4.5 Paid Claims Distribution
The Paid Claims Distribution report groups members into one of fifteen expense bands ranging from $250 to $1 million based on plan spending. This is useful in determining what percentage of the population is well, low risk, moderate risk, high risk, or likely involved in complex care.
The chart plots the percentage of members against the percentage of total plan expenditure for each expense band. Plans tend to conform to a rough 80/20 relationship between cost and members; i.e., more than eighty percent of plan expenditure goes to less than twenty percent of the covered population. The cumulative usage and paid values can be used to see how closely the plan follows this general trend.
The following fields are given for each expense band:
# of Claimants: The total number of claimants (members) whose plan expense fell within the corresponding expense band.
% of Total Claimants: The percentage of claimants (members) whose plan expense fell within the corresponding expense band. This is calculated by dividing the # of Claimants by the total number of covered claimants.
Plan Paid: The total amount paid by the plan sponsor on members in the corresponding expense band.
% Usage ( Percentage of Usage ): The percentage of total dollars paid by the plan sponsor. More.
Cumulative % Usage: The cumulative percentage of total dollars paid by the plan sponsor at the corresponding expense band.
Cumulative Paid: The cumulative total amount paid by the plan sponsor on members in corresponding expense band.