INLAND EMPIRE HEALTH PLAN STANDARD MONTHLY REPORTS

Transcription

1 INLAND EMPIRE HEALTH PLAN STANDARD MONTHLY REPORTS Supplemental to: Board Report #256

2 ADMINISTRATION (Bradley P. Gilbert, M.D.) 1. Standard IEHP Monthly Reports a. IEHP Finance Reports (Attachment A) 1) Income Statements 2) Capitation Income And Expense 3) Purchasing Transaction History Report** b. IEHP Operations Reports (Attachment B) 1) Claims Summary Report 2) Claims Processing Turnaround Time 3) PCP Member Allocation Report 4) Member Services Telephone Activity Report 5) Provider Automated Eligibility Contact Report 6) Member Eligibility Verification Report c. IEHP Provider Reports (Attachment C) 1) IPA Consolidated Membership Report 2) Hospital Consolidated Membership Report 3) New Enrollment Trend Report By Consolidated IPA d. IEHP Marketing Reports (Attachment D) 1) All Medi-Cal Aid Codes Enrollment Report 2) Medi-Cal Mandatory Families Aid Codes Enrollment Report 3) Medi-Cal Mandatory Seniors & Persons With Disabilities (SPD) Aid Codes Enrollment Report 4) IEHP s Medi-Cal Non-Mandatory Aid Codes Enrollment Report 5) IEHP s Medi-Cal Expansion Aid Codes Enrollment Report 6) IEHP s Healthy Kids Program Enrollment Report 7) IEHP Medicare Enrollment Report **(Reports not available due to system conversion)

3 ADMINISTRATION (Dr. Gilbert) 1. Review of the Financial Monthly Reports a. Finance Reports 1) Year-To-Date Income Statement for the Nine Months Ended March 31, 2016 Medi-Cal Healthy Kids Medicare Actual Budget Variance $ Actual Budget Variance $ Actual Budget Variance $ Organizational Expenditures Grand Total Capitation Revenue 2,473,309 2,445,550 27, , ,625 (8,480) - 2,692,161 Capitation Revenue - Retro 50,775-50, ,775 Supplemental 224, ,457 (194,167) ,290 Other Revenue (1) - (1) (51) 40,041 44,135 (4,095) - 40,476 Net Revenue 2,748,372 2,864,007 (115,635) 1,144 1, , ,760 (12,574) - 3,007,702 Facility Claims 771, ,798 57, (82) 82,013 96,313 (14,301) - 853,821 Capitation Expense 529, ,221 81, ,182 82,935 (3,753) - 609,214 Professional 202, ,797 55, ,717 15,967 10, ,624 Pharmacy 393, ,702 (44,500) (196) 62, ,910 (40,842) - 455,320 Incentives 112, ,709 (181,961) , ,222 IEHP Responsible 389, ,276 (20,988) (118) 13,942 9,177 4, ,244 Other Expenses 4, ,638 (163,652) (64) (1) (57,359) 57,358-5,409 G & A Expenses - Medical ,058 41,058 Behavior Health Allocations ,047-1,047 (1,797) - Medical Cost Allocations 34,691 46,581 (11,891) ,558 3, (39,294) - DSNP Co-Insurance Allocation MD (634) - (634) - - Total Medical Costs 2,440,590 2,667,721 (227,131) 1,013 1,358 (345) 270, ,150 16,192 (33) 2,711,911 Gross Margin 307, , , (272) 402 (12,155) 16,611 (28,766) ,791

4 ADMINISTRATION (Dr. Gilbert) 1. Review of the Financial Monthly Reports a. Finance Reports 1) Year-To-Date Income Statement for the NineMonths Ended March 31, 2016 (Continued) Medi-Cal Healthy Kids Medicare Actual Budget Variance $ Actual Budget Variance $ Actual Budget Variance $ Organizational Expenditures Grand Total Operating Expenses Administrative Expense 39, ,947 (69,105) (28) 3,900 8,474 (4,574) (43,756) - Administration 4,347-4, ,257 10,744 Finance 1,848-1, ,129 5,016 Information Technology (IT) 19,289-19, ,866 31,561 Marketing 4,088-4, ,454 8,190 Medical Services 5,029-5, ,867-1,867 4,883 11,836 Network Development 2,941-2, ,007 5,009 Operations 17,713-17, ,930 31,016 Total Operating Expenses 95, ,947 (13,849) ,386 8,474 (1,089) ,372 Operating Surplus (Deficit) 212,684 87, , (313) 324 (19,541) 8,136 (27,677) (735) 192,419 Other Income (Expense) ,032 1,032 Property Management Income (Expense) (3,356) (3,356) Behavioral Health Clinic ,169 1,169 Hospital Community Fund ED Navigator Project Net Surplus (Deficit) 212,684 87, , (313) 324 (19,541) 8,136 (27,677) (4,508) 188,646

