# - Acu

# Data Elements Captured - CAD

The number of required data elements submitted for members in the Coronary Artery Disease (CAD) clinical cohort. Providers will not receive credit for tests (elements) completed above the required element quantity.

Operational Performance - Dashlet

# Data Elements Captured - CHF

The number of required data elements submitted for members in the Chronic Heart Failure (CHF) clinical cohort. Providers will not receive credit for tests (elements) completed above the required element quantity.

Operational Performance - Dashlet

# Data Elements Captured - Diabetes

The number of required data elements submitted for members in the Diabetes clinical cohort. Providers will not receive credit for tests (elements) completed above the required element quantity.

Operational Performance - Dashlet

# Data Elements Captured - Total

The number of required data elements submitted for members clinical cohort. Providers will not receive credit for tests (elements) completed above the required element quantity.

Operational Performance - Dashlet

# Data Elements Not Captured - CAD

The number of required data elements missing for members in the Coronary Artery Disease (CAD) clinical cohort.

Operational Performance - Dashlet

# Data Elements Not Captured - CHF

The number of required data elements missing for members in the Chronic Heart Failure (CHF) clinical cohort.

Operational Performance - Dashlet

# Data Elements Not Captured - Diabetes

The number of required data elements missing for members in the Diabetes clinical cohort.

Operational Performance - Dashlet

# Data Elements Not Captured - Total

The number of required data elements missing for members clinical cohort.

Operational Performance - Dashlet

# of Cohort Patients - CAD

The number of members during the current period in the Coronary Artery Disease (CAD) clinical cohort.

Quality Performance - Dashlet

# of Cohort Patients - CHF

The number of members during the current period in the Chronic Heart Failure (CHF) clinical cohort.

Quality Performance - Dashlet

# of Cohort Patients - DM

The number of members during the current period in the Diabetes clinical cohort.

Quality Performance - Dashlet

# of Patients at Goal - CAD

The number of members during the current period in the Coronary Artery Disease (CAD) clinical cohort that have completed all required data elements and are in the quality compliance range.

Quality Performance - Dashlet

# of Patients at Goal - CHF

The number of members during the current period in the Chronic Heart Failure (CHF) clinical cohort that have completed all required data elements and are in the quality compliance range.

Quality Performance - Dashlet

# of Patients at Goal - DM

The number of members during the current period in the Diabetes clinical cohort that have completed all required data elements and are in the quality compliance range.

Quality Performance - Dashlet

# of Patients Excluded by Practice - CAD

The number of members during the current period that should be removed from the Coronary Artery Disease (CAD) clinical cohort due to a situational issue or incorrect assignment to the cohort based on input from the member's attributed provider practice.

Quality Performance - Dashlet

# of Patients Excluded by Practice - CHF

The number of members during the current period that should be removed from the Chronic Heart Failure (CHF) clinical cohort due to a situational issue or incorrect assignment to the cohort based on input from the member's attributed provider practice.

Quality Performance - Dashlet

# of Patients Excluded by Practice - DM

The number of members during the current period that should be removed from the Diabetes clinical cohort due to a situational issue or incorrect assignment to the cohort based on input from the member's attributed provider practice.

Quality Performance - Dashlet

# of Patients Not at Goal - CAD

The number of members during the current period in the Coronary Artery Disease (CAD) clinical cohort that have completed all required data elements but are not in the quality compliance range.

Quality Performance - Dashlet

# of Patients Not at Goal - CHF

The number of members during the current period in the Chronic Heart Failure (CHF) clinical cohort that have completed all required data elements but are not in the quality compliance range.

Quality Performance - Dashlet

# of Patients Not at Goal - DM

The number of members during the current period in the Diabetes clinical cohort that have completed all required data elements but are not in the quality compliance range.

Quality Performance - Dashlet

# of Prescriptions Filled

The total number of 30 day equivalent prescriptions.

Prescribing Pattern -Action Report

% Data Captured - CAD

The percentage of required data elements submitted for members in the Coronary Artery Disease (CAD) clinical cohort.

Operational Performance - Dashlet

% Data Captured - CHF

The percentage of required data elements submitted for members in the Chronic Heart Failure (CHF) clinical cohort.

Operational Performance - Dashlet

% Data Captured - Diabetes

The percentage of required data elements submitted for members in the Diabetes clinical cohort.

Operational Performance - Dashlet

% Data Captured - Total

The percentage of required data elements submitted for members clinical cohort.

Operational Performance - Dashlet

% Engaged in CM - Long-Term

The percentage of members who are actively participating in a long term case management program during the current period.

Program Management - Dashlet

% Engaged in CM -Short Term

The percentage of members who are actively participating in a short term case management program during the current period. Interventions are normally completed within a day or two.

Program Management - Dashlet

% Engaged in DM -High / Moderate Risk

The percentage of high and moderate risk members who are actively participated in a disease management program during the current period.

Program Management - Dashlet

% of Patients at Goal (Composite) - CAD

The percentage of members in the Coronary Artery Disease (CAD) clinical cohort that have completed all required data elements and are in the quality compliance range.

Quality Performance - Dashlet

% of Patients at Goal (Composite) - CHF

The percentage of members in the Chronic Heart Failure (CHF) clinical cohort that have completed all required data elements and are in the quality compliance range.

Quality Performance - Dashlet

% of Patients at Goal (Composite) - DM

The percentage of members in the Diabetes clinical cohort that have completed all required data elements and are in the quality compliance range.

Quality Performance - Dashlet

% of Total Cost Bucket

The percentage of total cost.

Top 10 Performing Providers by Cost Bucket, Top 10 Performing Providers by Specialty - Action Report

% of Total Specialty Bucket

The percentage of specialty bucket total dollars associated with the performing provider.

