Rad - Ser

Radiology - Cost

The per member per month cost associated with Radiology 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

Radiology - Utilization

The encounter count per 1,000 members for Radiology 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

Radiology All PMPM

The per member per month radiology 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

Radiology Index

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

Savings Opportunities - Dashlet

Radiology 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 radiology cost.

Savings Opportunities - Dashlet

Radiology Opportunity $

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

Savings Opportunities - Dashlet

Radiology Outliers only PMPM

The per member per month radiology 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

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

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

Variable Time Period Cost Overview -Dashlet

Radiology PMPM Actual Time Period 1 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

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

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

Variable Time Period Cost Overview -Dashlet

Radiology PMPM Actual Time Period 2 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

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

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

Variable Time Period Cost Overview -Dashlet

Radiology PMPM Peer Time Period 1 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

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

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

Variable Time Period Cost Overview -Dashlet

Radiology PMPM Peer Time Period 2 (w/Outliers)

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

Variable Time Period Cost Overview -Dashlet

Radiology PMPM Variance %

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

Savings Opportunities - Dashlet

Radiology Risk Adj PMPM Actual

The per member per month radiology 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

Radiology Risk Adj PMPM Actual (w/o Outliers)

The per member per month radiology 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

Radiology Risk Adj PMPM Peer

The peer comparison population's per member per month radiology 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

Radiology Risk Adj PMPM Peer (w/o Outliers)

The peer comparison population's per member per month radiology 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

Radiology Risk Adjusted Actual PMPM

The per member per month radiology 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

Radiology Risk Adjusted Peer PMPM

The peer comparison population's per member per month radiology 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

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

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

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

Variable Time Period Utilization Overview -Dashlet

Radiology Visits/1000 Count

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

Cost and Utilization Summary by Cost Bucket -Action Report

Radiology w/o Outliers PMPM

The per member per month radiology 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

RAF

Risk Adjustment Factor

General Definition

RAF / CRA

The member's risk score determined using either CMF Risk Adjustment Model (RAF) or HHS risk adjustment model (CRA).

Patient Panel, Patient Profile - Action Report

Readmission

The total costs for the associated readmissions.

Readmission Costs -Dashlet

Readmit %

The percentage of admissions that resulted in a readmissions to an acute care facility (within 30 days) during the current period.

Inpatient Comparative - Dashlet

Readmit Date

This date appears on an inpatient admission that was followed by an acute inpatient admission within 30 days of discharge. It contains the date the member was readmitted to an acute inpatient setting.

Inpatient Admission - Action Report

Readmit Date

As of the most recent full data refresh, if the member had a readmission within the current reporting period, then this field contains the admission date related to the readmission. A readmission is defined as returning to an acute inpatient facility within 30 days of discharge from any type of inpatient facility.

Patient Panel - Action Report

Readmit Discharge Date

This date appears on an inpatient admission that was followed by an acute inpatient admission within 30 days of discharge. It contains the date the member was discharge from the readmission.

Inpatient Admission - Action Report

Readmit Discharge Date

As of the most recent full data refresh, if the member had a readmission within the current reporting period, then this field contains the discharge date related to the readmission. A readmission is defined as returning to an acute inpatient facility within 30 days of discharge from any type of inpatient facility.

Patient Panel - Action Report

Readmit Flag

A flag that indicates whether there was a readmission to an acute care facility within 30 days.

General Definition

Readmits - Utilization

The re-admission count per 1,000 members who had a previous admission. 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

Readmits/1000 Actual

For members, any age, the number of inpatient stays during the current period that were followed by an unplanned acute admission for any diagnosis within 30 days. Additional exclusions include: 1) The member died during the initial admission, 2) A discharge status indicating the member was discharged against medical advice on the initial admission, 3) A principal diagnosis of pregnancy on readmission, 4) A principal diagnosis of perinatal conditions on readmission, 5) A principal diagnosis of maintenance chemotherapy on readmission, 6) A principal diagnosis of maintenance radiation treatment on readmission, 7) A principal diagnosis of maintenance dialysis treatment on readmission, 8) Direct transfers from one facility to another, 9) Inpatient stays where the admission and discharge dates are equal

Inpatient Utilization - Dashlet

Readmitting Diagnosis Code

This code appears on an inpatient admission that was followed by an acute inpatient admission within 30 days of discharge. It contains the International Classification for Diseases (ICD) code for classifying the primary diagnosis reported when the member was discharge from the readmission.

Inpatient Admission - Action Report

Readmitting Diagnosis Code

As of the most recent full data refresh, if the member had a readmission within the current reporting period, then this field contains the International Classification for Diseases (ICD) code for classifying the primary diagnosis reported on the readmission. A readmission is defined as returning to an acute inpatient facility within 30 days of discharge from any type of inpatient facility.

Patient Panel - Action Report

Readmitting Diagnosis Description

This description appears on an inpatient admission that was followed by an acute inpatient admission within 30 days of discharge. It contains the International Classification for Diseases (ICD) description for classifying the primary diagnosis reported when the member was discharge from the readmission.

