Hos - Med

Hospital Services - Cost

The per member per month cost associated with Hospital 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

Hospital Services - Utilization

The encounter count per 1,000 members for Hospital 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

Hospital Services All PMPM

The per member per month hospital services 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

Hospital Services Index

The ratio of the health system's per member per month risk adjusted hospital service cost compared to the peer comparison population's per member per month risk adjusted hospital services cost.

Savings Opportunities - Dashlet

Hospital Services 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 hospital services cost.

Savings Opportunities - Dashlet

Hospital Services Opportunity $

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

Savings Opportunities - Dashlet

Hospital Services Outliers only PMPM

The per member per month laboratory 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

Hospital Services Outliers only PMPM

The per member per month hospital services 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

Hospital Services PMPM Actual Time Period 1 (w/Outliers)

The per member per month hospital services cost, including high cost claimants, for the current period.

Variable Time Period Cost Overview -Dashlet

Hospital Services PMPM Actual Time Period 1 (w/out Outliers)

The per member per month hospital services cost, excluding high cost claimants, for the current period.

Variable Time Period Cost Overview -Dashlet

Hospital Services PMPM Actual Time Period 2 (w/Outliers)

The per member per month hospital services cost, including high cost claimants, for the previous period.

Variable Time Period Cost Overview -Dashlet

Hospital Services PMPM Actual Time Period 2 (w/out Outliers)

The per member per month hospital services cost, excluding high cost claimants, for the previous period.

Variable Time Period Cost Overview -Dashlet

Hospital Services PMPM Peer Time Period 1 (w/out Outliers)

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

Variable Time Period Cost Overview -Dashlet

Hospital Services PMPM Peer Time Period 1 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

Hospital Services PMPM Peer Time Period 2 (w/out Outliers)

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

Variable Time Period Cost Overview -Dashlet

Hospital Services PMPM Peer Time Period 2 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

Hospital Services PMPM Variance %

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

Savings Opportunities - Dashlet

Hospital Services Risk Adj PMPM Actual

The per member per month hospital services 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

Hospital Services Risk Adj PMPM Actual (w/o Outliers)

The per member per month hospital services 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

Hospital Services Risk Adj PMPM Peer

The peer comparison population's per member per month hospital services 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

Hospital Services Risk Adj PMPM Peer (w/o Outliers)

The peer comparison population's per member per month hospital services 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

Hospital Services Risk Adjusted Actual PMPM

The per member per month hospital services 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

Hospital Services Risk Adjusted Peer PMPM

The peer comparison population's per member per month hospital services 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

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

The selected population’s Utilization/1000 hospital services utilization, excluding high utilization claimants, for the current period.

Variable Time Period Utilization Overview -Dashlet

Hospital Services Utilization/1000 Actual Time Period 1 (w/Outliers)

The selected population’s Utilization/1000 hospital services utilization, including high utilization claimants, for the current period.

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

Hospital Services Utilization/1000 Actual Time Period 2 (w/Outliers)

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

Hospital Services Utilization/1000 Peer Time Period 1 (w/Outliers)

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

Hospital Services Utilization/1000 Peer Time Period 2 (w/Outliers)

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

Variable Time Period Utilization Overview -Dashlet

Hospital Services w/o Outliers PMPM

The per member per month hospital services 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

Hospital Visits/1000 Count

The total visit count per 1,000 members for hospital services.

Cost and Utilization Summary by Cost Bucket -Action Report

ICD Type Code

The ICD version code related to the claim.

Claim Detail, Claim Summary, Inpatient Admission -Action Report

Identified Member Count

The number of members identified for possible participation in a medical care coordination program.

Program Summary - Action Report

Inpatient Service Type

A grouping of the type of procedure or treatment received during an admission to a care facility.

General Definition

International Classification of Diseases (ICD)

A standardized medical code set for medical conditions, diagnoses, and inpatient hospital procedures.

General Definition

IP

Inpatient

General Definition

IP Admits via ED - Utilization

The admissions count per 1,000 members for Inpatient Admissions through the Emergency Department. 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

Key Performance Indicators

Key Performance Indicators (KPIs) are measures used by organizations to determine how well they are performing against targets or expectations.