Top 10 Performing Providers by Specialty - Action Report

30 Day Readmission Flag

This flag appears on an inpatient admission that was followed by an acute inpatient admission within 30 days of discharge.

Inpatient Admission - Action Report

ACA

Accountable Care Arrangement

General Definition

Active Participant

Indicates if the members is currently active in the medical care coordination program.

Program Detail -Action Report

Actual Acute Admits/1000 Actual

For members, any age, the number of acute inpatient stays during the current period. Exclusions include: 1) A place or service, type of bill and/or revenue code indicating the stays was in a skilled nursing facility, 2) A place or service and/or revenue c

Inpatient Utilization - Dashlet

Actual ED Visits/1000

For members, any age, the number of emergency department visits during the current period. Exclusions: Emergency department visits that are associated with an inpatient stay.

Acute Care Utilization -Dashlet

Actual ED/1000

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

Utilization Overview -Dashlet

Actual Hospital Services/1000

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

Utilization Overview -Dashlet

Actual IP Admits via ED/1000

For members, any age, the number of inpatient stays during the current period that had an associated emergency department visit.

Acute Care Utilization -Dashlet

Actual Lab/1000

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

Utilization Overview -Dashlet

Actual Medical Cost

The actual per member per month medical cost. 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

Executive Summary - Action Report

Actual Medical Cost w/o Outliers

The per member per month medical cost excluding high total claim cost members. 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 we

Executive Summary - Action Report

Actual Medical PMPM

The per member per month medical cost during the current period including costs exceeding the stop loss threshold.

Medical Cost - Dashlet

Actual MHSA Admits/1000 Actual

For members, any age, the number of mental health or substance abuse inpatient stays during the current period. Inclusion in this measure is based on diagnosis code, Clinical Classification Software (CCS) category, Diagnosis Related Group (DRG) code and/o

Inpatient Utilization - Dashlet

Actual Observations/1000

For members, any age, the number of observation room visits during the current period. Observation room care on this dashlet is based on revenue code and procedure code. Excluded are observation room visits that are associated with an inpatient stay.

Acute Care Utilization -Dashlet

Actual Peer Medical PMPM

The peer comparison population's per member per month medical cost during the current period including costs exceeding the stop loss threshold.

Medical Cost - Dashlet

Actual Peer Pharmacy PMPM

The peer comparison population's per member per month pharmacy cost during the current period including costs exceeding the stop loss threshold.

Pharmacy Cost -Dashlet

Actual Pharmacy Cost

The actual per member per month pharmacy cost. 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 period. 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

Actual Pharmacy Cost w/o Outliers

The per member per month pharmacy cost excluding high total claim cost members. 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

Actual Pharmacy PMPM

The per member per month pharmacy cost during the current period including cost exceeding the stop loss threshold.

Pharmacy Cost -Dashlet

Actual Pharmacy/1000

The total encounter count per 1,000 members for pharmacy services. Service count is based on 30 day drug supply.

Utilization Overview -Dashlet

Actual Primary Care Visits/1000

The total encounter count per 1,000 members for primary care services.

Utilization Overview -Dashlet

Actual Radiology/1000

The total encounter count per 1,000 members for radiology services.

Utilization Overview -Dashlet

Actual Rehab Admits/1000 Actual

For members, any age, the number of rehab facility inpatient stays during the current period. Inclusion in this measure is based on place or service and/or revenue code.

Inpatient Utilization - Dashlet

Actual SNF Admits/1000 Actual

For members, any age, the number of skilled nursing facility inpatient stays during the current period. Inclusion in this measure is based on place or service, type of bill and/or revenue code.

Inpatient Utilization - Dashlet

Actual Specialty/1000

The total encounter count per 1,000 members for specialty services.

Utilization Overview -Dashlet

Actual Time Period 1

The PMPM for the population as determined by the Global Prompts for the first time period selected by the user.

Variable Time Period Cost Overview -Dashlet

Actual Time Period 1

The Utilization/1000 for the population as determined by the Global Prompts for the first time period selected by the user.

Variable Time Period Utilization Overview- Dashlet

Actual Time Period 2

The PMPM for the population as determined by the Global Prompts for the second time period selected by the user.

Variable Time Period Cost Overview -Dashlet

Actual Time Period 2

The Utilization/1000 for the population as determined by the Global Prompts for the second time period selected by the user.

Variable Time Period Utilization Overview -Dashlet

Actual Total Cost

The sum of the actual per member per month medical and actual per member per month pharmacy costs. 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

Actual Total Cost w/o Outliers

The sum of Actual Pharmacy Cost w/o Outliers and Actual Adjusted Medical Cost w/o Outliers. 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

Actual Urgent Care Visits/1000

For members, any age, the number of urgent care visits during the current period. Urgent care on this dashlet is based on procedure code.

Acute Care Utilization -Dashlet

Actual w/o Outliers Medical PMPM

The per member per month medical cost excluding high total claim cost members during the current period.

Medical Cost - Dashlet

Actual w/o Outliers Peer Medical PMPM

The peer comparison population's per member per month medical cost excluding high total claim cost members during the current period for the peer comparison population.

Medical Cost - Dashlet

Actual w/o Outliers Peer Pharmacy PMPM

The peer comparison population's per member per month pharmacy cost excluding high total claim cost members during the current period.

Pharmacy Cost -Dashlet

Actual w/o Outliers Pharmacy

The per member per month pharmacy cost excluding high total claim cost members during the current period.

Pharmacy Cost -Dashlet

Acute Admits - Utilization

The admissions count per 1,000 members for Acute Inpatient Admissions. 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

Acute Flag

Indicates if the admission was for acute care.

Inpatient Admission - Action Report