Measure

Measure description

Occurrence

Diagnosis 2 Code

An International Classification for Diseases (ICD) code related to a non-primary diagnosis reported for the service.

Claim Detail -Action Report

Diagnosis 2 Description

An International Classification for Diseases (ICD) description related to a non-primary diagnosis reported for the service.

Claim Detail -Action Report

Diagnosis 3 Code

An International Classification for Diseases (ICD) code related to a non-primary diagnosis reported for the service.

Claim Detail -Action Report

Diagnosis 3 Description

An International Classification for Diseases (ICD) description related to a non-primary diagnosis reported for the service.

Claim Detail -Action Report

Discharge Date

The date of discharge from an inpatient facility.

Inpatient Admission - Action Report

Discharge Status

The national standard description that indicates the member's status at time of discharge.

Inpatient Admission - Action Report

Discharge Status Code

The national standard code that indicates the member's status at the end of the claim period.

Claim Detail, Claim Summary -Action Report

Discharge Status Description

The national standard description that indicates the member's status at the end of the claim period.

Claim Detail, Claim Summary -Action Report

Discharged in Last 10 Days

The number of members in the panel during the current period discharged from the inpatient hospital within the last 10 days (based on discharge date). This number is updated daily.

Discharged in Last 10 Days - Population Measures

DRG Code

The Diagnosis Related Group (DRG) code, defined by CMS, that summarizes the services provided based on diagnosis, type of treatment, age, and other relevant criteria.

Claim Summary, Inpatient Admission -Action Report

DRG Description

The Diagnosis Related Group (DRG) description defined by CMS, that summarizes the services provided based on diagnosis, type of treatment, age, and other relevant criteria.

Claim Summary, Inpatient Admission -Action Report

DRG Weight

This field will be defined as part of a future enhancement.

Claim Summary -Action Report

ED

Emergency Department

General Definition

ED All PMPM

The per member per month emergency department cost for the current period adjusted for member risk. See the definition of Risk Adjusted Per Member Per Month (PMPM) for more information.

Cost and Utilization Summary by Cost Bucket -Action Report

ED Index

The ratio of the target's per member per month risk adjusted emergency department cost compared to the peer comparison population's per member per month risk adjusted emergency department cost.

Savings Opportunities - Dashlet

ED Index Goal

The savings opportunity goal set for comparing the target's per member per month risk adjusted emergency department cost to the peer comparison population's per member per month risk adjusted emergency department cost.

Savings Opportunities - Dashlet

ED Opportunity $

The cost savings for emergency department services if index goal had been met. (Lost savings)

Savings Opportunities - Dashlet

ED Outliers only PMPM

The per member per month emergency department cost for high total claim cost members only during the current period adjusted for member risk. See the definition of Risk Adjusted Per Member Per Month (PMPM) for more information.

Cost and Utilization Summary by Cost Bucket -Action Report

ED PMPM Actual Time Period 1 (w/out Outliers)

The per member per month emergency department cost, excluding high cost claimants, for the current period.

Variable Time Period Cost Overview -Dashlet

ED PMPM Actual Time Period 1 (w/Outliers)

The per member per month emergency department cost, including high cost claimants, for the current period.

Variable Time Period Cost Overview -Dashlet

ED PMPM Actual Time Period 2 (w/out Outliers)

The per member per month emergency department cost, excluding high cost claimants, for the previous period.

Variable Time Period Cost Overview -Dashlet

ED PMPM Actual Time Period 2 (w/Outliers)

The per member per month emergency department cost, including high cost claimants, for the previous period.

Variable Time Period Cost Overview -Dashlet

ED PMPM Peer Time Period 1 (w/out Outliers)

The peer comparison population's per member per month emergency department cost, excluding high cost claimants, for the current period.

Variable Time Period Cost Overview -Dashlet

ED PMPM Peer Time Period 1 (w/Outliers)

The peer comparison population's per member per month emergency department cost, including high cost claimants, for the current period.

Variable Time Period Cost Overview -Dashlet

ED PMPM Peer Time Period 2 (w/out Outliers)

The peer comparison population's per member per month emergency department cost, excluding high cost claimants, for the previous period.

Variable Time Period Cost Overview -Dashlet

ED PMPM Peer Time Period 2 (w/Outliers)

The peer comparison population's per member per month emergency department cost, including high cost claimants, for the previous period.

Variable Time Period Cost Overview -Dashlet

ED PMPM Variance %

The change in per member per month risk adjusted emergency department cost from the prior to the current period.