5 ADMINISTRATION (Dr. Gilbert) 1. Review of the Financial Monthly Reports a. Finance Reports 1) Income Statement for the Month Ended March 31, 2016 Medi-Cal Healthy Kids Medicare Actual Budget Variance $ Actual Budget Variance $ Actual Budget Variance $ Organizational Expenditures Grand Total Capitation Revenue 283, ,022 2, ,598 25,224 2, ,372 Capitation Revenue - Retro 13,741-13, ,741 Supplemental 22,395 47,967 (25,571) ,395 Other Revenue (15) 5,801 4, ,840 Net Revenue 319, ,988 (9,167) ,399 30,061 3, ,349 Facility Claims 86,451 82,225 4, ,994 10,713 (3,718) - 93,476 Capitation Expense 62,345 51,375 10, ,144 9,339 1,805-73,529 Professional 23,475 16,666 6, ,042 1,740 1,302-26,523 Pharmacy 48,961 48, (22) 6,739 12,116 (5,378) - 55,706 Incentives 6,893 32,745 (25,853) ,205 IEHP Responsible 46,321 47,077 (756) 8 15 (7) 1,302 1, ,631 Other Expenses ,670 (18,017) (15) 54 (69) - (6,316) 6, G & A Expenses - Medical ,566 5,566 Medical Cost Allocations 4,858 5,617 (759) (5,566) - Total Medical Costs 279, ,053 (23,096) (65) 30,229 29,161 1, ,275 Gross Margin 39,864 25,935 13, (33) 74 3, ,270-43,075

6 ADMINISTRATION (Dr. Gilbert) 1. Review of the Financial Monthly Reports a. Finance Reports 1) Income Statement for the Month Ended March 31, 2016 (Continued) Medi-Cal Healthy Kids Medicare Actual Budget Variance $ Actual Budget Variance $ Actual Budget Variance $ Organizational Expenditures Grand Total Operating Expenses Administrative Expense - 12,377 (12,377) - 5 (5) (963) - - Administration Finance Information Technology (IT) 5,367-5, ,477 Marketing 1,072-1, ,173 Medical Services ,376 Network Development Operations 3,743-3, ,819 Total Operating Expenses 13,156 12, (162) - 13,982 Operating Surplus (Deficit) 26,708 13,559 13, (37) 53 2,369 (63) 2,432-29,093 Other Income (Expense) Property Management Income (Expense) (213) (213) Behavioral Health Clinic ED Navigator Project Net Surplus (Deficit) 26,708 13,559 13, (37) 53 2,369 (63) 2,432 (439) 28,654

7 ADMINISTRATION (Dr. Gilbert) 1. Review of the Standard IEHP Monthly Reports a. Finance Reports 2) Capitation Income and Expense for the Period Ended March 31, 2016 March Year-to-Date Riverside SB Total Riverside SB Total Membership: Medi-Cal 559, ,902 1,125,105 4,920,325 5,005,894 9,926,219 Healthy Families Healthy Kids 1, ,129 8, ,720 Medicare ,168 3,172 6,340 CMC 11,047 10,785 21, ,337 98, ,111 Total Members: 571, ,721 1,148,066 5,032,286 5,108,104 10,140,390 Revenue: Medi-Cal 154,880, ,707, ,588,596 1,325,428,381 1,313,587,059 2,639,015,440 Healthy Families Healthy Kids 87,160 42, , , ,975 1,143,778 Medicare ,251,664 4,978,452 9,230,116 CMC 23,675,819 20,954,583 44,630, ,578, ,733, ,312,533 Net Revenue: 178,644, ,704, ,349,088 1,511,948,751 1,495,753,116 3,007,701,867 Medical Costs: Medi-Cal 137,848, ,231, ,080,279 1,192,777,018 1,173,277,887 2,366,054,906 Healthy Families (19) - (19) (19) - (19) Healthy Kids 100,476 (12,364) 88, , ,571 1,013,204 Medicare (4,267) 16,511 12,245 4,643,521 3,501,824 8,145,345 CMC 18,017,842 20,076,092 38,093, ,962, ,768, ,730,893 Total Medical Costs: 155,962, ,311, ,274,550 1,357,956,001 1,353,988,327 2,711,944,329 Gross Margin: 22,681,889 20,392,649 43,074, ,992, ,764, ,757,539

