2015-16 State Fiscal Year Financial Report · 2015-16 State Fiscal Year . Financial Report. Financial Results: Actual v. Budgeted Fiscal Year 2015- 16. 2. Fiscal Year 2015-16. Actual:

August 4, 2016

Board of Trustees Meeting

2015-16 State Fiscal Year Financial Report

Financial Results: Actual v. BudgetedFiscal Year 2015-16

2

Fiscal Year 2015-16Actual

thru June2016

Certified Budget

(per Segal 10-13-15)

Variance Over/(Under)

Budget

Beginning Cash Balance $1.024 b $1.024 b $0.0

Plan Revenue $3.114 b $3.049 b $64.7 m

Net Claims Payments $2.821 b $2.825 b ($4.5 m)

Medicare Advantage Premiums $183.8 m $181.1 m $2.7 m

Net Administrative Expenses $179.8 m $244.2 m ($64.4 m)

Total Plan Expenses $3.185 b $3.251 b ($66.2 m)

Net Income/(Loss) ($70.6 m) ($201.5 m) $130.9 m

Ending Cash Balance $953.5 m $822.6 m $130.9 m

Adjusted Variance ReportFiscal Year 2015-16

3

Fiscal Year 2015-16Actual thru June 2016,

As Adjusted

Certified Budget



Budget

Plan Revenue * $3.099 b $3.049 b $49.8 m

Net Claims Payments ^ $2.819 b $2.825 b ($5.9 m)

Medicare Advantage Premiums $183.8 m $181.1 m $2.7 m

Net Administrative Expenses $179.8 m $244.2 m ($64.4 m)

Total Plan Expenses $3.183 b $3.251 b ($67.6 m)

Net Income/(Loss) ($84.1 m) ($201.5 m) $117.4 m

* Adjusted for timing issues and to exclude non-budgeted revenues.^ Adjusted to include budgeted pharmacy rebates not received by the end of June and to exclude a non-budgeted pharmacy recovery.

Financial Results Actual v. Budgeted Fiscal Year 2015-16

4

Fiscal Year 2015-16Actual

thru June2016

Certified Budget



Budget

Plan Revenue $373.30 $371.72 $1.58

Net Claims Payments $339.63 $344.21 ($4.58)

Medicare Advantage Premiums $22.14 $22.06 $0.08

Net Administrative Expenses $21.65 $29.76 ($8.11)

Total Plan Expenses $383.42 $396.03 ($12.61)

Net Income/(Loss) ($10.12) ($24.31) $14.19

Comparing actual results to the budget projection on a PMPM basis helps correct forchanges in membership that occurred during the year.

Per Member Per Month (PMPM) Analysis

Adjusted Variance ReportFiscal Year 2015-16

5

Fiscal Year 2015-16Actual thru June 2016,as Adjusted

Certified Budget



Budget

Plan Revenue * $371.51 $371.72 ($0.21)

Net Claims Payments ^ $339.46 $344.21 ($4.75)

Medicare Advantage Premiums $22.14 $22.06 $0.08

Net Administrative Expenses $21.65 $29.76 ($8.11)

Total Plan Expenses $383.25 $396.03 ($12.78)

Net Income/(Loss) ($11.74) ($24.31) $12.57

Per Member Per Month (PMPM) Analysis

* Adjusted for timing issues and to exclude non-budgeted revenues.^ Adjusted to include budgeted pharmacy rebates not received by the end of June and to exclude a non-budgeted pharmacy recovery.

Fiscal Year 2015-16 Expenditure TrendPer Member Per Month

6

$250

$275

$300

$325

$350

$375

$400

$425

$450

YTD Actual Expenses YTD Budgeted Expenses

Budgeted PMPM FY 2014-15 Budgeted PMPM FY 2015-16

FY 2014-15 Budgeted = $365.74Actual = $367.10

FY 2015-16 Budgeted = $396.03Actual = $383.41

7

Allocation of Claims ExpendituresMedical, Blue Card and Pharmacy Payments

Fiscal Year 2015-16

Dental0.0%

Inpatient Facility17.2%

Outpatient Facility23.8%

Other2.5%

Profess-ional

28.5%

Pharmacy27.9%

Fiscal Year 2014-15

Dental0.0%

Inpatient Facility17.6%

Outpatient Facility23.2%

Other2.9%

Profess-ional

29.5%

Pharmacy26.9%

Source: BCBSNC Summary of Billed Charges

Recent Historical Financial ResultsRevenues and Expenses

$2.273

$2.676

$2.490

$2.798$2.852

$2.960$3.020

$3.063

$3.114

$2.290$2.625

$2.559$2.650 $2.620

$2.679

$2.845

$2.998

$3.185

$2.0

$2.2

$2.4

$2.6

$2.8

$3.0

$3.2

$3.4

FY 2008 FY 2009* FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016

$ Billions

Revenues Expenses

8

*FY 2009 revenues include a $250 million general fund appropriation from the State.

FB 2007-09 FB 2009-11 FB 2011-13 FB 2013-15 FB 2015-17

Recent Historical Financial ResultsNet Income/(Loss) & Ending Cash Balance

($17)

$51

($69)

$148 $232

$281 $175

$66

($71)

$140$190

$122

$270

$502

$784

$959$1,024

$953

-$200

$0

$200

$400

$600

$800

$1,000

$1,200

FY 2008 FY 2009* FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016

$ Millions

Plan Income/(Loss)

Ending Cash Balance

9

*The Plan received a $250 million general fund appropriation from the State in FY 2009.

FB 2007-09 FB 2009-11 FB 2011-13 FB 2013-15 FB 2015-17

Recent Historical Financial ResultsExpenditures (Claims + Administrative) PMPM

$299

$331$322 $333

$329$335

$352

$367 $383

$290

$333

$317

$347

$362 $359

$375

$366

$396

$280

$300

$320

$340

$360

$380

$400

$420

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016

PMPM Expenditures

Actual Expenses

Budgeted Expenses

10

FB 2007-09 FB 2009-11 FB 2011-13 FB 2013-15 FB 2015-17

Fiscal Year 2015-16Administrative Expenses

FY 2015-16($179.8 Million)

BCBSNC and

MedCost47%

Eligibility, Enrollment, and Billing

5%Inclusive

Health and ACA Fees

18%

Express Scripts

8%

Actuarial, Auditing, and Legal

1%

Population Health Mgmt15%

Wellness Initiatives

<1%

State Health Plan6%

FY 2014-15($168.4 Million)

11

BCBSNC and

MedCost45%

Eligibility, Enrollment, and Billing

10%Inclusive Health and ACA Fees

14%

Express Scripts

7%

Actuarial, Auditing, and Legal

2%

Population Health Mgmt15%

Wellness Initiatives

<1%

State Health Plan7%

FSR-FY

12

FSR-Cur v Pr Yr

1313

AVR - FY

14

Documents

2015-16 State Fiscal Year Financial Report · 2015-16 State Fiscal Year . Financial Report. Financial Results: Actual v. Budgeted Fiscal Year 2015- 16. 2. Fiscal Year 2015-16. Actual: