 64 50 - 59 • 22.5% are females 40 - 49 between the ages of 20 and 39 30 - 39 Spouse 20 - 29 23% • Dependents account for <1 - 19 CLAIM SPEND BY RELATION 36% of those covered, and 30% of plan spend. 0 10 20 30 40 50 60 70 80 90 100 • Spouse spend PMPM is up 8.5% from the year prior, 2021 Paid 2020 Paid Dependent Row Labels Paid Enrolled PMPM PMPM % Change 30% while employee and Dependent $797,208 220 $301.97 $349.14 -13.5% dependent spend is down Spouse $602,779 145 $346.42 $319.26 8.5% Subscriber Subscriber $1,291,281 253 $425.32 $519.80 -18.2% 48% by more than 13%. There Grand Total $2,691,267 618 $362.90 $412.21 -12.0% are 2 high cost spouse claimants in 2021, vs 0 in • Average contract size: 2.44 the year prior. • Norm: 2.0 Spouse 22% [ 4 ]

DOLLAR BAND DISTRIBUTION • 23% of members spent less than $501 in 2021 (1% spent $0) • 45% of claimants spent between $501 and $2,501 • 17% of claimants had spend of more than $5K CLAIMANTS WITH SPEND > $10K 35 33 30 25 22 claimants over $20K, while the norm is 32 20 15 10 7 5 5 2 3 2 2 1 1 0 [ 5 ]

SERVICE CATEGORY SUMMARY Metrics ABC Company Benchmark Cohort Benchmark Cohort % Var Jan 2020 - Dec 2020 Jan 2021 - Dec 2021 % Change Jan 2020 - Dec 2020 Jan 2021 - Dec 2021 Jan 2020 - Dec 2020 Jan 2021 - Dec 2021 IP Admissions per 1000 48.0 32.8 -32% 45.3 49.4 -5.51% +50.74% Total Paid PMPM $119.40 $61.82 -48% $83.30 $98.65 -30.24% +59.57% Facility Inpatient Paid per IP Admission $29,860 $22,652 -24% $24,096 $26,063 -19.30% +15.06% Total Allowed PMPM $120.44 $62.21 -48% $85.09 $100.48 -29.35% +61.50% Allowed per IP Admission $30,119 $22,796 -24% $24,401 $26,351 -18.99% +15.60% OP Visits per 1000 1,755.4 2,980.3 70% 1,650.8 2,162.8 -5.96% -27.43% Total Paid PMPM $98.28 $123.74 26% $99.02 $130.36 +0.75% +5.35% Facility Outpatient Paid per OP Visit $672 $498 -26% $704 $696 +4.74% +39.62% Total Allowed PMPM $110.78 $140.73 27% $107.47 $140.34 -2.99% -0.28% Allowed per OP Visit $757 $567 -25% $767 $752 +1.28% +32.74% Professional Procedures per 1000 17,888.0 21,800.0 22% 16,978.5 20,889.5 -5.08% -4.18% Professional Total Paid PMPM $163.43 $184.84 13% $153.59 $186.59 -6.02% +0.94% Paid per Professional Procedure $110 $102 -7% $108 $107 -1.14% +5.10% Total Allowed PMPM $188.97 $213.48 13% $174.45 $212.10 -7.68% -0.65% Prescriptions per 1000 9,920.7 11,370.0 15% 8,450.0 8,961.8 -14.82% -21.18% Pharmacy Pharmacy Paid PMPM $52.97 $60.90 15% $89.97 $98.36 +69.85% +61.52% Paid per Prescription $64 $64 0% $131 $132 +105.15% +105.62% Pharmacy Allowed PMPM $61.80 $70.86 15% $98.61 $108.08 +59.55% +52.52% Overall Summary Total Paid PMPM $434.08 $431.30 -1% $391.55 $474.52 -9.80% +10.02% Total Allowed PMPM $482 $487 1% $428 $518 -11.20% +6.23% Pharmacy Pharmacy 12% 14% Inpatient • OP visits per 1000 increased 70% between 2020 and 2021, and are Inpatient 14% 27% higher than benchmark. 27% 2020 2021 • Prescriptions per 1000 increased 15%, and are 21% above benchmark. Professional Outpatient 38% Professional 29% • 32% less inpatient admissions in 2021 than in 2020. Outpatient 43% 23% [ 6 ]