8 ADMINISTRATION (Brad Gilbert, M.D.) b. Operations Reports 1) Claims Summary Report (March 2016) Month End March 2016 Inland Empire Health Plan Claims Beginning Claims Claims Claims Claims Ending Category Inventory Received Paid Denied Capitated Inventory Professional IEHP Responsible 10, ,608 92,046 4,182 2,320 13,062 IEHP Direct 113, , ,235 24,025 29, ,795 Per Diem Hospital Contract ,112 10, Vision 1,897 20,567 19, ,004 Pay For Performance (P4P) 1,731 5,624 5, ,639 Mental Health 8,487 21,454 19,606 2, ,685 Member Reimbursement Redirected ,655 5,593 61,876 1, Decaps No Category Professional Subtotal 136, , ,218 94,009 33, ,277 Institutional IEHP Responsible 11,708 20,737 18, ,054 IEHP Direct 33,069 15,163 12,001 1,235 2,115 32,881 Per Diem Hospital Contract 6,385 93,627 84,379 5,540 6,057 4,036 Vision Pay For Performance (P4P) Mental Health Member Reimbursement Redirected 3,392 14,681 2,242 12, ,485 Decaps No Category Institutional Subtotal 55, , ,299 20,061 8,203 54,022 Total Claims in Diamond 191, , , ,070 41, ,299

9 ADMINISTRATION (Brad Gilbert, M.D.) b. Operations Reports 2) Claims Processing Turnaround Time (March 2016) Claim Processing Turnaround Time 1-30 Days Days Days Over 90 Days Total Professional IEHP Responsible 98, ,548 IEHP Direct 268, ,652 Per Diem Hospital Contract 10, ,953 Vision 19, ,460 Pay For Performance (P4P) 5, ,716 Mental Health 22, ,256 Member Reimbursement Redirected 69, ,402 Decaps No Category Professional Subtotal 493,582 1, ,996 % of Total 99.71% 0.21% 0.08% 0.00% Institutional IEHP Responsible 19, ,391 IEHP Direct 15, ,351 Per Diem Hospital Contract 94, ,976 Vision Pay For Performance (P4P) Mental Health Member Reimbursement Redirected 14, ,588 Decaps No Category Institutional Subtotal 144,029 1, ,563 % of Total 98.95% 0.71% 0.32% 0.02% Grand Total 637,611 2, ,559 % of Total 99.54% 0.32% 0.13% 0.01% Month Reporting:03/16 Submitted:04/16

10 A. ADMINISTRATION (Brad Gilbert, M.D.) b. Operations Reports 3) PCP Member Allocation Report (May 2016) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 30% 47% 46% 47% 44% 45% 44% 47% 57% 52% 51% 67% 70% 53% 54% 53% 56% 55% 56% 53% 43% 48% 49% 33% Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Member Choice Member Assignment

11 A. ADMINISTRATION (Brad Gilbert, M.D.) b. Operations Reports 4) Member Services Telephone Activity Report (March 2016) Response Month Actual Time in Call Length Outbound Inbound Calls Abandonment % of Inbound Calls Membership Seconds in Minutes Rate Calls Total Calls Actual Forecast Variance Member Provider Provider Eligibility General April '15 1,069, , ,910-27,359 0:15 8: % 99.1% 0.5% 0.4% 29, ,465 May '15 1,087, , ,079-15,679 0:35 8: % 99.2% 0.5% 0.3% 29, ,949 June '15 1,084, , ,727-3,142 0:44 8: % 99.2% 0.5% 0.3% 32, ,007 July '15 1,091, , , :09 8: % 99.2% 0.5% 0.3% 39, ,838 August '15 1,105, , ,276-5,416 0:14 8: % 99.3% 0.4% 0.3% 45, ,962 September '15 1,121, , ,356-2,510 0:34 8: % 99.3% 0.4% 0.3% 39, ,488 October '15 1,116,567 * 114, ,241-3,956 0:23 8: % 99.3% 0.4% 0.3% 37, ,146 November '15 1,115,005 * 100, , :10 9: % 99.3% 0.4% 0.3% 34, ,757 December '15 1,119,715 * 98, ,750-6,304 0:51 8: % 99.3% 0.4% 0.3% 38, ,862 January '16 1,125,820 * 110, ,607-3,873 0:45 8: % 99.3% 0.5% 0.2% 36, ,288 February '16 1,131, , , :06 8: % 99.3% 0.4% 0.3% 36, ,423 March '16 1,138, , ,034-1,089 1:18 8: % 99.3% 0.4% 0.3% 42, ,557 * 03/15/16: Revised Membership numbers

