Pha - Pla

Pharmacy - Cost

The per member per month cost associated with Pharmacy 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

Pharmacy - Utilization

The encounter count per 1,000 members for Pharmacy 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

Pharmacy All PMPM

The per member per month pharmacy cost for the 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

Pharmacy Applying Stoploss

The per member per month pharmacy cost for the after capping member total cost based on the pre-selected threshold. 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

Pharmacy Care Peer Time Period 2 (w/out Outliers)

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

Variable Time Period Cost Overview -Dashlet

Pharmacy Care Peer Time Period 2 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

Pharmacy Care PMPM Actual Time Period 2 (w/out Outliers)

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

Variable Time Period Cost Overview -Dashlet

Pharmacy Care PMPM Actual Time Period 2 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

Pharmacy Care PMPM Peer Time Period 1 (w/out Outliers)

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

Variable Time Period Cost Overview -Dashlet

Pharmacy Care PMPM Peer Time Period 1 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

Pharmacy Cost Health System Current PMPM Applying Stop Loss Dollars

The health system's per member per month pharmacy cost for the current period after capping member total cost based on the pre-selected threshold.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Cost Health System PMPM Applying Stop Loss Dollars

The change in the health system's per member per month pharmacy cost from the prior to the current period after capping member total cost based on the pre-selected threshold.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Cost Health System Previous PMPM Adjusted

The health system's per member per month pharmacy cost for the current period after capping member total cost based on the pre-selected threshold and adjusted for the change in member risk from prior to current period.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Cost Health System Previous PMPM Applying

The health system's per member per month pharmacy cost for the prior period after capping member total cost based on the pre-selected threshold.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Cost Peer Current PMPM Applying Stop Loss

The peer comparison population's per member per month pharmacy cost for the current period after capping member total cost based on the pre-selected threshold.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Cost Peer PMPM Applying Stop Loss % Change

The change in the peer comparison population's per member per month pharmacy cost from the prior to the current period after capping member total cost based on the pre-selected threshold.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Cost Peer Previous PMPM Adjusted for Change

The peer comparison population's per member per month pharmacy cost for the current period after capping member total cost based on the pre-selected threshold and adjusted for the change in member risk from prior to current period.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Cost Peer Previous PMPM Applying Stop Loss

The peer comparison population's per member per month pharmacy cost for the prior period after capping member total cost based on the pre-selected threshold.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Cost Risk Adjusted Peer PMPM w/o Outliers

The change in the peer comparison population's risk adjusted per member per month pharmacy cost excluding high total claim cost members from the prior to the current period.

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Cost Risk Adjusted Peer PMPM w/o Outliers

The peer comparison population's per member per month pharmacy 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.

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Cost Risk Adjusted Peer PMPM w/o Outliers

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

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Cost Risk Adjusted PMPM w/o Outliers - Current

The per member per month pharmacy 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.

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Cost Risk Adjusted PMPM w/o Outliers - Previous

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

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Cost Risk Adjusted PMPM w/o Outliers % Change

The change in the risk adjusted per member per month pharmacy cost excluding high total claim cost members from the prior to the current period.

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Current Risk

A weighted measure of a population’s potential to incur expenses based on a combination of the population’s eligibility, age, gender, medical and pharmacy history. Weighting is based on each individual’s pharmacy member months in relation to the population’s pharmacy member months in the current time period. A weighted risk greater than 1.0 indicates the population’s potential for incurring higher than average cost. For example, a population with a weighted risk score of 2.5 has the potential to cost 2.5 times the average population’s cost.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Current Rolling 12 with Runout PMPM

The per member per month pharmacy cost for the current period.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Current Rolling 12 with Runout PMPM Apply

The per member per month pharmacy cost for the current period after capping member total cost based on the pre-selected threshold.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Current Rolling 12 with Runout PMPM w/o Outliers

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

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Current Rolling 12 with Runout PMPM with Outliers

The per member per month pharmacy cost during the current period.

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Current Rolling 12 with Runout Risk Adjusted

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

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Current Rolling 12 with Runout Risk Adjusted

The per member per month pharmacy 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.