Savings Opportunities - Dashlet

ED Risk Adj PMPM Actual

The per member per month emergency department cost for the current period adjusted for member risk. See the definition of Risk Adjusted Per Member Per Month (PMPM) for more information.

Risk Adjusted Cost Overview -Dashlet

ED Risk Adj PMPM Actual (w/o Outliers)

The per member per month emergency department cost during the current period excluding high total claim cost members adjusted for member risk. See the definition of Risk Adjusted Per Member Per Month (PMPM) for more information.

Risk Adjusted Cost Overview w/o Outliers - Dashlet

ED Risk Adj PMPM Peer

The peer comparison population's per member per month emergency department cost for the current period adjusted for member risk. See the definition of Risk Adjusted Per Member Per Month (PMPM) for more information.

Risk Adjusted Cost Overview -Dashlet

ED Risk Adj PMPM Peer (w/o Outliers)

The peer comparison population's per member per month emergency department cost during the current period excluding high total claim cost members adjusted for member risk. See the definition of Risk Adjusted Per Member Per Month (PMPM) for more informatio

Risk Adjusted Cost Overview w/o Outliers - Dashlet

ED Risk Adjusted Actual PMPM

The per member per month emergency department cost for the current period adjusted for member risk. See the definition of Risk Adjusted Per Member Per Month (PMPM) for more information.

Cost and Utilization Summary by Cost Bucket -Action Report

ED Risk Adjusted Peer PMPM

The peer comparison population's per member per month emergency department cost for the current period adjusted for member risk. See the definition of Risk Adjusted Per Member Per Month (PMPM) for more information.

Cost and Utilization Summary by Cost Bucket -Action Report

ED Utilization/1000 Actual Time Period 1 (w/out Outliers)

The selected population Utilization/1000 emergency department utilization, excluding high utilization claimants, for the current period.

Variable Time Period Utilization Overview -Dashlet

ED Utilization/1000 Actual Time Period 1 (w/Outliers)

The Utilization/1000 emergency department utilization including high utilization claimants, for the current period.

Variable Time Period Utilization Overview -Dashlet

ED Utilization/1000 Actual Time Period 2 (w/out Outliers)

The selected population’s Utilization/1000 emergency department utilization, excluding high utilization claimants, for the previous period.

Variable Time Period Utilization Overview -Dashlet

ED Utilization/1000 Actual Time Period 2 (w/Outliers)

The selected population’s Utilization/1000 emergency department utilization, including high utilization claimants, for the previous period.

Variable Time Period Utilization Overview -Dashlet

ED Utilization/1000 Peer Time Period 1 (w/out Outliers)

The peer comparison population's Utilization/1000 emergency department utilization, excluding high utilization claimants, for the current period.

Variable Time Period Utilization Overview -Dashlet

ED Utilization/1000 Peer Time Period 1 (w/Outliers)

The peer comparison population's Utilization/1000 emergency department utilization, including high utilization claimants, for the current period.

Variable Time Period Utilization Overview -Dashlet

ED Utilization/1000 Peer Time Period 2 (w/out Outliers)

The peer comparison population's Utilization/1000 emergency department utilization, excluding high utilization claimants, for the previous period.

Variable Time Period Utilization Overview -Dashlet

ED Utilization/1000 Peer Time Period 2 (w/Outliers)

The peer comparison population's Utilization/1000 emergency department utilization, including high utilization claimants, for the previous period.

Variable Time Period Utilization Overview -Dashlet

ED Visits/1000 Count

The total visit count per 1,000 members for emergency department service.

Cost and Utilization Summary by Cost Bucket -Action Report

ED w/o Outliers PMPM

The per member per month emergency department cost excluding high total claim cost members during the current period adjusted for member risk. See the definition of Risk Adjusted Per Member Per Month (PMPM) for more information.

Cost and Utilization Summary by Cost Bucket -Action Report

Efficiency Index Result

The peer efficiency score represents the peer's actual medical cost compared to the target population's medical cost. An amount < 1.00, indicates that the target population is performing less efficiently than their peer.

Peer Comparison - Dashlet

Efficiency Index Result

The target population efficiency score represents the target population's actual medical cost compared to the peer's medical cost. An amount < 1.00, indicates that the target population is performing more efficiently than their peer.

Performance Overview - Dashlet

Eligble End

The latest documented coverage date.

Patient Profile - Action Report

Eligble Participant

Indicates if the member's medical benefit covers medical care coordination program participation.