12 A. ADMINISTRATION (Brad Gilbert, M.D.) b. Operations Reports 5) Provider Automated Eligibility Contact Report (March 2016) Total Actual IVR WEB Page Spot Check Automated Month Membership Contacts Contacts Contacts Contacts April '15 1,069,862 21,175 1,349, ,659 1,538,157 May '15 1,087,833 25,953 1,245, ,432 1,522,938 June '15 1,084,186 58,666 1,353, ,266 2,373,383 July '15 1,091,662 32,336 1,367, ,674 1,829,485 August '15 1,105,348 29,678 1,345, ,498 1,635,238 September '15 1,121,183 18,413 1,362, ,759 1,686,062 October '15 1,116,567 * 19,655 1,409, ,696 1,690,925 November '15 1,115,005 * 28,097 1,322, ,151 1,561,572 December '15 1,119,715 * 24,799 1,361, ,008 1,594,661 January '16 1,125,820 * 26,665 1,430, ,390 1,642,910 February '16 1,131,917 19,627 1,491, ,329 1,719,880 March '16 1,138,467 20,111 1,616, ,989 2,012,410 * 03/15/16: Revised Membership numbers

13 A. ADMINISTRATION (Brad Gilbert, M.D.) b. Operations Reports 6) Member Eligibility Verification Report (March 2016 Total: 2,012,410) Inland Empire Health Plan Spot Check 375,989 IVR 20,111 Web Page 1,616,310 IVR Web Page Spot Check

14 A. ADMINISTRATION (Brad Gilbert, M.D.) 1. Review Of the Standard IEHP Monthly Reports c. Provider Reports 1) IPA Consolidated Membership Report (April 2016) Inland Empire Health Plan Number of Service PCPs Enrollment IPA NAME Areas 04/01/16 * 04/01/16ŧ Inland Empire Health Plan Direct All Areas ,100 Vantage Medical Group All Areas ,380 Inland Faculty Medical Group R1/R4/S1/S2/S ,461 Kaiser Foundation Health Plan, Inc. R1/S1 N/A 94,804 Alpha Care Medical Group, Inc. R1/R3/R6/S1/S ,528 LaSalle Medical Associates R1/R2/R4/S1/S2/S ,474 Inland Valleys IPA All Areas ,777 Physicians Health Network S ,425 Horizon Valley Medical Group E7/S ,008 Dignity Health Medical Group - Inland S1 9 11,725 Empire Allied Pacific IPA S2 22 4,394 Regal Medical Group R1/R2/R3/R4/R5/S1/S2/S Desert Oasis E2/R Beaver Medical Group S San Bernardino Medical Group S PrimeCare Medical of Chino Valley S Riverside Medical Clinic R1/R PrimeCare of San Bernardino S1/S PrimeCare of Riverside R1/R Pinnacle Medical Group S PrimeCare of Inland Valley S PrimeCare of Moreno Valley R1/R CPN-Horizon Valley Medical Group E7/S Heritage Victor Valley E7/S PrimeCare of Temecula R PrimeCare of Corona R1/R PrimeCare of Hemet Valley R Dignity Health Physician Network - IE 5 256

15 A. ADMINISTRATION (Brad Gilbert, M.D.) 1. Review Of the Standard IEHP Monthly Reports c. Provider Reports 1) IPA Consolidated Membership Report (April 2016) (continued.) Inland Empire Health Plan Pomona Valley Medical Group S PrimeCare of Citrus Valley R PrimeCare of Sun City R Redlands Yucaipa Medical group S Alliance Desert Physicians S PrimeCare of Redlands S Valley Physicians Network R Tri Valley Medical Group R Chaffey Medical Group S Totals: 1,789 1,086,381 Due to timing issues, these figures may not exactly reflect figures used for capitation * = Total number of non-terminated unique PCPs per IPA ŧ = Excludes Medi-Medi and Open Access Enrollment.