EPISODE TREATMENT GROUP ANALYSIS Prev. Prev. Claimant Total Paid % of total Top ETG’s by Amount Paid Rank Rank ETG Family Claimants Claimants % Change s/1000 Paid Prev. Paid PMPM Paid 1 4 01501 Pregnancy, Delivered 9 11 -18% 17.3 $222,306 $95,093 $35.69 11.1% • These categories can be 2 19 01805 Joint Degeneration, Localized 51 45 13% 98.3 $193,133 $19,993 $31.01 9.7% skewed by high cost 3 2 00401 Depression 82 66 24% 158.0 $126,099 $126,373 $20.24 6.3% 4 22 00480 Other Mental/Psychological Disorders 12 11 9% 23.1 $134,387 $26,415 $21.57 6.7% claimants. 5 3 02001 Immunizations/Screenings/Routine Exams 344 321 7% 662.7 $121,611 $117,791 $19.52 6.1% 6 8 01703 Inflammation: Skin & Subcutaneous Tissue 94 73 29% 181.1 $102,164 $65,709 $16.40 5.1% 7 9 00402 Anxiety/Phobia 76 76 0% 146.4 $72,714 $68,530 $11.67 3.6% • Behavioral Health, Skin 8 20 00201 Diabetes 18 17 6% 34.7 $61,899 $30,789 $9.94 3.1% Inflammation, Hypertension, 9 - 00609 Brain/Spinal Trauma 3 5.8 $59,840 $9.61 3.0% Obesity, Tonsilitis all 10 14 00406 Autism/Attention Deficit Disorder/Development Disorders 48 42 14% 92.5 $41,477 $45,005 $6.66 2.1% 11 13 01002 Asthma 58 59 -2% 111.7 $39,581 $47,574 $6.35 2.0% experienced double digit 12 - 00803 Congestive Heart Failure 4 7.7 $42,831 $6.88 2.1% increases in occurrence from 13 5 00909 Cancer: Ear/Nose/Throat 1 1 0% 1.9 $39,871 $89,210 $6.40 2.0% 14 24 00807 Conduction Disorder 13 13 0% 25.0 $27,661 $19,363 $4.44 1.4% 2020. 15 - 01705 Benign Neoplasm: Skin 60 115.6 $27,856 $4.47 1.4% 16 - 01011 Viral/Fungal Lung Infections 1 1.9 $30,214 $4.85 1.5% 17 10 00801 Hypertension 58 49 18% 111.7 $20,591 $63,835 $3.31 1.0% • Pregnancy, although fewer 18 - 01121 Bowel Obstruction 1 1.9 $27,852 $4.47 1.4% claimants, was about 134% 19 - 00707 Eye Trauma 3 5.8 $26,377 $4.23 1.3% higher for total paid in 2021. 20 - 01412 Kidney Stones 3 5.8 $22,783 $3.66 1.1% 21 21 00404 Other Neuropsychological/Behavioral Disorder 37 36 3% 71.3 $18,654 $32,789 $2.99 0.9% 22 17 00205 Obesity 52 40 30% 100.2 $18,296 $38,008 $2.94 0.9% • Skin Cancer wasn’t on this 23 - 01901 Neonatal Management 4 7.7 $19,895 $3.19 1.0% 24 - 00710 Visual Disturbances 74 142.6 $17,764 $2.85 0.9% report last year, but recorded 25 16 00903 Tonsillitis, Adenoiditis 57 48 19% 109.8 $16,024 $37,554 $2.57 0.8% 60 claimants for 2021 for #15 Total: Selected Filter(s) 471 907.4 $1,531,881 $245.93 76.6% on the report. Total: All Others 373 718.6 $458,733 $73.64 22.9% Total: All 507 976.7 $2,000,145 $321.10 100.0% [ 7 ]