Inpatient Admission - Action Report

Readmitting Diagnosis Description

As of the most recent full data refresh, if the member had a readmission within the current reporting period, then this field contains the International Classification for Diseases (ICD) description for classifying the primary diagnosis reported on the readmission. A readmission is defined as returning to an acute inpatient facility within 30 days of discharge from any type of inpatient facility.

Patient Panel - Action Report

Readmitting Facility

This name appears on an inpatient admission that was followed by an acute inpatient admission within 30 days of discharge. It contains the facility name that the member was discharge from related to the readmission.

Inpatient Admission - Action Report

Readmitting Facility

As of the most recent full data refresh, if the member had a readmission within the current reporting period, then this field contains the facility name related to the readmission. A readmission is defined as returning to an acute inpatient facility within 30 days of discharge from any type of inpatient facility.

Patient Panel - Action Report

Readmitting ICD Type Code

This code appears on an inpatient admission that was followed by an acute inpatient admission within 30 days of discharge. It contains the ICD version code reported for readmission to an acute inpatient setting.

Inpatient Admission - Action Report

Readmitting ICD Type Code

As of the most recent full data refresh, if the member had a readmission within the current reporting period, then this field contains the ICD version code related to the readmission. A readmission is defined as returning to an acute inpatient facility within 30 days of discharge from any type of inpatient facility.

Patient Panel - Action Report

Referral Close Reason Code

A code that indicates the reason the attempt to engage the member in a medical care coordination program was discontinued.

Program Detail -Action Report

Referral Close Reason Description

A description that indicates the reason the attempt to engage the member in a medical care coordination program was discontinued.

Program Detail -Action Report

Referred from Another Program Count

The number of identified members who were referred from another medical care coordination program.

Program Summary - Action Report

Referred From another Program Indicator

Indicates the source that referred the member to the medical care coordination program.

Program Detail -Action Report

Rehab Admits - Utilization

he admission count per 1,000 members for Rehabilitation 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

Rehab Flag

Indicates if the admission was for rehabilitation care.

Inpatient Admission - Action Report

Revenue Code

The National Uniform Billing Community (NUBC) revenue code for a hospital service line. It indicates the type of services that are being billed for.

Claim Detail -Action Report

Revenue Code Description

The National Uniform Billing Community (NUBC) revenue description for a hospital service line. It indicates the type of services that are being billed for.

Claim Detail -Action Report

Risk Ad Peer Pharmacy 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.

Pharmacy Cost -Dashlet

Risk Ad Pharmacy 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.

Pharmacy Cost -Dashlet

Risk Ad w/o Outliers Peer Pharmacy PMPM

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

Pharmacy Cost -Dashlet

Risk Ad w/o Outliers Pharmacy 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.

Pharmacy Cost -Dashlet

Risk Adj Medical PMPM

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

Medical Cost - Dashlet

Risk Adj Peer Medical PMPM

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

Medical Cost - Dashlet

Risk Adj w/o outliers Medical PMPM

The per member per month medical 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 Cost - Dashlet

Risk Adj 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 adjusted for member risk. See the definition of Risk Adjusted Per Member Per Month (PMPM) for more information.

Medical Cost - Dashlet

Risk Adjusted Medical Cost

The per member per month medical cost for the current period adjusted for member risk. 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

Risk Adjusted Medical Cost w/o Outliers

The per member per month medical cost, excluding high total claim cost members, adjusted for member risk. 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

Risk Adjusted Per Member Per Month (PMPM)

A measurement that represents the average cost, adjusted for age, gender, clinical conditions and severity of treatment, for the member for each month of active coverage.

General Definition

Risk Adjusted Pharmacy Cost

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

Risk Adjusted Pharmacy Cost w/o Outliers

The per member per month pharmacy cost, excluding high total claim cost members, adjusted for member risk. 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

Risk Adjusted PMPM Actual

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

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

Risk Adjusted PMPM Index

The ratio of the actual per member per month risk adjusted cost to the PCP peer per member per month risk adjusted cost.

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

Risk Adjusted PMPM PCP Peers

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

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

Risk Adjusted Total Cost

The sum of the risk adjusted pharmacy per member per month cost and risk adjusted medical per member per month 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.  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

Risk Adjusted Total Cost w/o Outliers

The sum of risk adjusted pharmacy cost w/o outliers and risk 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

Risk Adjustment Factor (RAF)

Related to CMS’ HCC Coding: Provides a numerical score of a Medicare member’s potential for future cost and utilization.

General Definition

Risk Score

A measure of a member's potential to incur expenses based on a combination of their age, gender, medical and pharmacy history.  A risk greater than 1.0 indicates the potential for incurring higher than average cost. For example, a member with a risk score of 2.5 has the potential to cost 2.5 times the average member’s cost.

General Definition

Service From Date

The earliest date of service for the claim.

Claim Detail -Action Report

Service From Date

The earliest date of service for the claim service line.

Claim Summary -Action Report

Service To Date

The latest date of service for the claim.

Claim Detail -Action Report

Service To Date

The latest date of service for the claim service line.

Claim Summary -Action Report