16 IPA GEOGRAPHIC SERVICE AREAS R1 R2 R3 R4 R5 R6 S1 S2 S3 Riverside Proper Mira Loma, Riverside, Nuevo, Perris, Moreno Valley The Pass Banning, Beaumont, Cabazon, Calimesa Hemet Region Idyllwild, Hemet, Homeland, Mountain Center, San Jacinto, Winchester Corona Region Corona, Norco Temecula Region Aguaga, Anza, Canyon Lake, Lake Elsinore, Menifee, Murrieta, Sun City, Temecula, Wildomar Low Desert Cathedral City, Coachella, Desert Hot Springs, Indian Wells, Indio, La Quinta, Mecca, North Palm Springs, Palm Desert, Palm Springs, Rancho Mirage, Thermal, Thousand Palms, Whitewater San Bernardino Proper Bloomington, Colton, Fontana, Grand Terrace, Highland, Patton, Rialto, San Bernardino, Bryn Mawr, Crafton, Loma Linda, Mentone, Redlands, Yucaipa West End San Bernardino Alta Loma, Chino, Chino Hills, Etiwanda, Guasti, Montclair, Ontario, Pomona, Rancho Cucamonga, Upland High Desert Adelanto, Apple Valley, Hesperia, Lucerne Valley, Oro Grande, Phelan, Pinon Hills, Victorville

17 IPA GEOGRAPHIC SERVICE AREAS (Excluded Areas) Inland Empire Health Plan E1 Blythe Blythe, Ripley, Desert Center, Mesa Verde, Ehrenberg, Eagle Mountain E2* Yucca\Morongo Valley Amboy, Cadiz, Landers, Joshua Tree, Moronga Valley, Marine Corp Base, Pioneer Town, Twenty-nine Palms, Yucca Valley, Wonder Valley, Rimrock E3* Mountains Angelus Oak, Big Bear City, Big Bear Lake, Blue Jay, Cedar Glen, Cedarpines Park, Crestline, Crest Park, Phelan, Fawnskin, Forest Falls, Green Valley Lake, Lake Arrowhead, Rimforest, Running Springs, Sky Forest, Sugar Loaf, Twin Peaks E4 Needles\Laughlin Cima, Essex, Kelso, Needles, Nipton, Mountain Pass E5 Ridgecrest Johannesberg, Randsburg, Ridgecrest, Red Mountain, Trona E6 Colorado River Big River, Parker Dam E7* Barstow Baker, Barstow, Daggett, Fort Irwin, Hinkley, Ludlow, Yermo, Newberry Springs, Desert Center, Lenwood, Helendale * Active Membership in these areas

18 A. ADMINISTRATION (Brad Gilbert, M.D.) c. Provider Reports 2) Hospital Consolidated Membership Report (April 2016) Number of PCPs Enrollment HOSPITAL NAME 04/01/16 04/01/16 ŧ Dignity Health Community Hospital of San Bernardino 122 St. Bernardine Medical Center 84 79,122 62,899 Subtotal: ,021 Physicians For Healthy Hospitals Hemet Valley Medical Center 55 46,801 Subtotal: 55 46,801 Prime Healthcare Services Montclair Hospital Medical Center 62 Chino Valley Medical Center 2 24, Subtotal: 64 24,967 Tenet HealthCare Corporation John F. Kennedy Memorial Hospital 61 Desert Regional Medical Center 53 55,476 35,279 Subtotal: ,755 Universal Health Systems, Inc Rancho Springs Medical Center 52 53,934 Corona Regional Medical Center 63 40,226 Inland Valley Regional Medical Center 24 14,828 Subtotal: ,988 Victor Valley Global Medical Center ,158 Kaiser Fontana/Riverside N/A 94,804 Pomona Valley Hospital Medical Center ,022 Arrowhead Regional Medical Center 73 78,015 Riverside County Regional Medical Center 72 69,302