Medical and Pharmacy Cost Summary -Action Report

Pharmacy ID

The identifier of the pharmacy where the prescription was filled.

Pharmacy Detail - Action Report

Pharmacy Index

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

Savings Opportunities - Dashlet

Pharmacy 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 pharmacy cost.

Savings Opportunities - Dashlet

Pharmacy Member Months

The number of months that members were enrolled in a pharmacy product during the current period.

Cost and Utilization Summary by Cost Bucket -Action Report

Pharmacy Name

The name of the pharmacy where the prescription was filled.

Pharmacy Detail - Action Report

Pharmacy Opportunity $

The cost savings amount for pharmacy services if the index goal had been met. (Lost savings)

Savings Opportunities - Dashlet

Pharmacy Outliers only PMPM

The per member per month pharmacy 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

Pharmacy Peer Time Period 2 (w/out Outliers)

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

Variable Time Period Cost Overview -Dashlet

Pharmacy Peer Time Period 2 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

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

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

Variable Time Period Cost Overview -Dashlet

Pharmacy PMPM Actual Time Period 1 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

Pharmacy PMPM Applying Stop Loss Result

The per member per month pharmacy cost that does not exceed the stop loss threshold during the current period.

Peer Comparison, Performance Overview - Dashlet

Pharmacy PMPM Applying Stop Loss Trend

A directional arrow that indicates whether the change in cost was positive or negative.

Peer Comparison, Performance Overview - Dashlet

Pharmacy PMPM Applying Stop Loss Variance

The change in risk adjusted per member per month pharmacy cost from the prior to the current period after applying stop loss.

Peer Comparison, Performance Overview - Dashlet

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

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

Variable Time Period Cost Overview -Dashlet

Pharmacy PMPM Peer Time Period 1 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

Pharmacy PMPM Peer Time Period 2 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

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

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

Variable Time Period Cost Overview -Dashlet

Pharmacy PMPM Variance %

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

Savings Opportunities - Dashlet

Pharmacy Previous PMPM

The per member per month pharmacy cost for the prior period.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Previous PMPM Applying Stop Loss Adjusted

The per member per month pharmacy cost for the prior period after capping member total cost based on the pre-selected threshold and adjusted for the change in member risk from prior to current period.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Previous PMPM Applying Stop Loss Dollars

The per member per month pharmacy cost for the prior period after capping member total cost based on the pre-selected threshold.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Previous PMPM w/o Outliers

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

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Previous PMPM with Outliers

The per member per month pharmacy cost during the prior period.

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Previous Risk

A weighted measure of a population’s potential to incur expenses based on a combination of the population’s eligibility, age, gender, medical and pharmacy history. Weighting is based on each individual’s pharmacy member months in relation to the population’s pharmacy member months in the prior time period. A weighted risk greater than 1.0 indicates the population’s potential for incurring higher than average cost. For example, a population with a weighted risk score of 2.5 has the potential to cost 2.5 times the average population’s cost.

Medical and Pharmacy Financial Summary - Action Report

Pharmacy Previous Risk Adjusted PMPM w/o Outliers

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

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Previous Risk Adjusted PMPM With Outliers

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

Medical and Pharmacy Cost Summary -Action Report

Pharmacy Risk Adj PMPM Actual

The per member per month pharmacy 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

Pharmacy Risk Adj PMPM Actual (w/o Outliers)

The per member per month pharmacy 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

Pharmacy Risk Adj PMPM Peer

The peer comparison population's per member per month pharmacy 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

Pharmacy Risk Adj PMPM Peer (w/o Outliers)

The peer comparison population's per member per month pharmacy 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

Pharmacy Risk Adjusted Actual PMPM

The per member per month pharmacy 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

Pharmacy Risk Adjusted Peer PMPM

The peer comparison population's per member per month pharmacy 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

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

Pharmacy Visits/1000 Count

The total prescription count per 1,000 members for pharmacy services. Prescription count is based on 30 day script supply.

Cost and Utilization Summary by Cost Bucket -Action Report

Pharmacy w/o Outliers PMPM

The per member per month pharmacy 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

Place of Service

The indicator of where the service was performed.

Inpatient Admission - Action Report