Program Detail -Action Report

Eligble Start

The earliest documented coverage date.

Patient Profile - Action Report

Emergency Department - Cost

The per member per month cost associated with Emergency Department Services. This data is presented for the current and previous period for the selected health system. Appropriate peer values are displayed. Variances are calculated for peer values as well

Executive Summary - Action Report

Emergency Department - Utilization

The encounter count per 1,000 members for Emergency Department services. This data is presented for the current and previous period for the selected health system. Appropriate peer values are displayed. Variances are calculated for peer values as well as current to previous periods.  Previous to Current variances have trend indicators. To aid in rapid identification of trend changes, increases of 5.0% or more are highlighted in red, while decreases of 5.0% or more are highlighted in green.

Executive Summary - Action Report

Engaged End Date

The date when member's participation in the medical care coordination program was terminated.

Program Detail -Action Report

Engaged Indicator

Indicates the member's current status in the medical care coordination program.

Program Detail -Action Report

Engaged Member Count

The number of identified members who are actively participating in a medical care coordination program.

Program Summary - Action Report

Engaged member Percentage

The percentage of identified members who are actively participating in a medical care coordination program.

Program Summary - Action Report

Engaged Start Date

The date the member agreed to participate in the medical care coordination program.

Program Detail -Action Report

Enrollment Close Date

The date when the member's participation in the medical care coordination program was terminated.

Program Detail -Action Report

Enrollment Open Date

The date the member was identified to participate in the medical care coordination program.

Program Detail -Action Report

Followed by Acute Admission

Indicates if there was an acute care admission within 30 days of the discharge date of the shown admission.

Inpatient Admission - Action Report

Followed by SNF Admission

Indicates if there was an skilled nursing care admission within 30 days of the discharge date of the shown admission.

Inpatient Admission - Action Report

Gaps in Coding

The predicted number of missing or open Hierarchical Condition Category (HCC) coding opportunities for a given member or member based on the absence of a condition or the presence of other factors observed in the claims data.

General Definition

Generic Available Indicator

Indicates if a generic version is available for the reported drug.

Prescribing Pattern -Action Report

Generic Fill Ratio

The percentage of total prescriptions that were filled with a generic drug for members in the target population in the current period.

Prescribing Pattern -Action Report

Generic Name

The drug name assigned by the United States Adopted Names Council (USAN).

Prescribing Pattern -Action Report

Generic Total Costs

The maximum amount on which payment is based for covered generic drug prescriptions.

Prescribing Pattern -Action Report

Generic Total Scripts

The number of 30 day equivalent prescription for generic drug prescriptions.

Prescribing Pattern -Action Report

HCC

Hierarchical Condition Category

General Definition

HCC's Suspected

The total and average number of suspected chronic HCCs during the current period for commercial members. Suspected HCCs are not previously coded in year 1, year 2 or year 3.

Commercial Risk Adjustment - Dashlet

HCC's Suspected Average

The average number of suspected chronic HCCs during the current period for members who have a Commercial medical health insurance product.

Commercial Risk Adjustment - Dashlet

HCC's Suspected Average

The average number of suspected chronic HCCs during the current period for members who have a Medicare Advantage health insurance product.

Medicare Advantage Risk Adjustment - Dashlet

HCC's Suspected Total #

The number of suspected chronic HCCs during the current period for members who have a Commercial medical health insurance product.

Commercial Risk Adjustment - Dashlet

HCC's Suspected Total #

The number of suspected chronic HCCs during the current period for members who have a Medicare Advantage health insurance product.

Medicare Advantage Risk Adjustment - Dashlet

Healthcare Effectiveness Data and Information Set

A tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.

General Definition

HHS

Health and Human Services

General Definition

Hierarchical Condition Category (HCC)

Hierarchical Condition Category Coding is used by Centers for Medicare and Medicaid Services’ (CMS) to adjust capitation payments based upon health expenditure risk of patient panel.

General Definition

High Cost Patient Count

The number of members in the panel during the current period with total cost that exceeds a pre-defined threshold. (configurable parameter value defined by the health system). High cost includes both medical and pharmacy costs.

Executive Summary - Action Report

High Cost Patients

The number of members in the panel during the current period with total cost that exceeds a pre-defined threshold. (configurable parameter value defined by the health system). High cost includes both medical and pharmacy costs.

High Cost Patients -Population Measures

High Cost Patients

Count of the number of high cost patients in the selected health system and practice.

Executive Detail - Action Report