19 5 A. ADMINISTRATION (Brad Gilbert, M.D.) c. Provider Reports 2) Hospital Consolidated Membership Report (April 2016) (continued..) Number of PCPs Enrollment HOSPITAL NAME 04/01/16 04/01/16 ŧ Riverside Community Hospital 91 66,014 Parkview Community Hospital Medical Center ,394 Eisenhower Medical Center 36 23,850 Redlands Community Hospital 21 16,126 Loma Linda Children Hospital 19 15,819 San Gorgonio Memorial Hospital 17 15,363 St. Mary Medical Center 11 13,729 Barstow Community Hospital 7 5,709 Mountains Community Hospital 8 1,308 Subtotal: ,613 Total: 1,420 1,063,145 Due to timing issues, these figures may not exactly reflect figures used for capitation PCP totals deviate from IPA report totals due to multiple hospital affiliations ŧ = Excludes Medi-Medi, Medicare and Open Access Members

20 I Inland Empire Health Plan A. ADMINISTRATION (Brad Gilbert, M.D.) c. Provider Reports 3) New Enrollment Trend Report By Consolidated IPA (April 2016) Average Defaulted Member Analysis Healthy Kids New Members New Member Family Auto Family New Medicare Per IPA Name Members Choice Link Assign Assign Members Members PCP Horizon Valley Medical Group Inland Faculty Medical Group 2, Dignity Health Medical Group Inland Empire Vantage Medical Group 4,930 1,935 1,237 1, LaSalle Medical Associates 1, Alpha Care Medical Group 2, Physicians Health Network Inland Valleys IPA 1, Inland Empire Health Plan Direct 8,708 3, , Allied Pacific IPA CPN-Horizon Valley Medical Group PrimeCare of Hemet Valley PrimeCare of Moreno Valley PrimeCare of San Bernardino Alliance Desert Physicians Desert Oasis Pinnacle Medical Group PrimeCare of Riverside New

21 A. ADMINISTRATION (Brad Gilbert, M.D.) c. Provider Reports 3) New Enrollment Trend Report By Consolidated IPA (April 2016) (continued..) Average Defaulted Member I Inland Empire Health Plan Analysis Healthy Kids New Members New Member Family Auto Family New Medicare Per IPA Name Members Choice Link Assign Assign Members Members PCP Redlands Yucaipa Medical group Riverside Medical Clinic San Bernardino Medical Group Valley Physicians Network Beaver Medical Group Chaffey Medical Group Dignity Health Physician Network - IE Heritage Victor Valley Pomona Valley Medical Group PrimeCare Medical of Chino Valley PrimeCare of Citrus Valley PrimeCare of Corona PrimeCare of Inland Valley PrimeCare of Redlands PrimeCare of Sun City PrimeCare of Temecula Regal Medical Group Tri Valley Medical Group Total: 23,703 8,529 5,067 7,621 1, New

22 A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 1) All Medi-Cal Aid Codes Enrollment Report (April 2016) Month IEHP* Percent of IEHP Molina* Percent of Molina Total Enrolled Recipients** Jul ,068, % 167, % 1,570,000 Aug ,082, % 168, % 1,570,000 Sep ,098, % 169, % 1,570,000 Oct ,093, % 168, % 1,570,000 Nov ,091, % 166, % 1,570,000 Dec ,096, % 166, % 1,570,000 Jan ,102, % 166, % 1,570,000 Feb ,109, % 166, % 1,570,000 Mar ,116, % 165, % 1,570,000 Apr ,121, % 164, % 1,570,000 Sources: * - HCO Monthly Plan Enrollment Status Reports (COPS-25) ** - Medi-Cal Beneficiary Counts Pivot Table, County, May 2015

23 A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 2) Medi-Cal Mandatory - Families Aid Codes Enrollment Report (April 2016) Inland Empire Health Plan Month IEHP* % of IEHP Molina** % of Molina Mandatory in FFS & Excluded Zips % of Mandatory in FFS & Excluded Zips Total Families Mandatory Recipients*** Aug , % 154, % 301, % 1,166,000 Sep , % 155, % 288, % 1,166,000 Oct , % 154, % 298, % 1,166,000 Nov , % 153, % 302, % 1,166,000 Dec , % 152, % 303, % 1,166,000 Jan , % 152, % 302, % 1,166,000 Feb , % 152, % 297, % 1,166,000 Mar , % 152, % 295, % 1,166,000 Apr , % 151, % 295, % 1,166,000 Sources: * IEHP's Marketing Management Report #1 - Data as of 15th of the month ** - HCO Monthly Plan Enrollment Status Reports (COPS-25) / Total enrollment less 3% estimated non-mandatory population and less estimated Mandatory SPD. *** - Projections based on Medi-Cal Beneficiary Counts Pivot Table, county-level and state-level data, May 2015.

