Target Audience for this Report

Chief Medical Officer, Compliance & Regulatory Department, Finance Department and CFO, Leadership Team, Medical management/Care Management Department, Physician Relations, and Utilization Management.

 

Business Impacts of this Report 

This report will allow target audience to compare multiple detailed KPI data points within the platform hierarchies to their peers. Targeted strategies for areas of potential savings will be developed and priorities identified.  These KPI’s can be used to determine how groups of data are performing in relationship to their peers.

 

Detail and Definitions

Group and Peer comparisons for Cost and Utilization are displayed as % Diff, which shows the percentage of difference between the Group and the Peer.   Green indicates that the Group is doing better than the Peer, and Red indicates that the Peer is doing better than the Group.

 

Costs Metrics and Comparisons

  • Inpatient PMPM – Group and Peer Costs, with % Diff
  • Medical PMPM – Group and Peer Costs, with % Diff
  • Outpatient PMPM – Group and Peer Costs, with % Diff
  • Pharmacy PMPM – Group and Peer Costs, with % Diff
  • Professional PMPM – Group and Peer Costs, with % Diff
  • Total Paid – Group and Peer Costs, with % Diff
  • Total PMPM – Group and Peer Costs, with % Diff

Cost & Utilization

  • Admissions – Group and Peer Costs, with % Diff and Group and Peer Utilization, with % Diff
  • Average LOS (length of stay) – Group and Peer Costs, with % Diff and Group and Peer Utilization, with % Diff
  • ER Visits – Group and Peer Costs, with % Diff and Group and Peer Utilization, with % Diff
  • Maternity – Group and Peer Costs, with % Diff and Group and Peer Utilization, with % Diff
  • Radiology – Group and Peer Costs, with % Diff and Group and Peer Utilization, with % Diff

Pharmacy

  • Brand Usage – Group and Peer Costs, with % Diff and Group and Peer Utilization, with % Diff
  • Formulary – Group and Peer Costs, with % Diff and Group and Peer Utilization, with % Diff
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  • Scripts Per Member – Group and Peer Utilization, with % Diff

Predictive Costs

  • Costs Next 12 Months – Group and Peer Costs, with % Diff 

Quality

  • Avoidable ER – Group and Peer Costs, with % Diff and Group and Peer Utilization, with % Diff
  • Complication – Group and Peer Costs, with % Diff and Group and Peer Utilization, with % Diff
  • Readmissions – Group and Peer Costs, with % Diff and Group and Peer Utilization, with % Diff

Risk Score

  • Admissions Risk – Group and Peer, with % Diff
  • Concurrent Risk – Group and Peer, with % Diff
  • Projected Risk – Group and Peer, with % Diff