DIAGNOSTIC CATEGORIES BY SERVICE TYPE 3-Digit Principal Diagnosis Mask Jan 2020 - Dec 2020 Jan 2021 - Dec 2021 Variance 1 O26 -Maternal care for other conditions predominantly related to pregnancy $11.30 T 2 M17 -Osteoarthritis of knee $11.24 Behavioral Health increased in N 3 Z38 - Liveborn infants according to place of birth and type of delivery $24.45 $4.48 -81.69% E paid PMPM in all but Inpatient I 4 K56 - Paralytic ileus and intestinal obstruction without hernia $4.09 T 5 S05 - Injury of eye and orbit $3.97 A category. P 6 000 - BEHAVIORAL HEALTH $9.63 $3.92 -59.29% N 7 J12 - Viral pneumonia, not elsewhere classified $3.88 I 8 K92 - Other diseases of digestive system $3.53 $3.22 -8.85% 3 diagnoses in IP related to 9 O36 -Maternal care for other fetal problems $2.92 maternity/pregnancy. 10 A41 - Other sepsis $2.68 3-Digit Principal Diagnosis Mask Jan 2020 - Dec 2020 Jan 2021 - Dec 2021 Variance 1 000 - BEHAVIORAL HEALTH $2.10 $18.72 +793.24% These figures are typically T 2 M17 -Osteoarthritis of knee $0.06 $8.21 +13326.60% EN 3 G83 - Other paralytic syndromes $6.56 skewed by HCC activity, as I 4 N20 -Calculus of kidney and ureter $0.32 $5.20 +1524.61% T 5 R93 - Abnormal findings on diagnostic imaging of other body structures $4.64 A BCBSMA reporting tracks on a P 6 M27 -Other diseases of jaws $4.47 paid PMPM basis vs. T 7 Z12 - Encounter for screening for malignant neoplasms $4.38 $4.03 -7.81% OU 8 T81 - Complications of procedures, not elsewhere classified $0.04 $2.97 +7092.47% occurrence. 9 S83 - Dislocation and sprain of joints and ligaments of knee $0.54 $2.28 +318.78% 10 M25 -Other joint disorder, not elsewhere classified $0.65 $2.23 +242.80% 3-Digit Principal Diagnosis Mask Jan 2020 - Dec 2020 Jan 2021 - Dec 2021 Variance In the Professional category, we 1 000 - BEHAVIORAL HEALTH $31.86 $40.63 +27.54% can see the impact of COVID-19 2 Z00 - Encounter for general examination without complaint, suspected or reported $14.26 $15.73 +10.37% NAL diagnosis through the variances in paid O 3 Z20 - Contact with and (suspected) exposure to communicable diseases $0.02 $6.27 +37572.50% PMPM between plan years 4 Z12 - Encounter for screening for malignant neoplasms $3.24 $4.73 +45.96% SSI5 000 - INFECTIOUS DISEASE $3.67 $4.32 +17.78% within categories 1, 3, 5 and 7. FE 6 M25 -Other joint disorder, not elsewhere classified $1.96 $3.75 +90.99% O 7 Z23 - Encounter for immunization $1.38 $3.41 +146.71% R 8 Z01 - Encounter for other special examination without complaint, suspected or $2.80 $3.40 +21.70% P reported diagnosis 9 S83 - Dislocation and sprain of joints and ligaments of knee $3.17 $2.57 -18.87% 10 M17 -Osteoarthritis of knee $0.12 $2.56 +1961.15% [ 8 ]

TELEHEALTH 160 140 120 100 80 60 40 20 0 2020/01 2020/05 2020/08 2020/11 2021/02 2021/05 2021/08 2021/11 BH Claimants Medical Claimants BH Visits Medical Visits • Stats for providers outside of well-connection 2020 2021 % Change • Since the start of 2020, there have only been 16 people to Behavioral Health Claimants 414 597 44% utilize providers within the well-connection network Behavioral Health Visits 982 1,442 47% • 14 of the 16 fell under medical Medical Claimants 315 228 -28% • 16 total visits (no repeat utilizers) Medical Visits 370 244 -34% [ 9 ]