24 A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 3) Medi-Cal Mandatory Seniors & Persons with Disabilities (SPD)Aid Codes Enrollment Report (April 2016) Month IEHP* %IEHP Molina** %Molina Mandatory in FFS & Excluded Zips % of Mandatory in FFS & Excluded Zips Total SPD Mandatory Recipients*** Jul , % 9, % 36, % 108,000 Aug , % 8, % 38, % 108,000 Sep , % 8, % 35, % 108,000 Oct , % 8, % 38, % 108,000 Nov , % 8, % 38, % 108,000 Dec , % 8, % 38, % 108,000 Jan , % 8, % 38, % 108,000 Feb , % 8, % 38, % 108,000 Mar , % 8, % 38, % 108,000 Apr , % 8, % 38, % 108,000 Sources: * IEHP's Marketing Management Report #1 - Data as of 15th of the month ** 2% annual growth rate for enrollment starting July June *** - Projections based on Medi-Cal Beneficiary Counts Pivot Table, county-level and state-level data, May 2015.

25 A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 4) IEHP s Medi-Cal Non-Mandatory Aid Codes Enrollment Report (April 2016) Inland Empire Health Plan Month Medi-Medi's* Foster Children* Others* Total IEHP Non-Mandatory Total Non- Mandatory** Percent of IEHP Jul ,065 9,749 3,411 61, , % Aug ,981 9,761 3,125 60, , % Sep ,400 7,239 2,676 58, , % Oct ,007 9,944 2,702 60, , % Nov ,619 9,724 2,498 59, , % Dec ,527 9,953 2,405 59, , % Jan ,503 10,073 2,388 60, , % Feb ,462 10,128 2,859 61, , % Mar ,460 10,349 2,429 61, , % Apr ,434 9,684 2,867 60, , % Sources: * IEHP's Marketing Management Report #1 - Data as of 15th of the month ** - Projections based on Medi-Cal Beneficiary Counts Pivot Table, county-level and state-level data, May *** Excluded Medi-Medis who are enrolled in IEHP Medicare DualChoice.

26 A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 5) IEHP s Medi-Cal Expansion Aid Codes Enrollment Report (April 2016) Month LIHP Transition (L1) Medi-Cal Expansion Adults (M1 & 7U) Total IEHP Medi-Cal Expansion Jul , , ,272 Aug , , ,273 Sep , , ,166 Oct , , ,024 Nov , , ,791 Dec , , ,929 Jan , , ,400 Feb , , ,473 Mar , , ,389 Apr , , ,909 Source: IEHP's Marketing Management Report #1 - Data as of 15th of the month Note: Members with L1 aid code will be transitioned to M1 at their annual eligibility redetermination.

27 A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 6) IEHP s Healthy Kids Program Enrollment Report (April 2016) Month Enrollment in Riverside Enrollment in San Bernardino Total Enrollment Total Funded Eligibles Percent of Enrollment Jul , % Aug , % Sep , % Oct , % Nov ,021 1, % Dec , ,074 1, % Jan , ,114 1, % Feb , ,130 1, % Mar , ,125 1, % Apr , ,117 1, % Source: IEHP's Marketing Management Report #1 - Data as of 15th of the month

28 A. ADMINISTRATION (Brad Gilbert, M.D.) d. Marketing Reports 7) IEHP Medicare Enrollment Report (April 2016) Month D-SNP Medicare Members Cal MediConnect Medicare Members TOTAL MEDICARE MEMBERS Jul ,143 22,425 23,568 Aug ,135 22,490 23,625 Sep ,113 22,280 23,393 Oct ,099 22,350 23,449 Nov ,217 23,172 Dec ,062 22,974 Jan ,815 21,815 Feb ,811 21,811 Mar ,833 21,833 Apr ,688 21,688 Source: IEHP's Marketing Management Report #1 - Data as of 15th of the month