General Definition

Lab All PMPM

The per member per month laboratory 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

Lab Index

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

Savings Opportunities - Dashlet

Lab 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 lab cost.

Savings Opportunities - Dashlet

Lab Opportunity $

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

Savings Opportunities - Dashlet

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

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

Variable Time Period Cost Overview -Dashlet

Lab PMPM Actual Time Period 1 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

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

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

Variable Time Period Cost Overview -Dashlet

Lab PMPM Actual Time Period 2 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

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

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

Variable Time Period Cost Overview -Dashlet

Lab PMPM Peer Time Period 1 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

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

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

Variable Time Period Cost Overview -Dashlet

Lab PMPM Peer Time Period 2 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

Lab PMPM Variance %

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

Savings Opportunities - Dashlet

Lab Risk Adj PMPM Actual

The per member per month laboratory 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

Lab -Risk Adj PMPM Actual

The per member per month laboratory 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

Lab Risk Adj PMPM Peer

The peer comparison population's per member per month laboratory 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

Lab Risk Adj PMPM Peer (w/o Outliers)

The peer comparison population's per member per month laboratory 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

Lab Risk Adjusted Actual PMPM

The per member per month laboratory 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

Lab Risk Adjusted Peer PMPM

The peer comparison population's per member per month laboratory 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

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

The selected population’s Utilization/1000 laboratory utilization, excluding high utilization claimants, for the current period.

Variable Time Period Utilization Overview -Dashlet

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

The selected population’s Utilization/1000 laboratory utilization, including high utilization claimants, for the current period.

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

Lab Visits/1000 Count

The total visit count per 1,000 members for laboratory services.

Cost and Utilization Summary by Cost Bucket -Action Report

Lab w/o outliers PMPM

The per member per month laboratory 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

Laboratory - Cost

The per member per month cost associated with Laboratory 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

Laboratory - Utilization

The encounter count per 1,000 members for Laboratory 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

Last ED Visit

The date of the most recent emergency department admission during the current period that did not result in an inpatient admission.

Patient Panel - Action Report

Last IP Visit Date

As of the most recent full data refresh, the last inpatient discharge date. This may include discharges in the current reporting period or future, pre-authorized inpatient stays. If the last inpatient stay has a missing discharge date, the last admission

Patient Panel - Action Report

Last Occurrence Date

The date when the quality opportunity procedure was last performed.

Patient Opportunity Detail - Action Report

Last Prescription Fill Date

The fill date for the most recent prescription.

Patient Panel - Action Report

Last Related Service Date

Field will be part of a future enhancement.

Patient Opportunity Detail - Action Report

Last Specialist Visit Date

The date of the most recent visit with a specialist (non primary care physician) during the current period.

Patient Panel - Action Report

Length of Stay

The length of an inpatient episode of care. Calculated from the day of admission to the day of discharge.

Claim Summary,Inpatient Admission -Action Report

Line of Business

A high level description of the benefit coverage. (Commercial, Medicaid, etc.)

Inpatient Admission, Patient Panel, Patient Profile - Action Report

Master Patient ID

A unique identifier for a person that does not change over their lifetime.

Claim Detail, Claim Summary, Inpatient Admission, Patient Opportunity Detail, Patient Opportunity Summary, Patient Panel, Patient Profile, Pharmacy Detail, Program Detail -Action Report

MDC Code

The Major Diagnostic Category (MDC) code as defined by CMS classifying the principal diagnosis into an organ system category.

Claim Summary -Action Report

MDC Description

The Major Diagnostic Category (MDC) description as defined by CMS classifying the principal diagnosis into an organ system category.

Claim Summary -Action Report

Measure Description

The name of the quality opportunity.

Quality Deviation Summary -Action Report;Quality Opportunity Summary -Dashlet

Median Age

The age where 50% of the members in the panel during the current period fall below this age and 50% fall above this age.

Median Age -Population Measures