RX TOP THERAPEUTIC CLASSES Rank Prev. Rank Therapeutic Class Claimants % of total Services Services per % Change Pharmacy Paid % of total Paid Paid per Service Pharmacy Paid Claimants 1000 PMPM 1 1 58 - ANTIDEPRESSANTS 126 25.7% 893 1,720.3 16.5% $3,120 0.8% $3.49 $0.50 2 10 17 - VACCINES 311 63.5% 531 1,023.0 185.8% $21,385 5.6% $40.27 $3.43 3 2 61 - ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS 57 11.6% 451 868.8 28.6% $18,309 4.8% $40.60 $2.94 4 3 39 - ANTIHYPERLIPIDEMICS 48 9.8% 313 603.0 8.9% $1,456 0.4% $4.65 $0.23 5 4 44 - ANTIASTHMATIC AND BRONCHODILATOR AGENTS 58 11.8% 291 560.6 5.4% $17,884 4.7% $61.46 $2.87 6 9 36 - ANTIHYPERTENSIVES 48 9.8% 243 468.1 29.3% $763 0.2% $3.14 $0.12 7 N/A 27 - ANTIDIABETICS 16 3.3% 211 406.5 $37,219 9.8% $176.39 $5.98 8 8 90 - DERMATOLOGICALS 91 18.6% 210 404.6 8.8%% $94,048 24.8% $447.85 $15.10 9 5 25 - CONTRACEPTIVES 58 11.8% 203 391.1 -11.9% $8,510 2.2% $41.92 $1.37 10 7 72 - ANTICONVULSANTS 32 6.5% 191 368.0 -2.1% $2,396 0.6% $12.55 $0.38 Total: Selected Filter(s) 422 86.1% 3,537 6,813.9 23.3% $205,091 54.1% $57.98 $32.93 Total: All Others 335 68.4% 2,365 4,556.1 3.7% $174,234 45.9% $73.67 $27.97 Total: All 490 100.0% 5,902 11,370.0 14.6% $379,325 100.0% $64.27 $60.90 • Antidepressant prescriptions per 1000 increased 16.5% between 2020 and 2021 • Vaccines increased 185.8% • Antidiabetics were previously not on the top 10 report for 2020, but are #7 for 2021 (23% increase in scripts per 1000) • Drugs used to treat high blood pressure increased 29.3% • Overall, the # of scripts written in 2021 represents an increase of 15% from 2020. [ 10 ] [ 10

TOP 10 RX BY COST BENCHMARK Percent of Specialty Drug 2021 Claimants by Condition Drug Name Common Diagnoses Claimants Services Services per Pharmacy % of total Paid per Service 1000 Paid Paid DUPIXENT SYRINGE Eczema 1 12 23.1 $36,451 9.6% $3,037.57 DIMETHYL FUMARATE Multiple Sclerosis 1 5 9.6 $32,052 8.4% $6,410.38 SILIQ Anti-inflammatory 1 8 15.4 $29,727 7.8% $3,715.86 LUPRON DEPOT-PED Endometriosis, Prostate Cancer 1 2 3.9 $20,550 5.4% $10,275.20 MYCOPHENOLIC ACID Immunosuppressive Agents 2 24 46.3 $11,442 3.0% $476.73 JARDIANCE Type II Diabetes 4 31 59.7 $10,748 2.8% $346.72 TACROLIMUS Organ Rejection 6 30 57.8 $9,810 2.6% $327.00 DUPIXENT PEN Eczema 1 3 5.8 $9,053 2.4% $3,017.57 NUCYNTA ER Pain Reliever (Opioid) 1 13 25.1 $8,588 2.3% $660.65 MESALAMINE Ulcerative Colitis 1 10 19.3 $8,551 2.3% $855.14 Total: Selected Filter(s) 16 138 266.0 $176,972 46.6% $1,282.41 Total: All Others 490 5,765 11,111.5 $202,509 53.4% $35.13 Total: All 490 5,903 11,377.4 $379,481 100.0% $64.29 2020 Drug Name Common Diagnoses Claimants Services Services per Pharmacy % of total Paid Paid per 1000 Paid Service • ABC Drug Spend accounts for 14% TECFIDERA Multiple Sclerosis 1 4 8.0 $62,842 19.8% $15,710.54 SILIQ Anti-inflammatory 1 9 18.0 $31,524 9.9% $3,502.70 of total plan spend in 2021, and MYCOPHENOLATE MOFETIL Lupus, RA 1 9 18.0 $12,439 3.9% $1,382.12 11% in 2020 TACROLIMUS Organ Rejection 9 42 84.0 $10,453 3.3% $248.89 NUCYNTA ER Pain Reliever (Opioid) 1 13 26.0 $8,724 2.7% $671.11 JARDIANCE Type II Diabetes 5 25 50.0 $8,526 2.7% $341.05 • The norm is upwards of 25-28% TRUVADA HIV 1 9 18.0 $8,417 2.6% $935.25 DEXTROAMPHETAMINE-AMPH ADHD 18 160 319.9 $7,716 2.4% $48.23 XARELTO Blood Clot Prevention 4 26 52.0 $6,822 2.1% $262.40 ELIQUIS Blood Clot Prevention 3 24 48.0 $6,606 2.1% $275.24 Total: Selected Filter(s) 39 321 641.8 $164,071 51.6% $511.13 Total: All Others 425 4,641 9,278.9 $153,853 48.4% $33.15 Total: All 427 4,962 9,920.7 $317,924 100.0% $64.07 [ 11 ] [ 11

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