The Hospital/Service Line report provides the important detail required to understand the service line cost and utilization.  Selecting from the comprehensive list of service lines returns hospital and revenue code specific to the selection, and further review by selecting the one of the hospitals offers a complete analysis of the utilization and cost of that service line in that facility.



Target Audience for this Report

Chief Medical Officer, Finance Department and CFO, Leadership Team, Medical management/Care Management Department, Utilization Management, and Sales and Client Relations.


Business Processes Impacted by this Report

Service line data is important to understand member population and predict future utilization.  This detailed cost and utilization data supports comparison analysis of hospitals and provider referral patterns.  This hospital utilization information provides insight regarding member preferences for facilities by service line.  Service line detail for all services produces informed strategies for rates and premium setting.


Detail and Definitions


  • Service Line (selection) – .  The “Service Line” filter will filter the data based off the service line on the inpatient claims in that period.  It is the DRG code that provides the detailed service line description.  The header information will update with Service Line selection.
  • KPI’s
    • Hospitals
    • Total Admissions
    • Total Patients
    • Total Paid
    • ReAdmit Rate
    • Avg LOS
    • Paid/Admit
  • Hospital Cost & Utilization Quadrant – Selecting a Hospital in the “Hospitals” table will filter the “Top Revenue Codes” table to only that selection.   Each Hospital is plotted on the “Hospital Cost & Utilization Quadrant” scatter plot, with the Average Patient Risk being the X axis, and PMPM being the Y axis.  The broken lines indicate the mean, and each solid line above or below the mean indicate a standard deviation.
  • Hospitals – Displays the facilities with the selected Service Line filter.
    • Hospital 
    • Total Patients
    • Paid Amount
    • Avg Pat Risk
  • Top Revenue Codes
    • Rev Code
    • Patients
    • Admits
    • Total Paid
    • Paid/Admit
    • ALOS