The report is a comprehensive view of the condition drivers of cost using PMPM, Total Paid, Paid/Claim, or Patients as the Key Performance Indicator.  Filtering further refines the report to obtain the information relevant for the user.  By selecting the condition in the first panel, the information describes the physician, facility, and place of service tied to the cost, risk, and utilization.



Target Audience for this Report 

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


Business Impacts of this Report

This detailed cost and utilization data supports the analysis of specific cost drivers which increases understanding of member population health.  Supports care management and disease management program development and implementation.  Targeted strategies for areas of potential savings will be developed and priorities identified.  Offers predictive value for costs to support budget forecasts.


Physician and facility analysis focuses the health plan strategies for cost reduction where appropriate.  Sharing the information with employers at an aggregate level assists with an understanding of their employee's health status.


Detail and Definitions

The list of chronic conditions for this report with associated diagnoses, is based off of the CMS table, as refined by the Clinigence Health Medical Advisory Board.  That list is available for review in Appendix A.  This report is based on the detailed reporting period, which means the Diseases Cost and Patients information included in the header are within that reporting period.  Note that the header information is active, and will change when selections are made/filters are applied.  The selection box in the header “Cost and Utilization Measure” allow the user to change the view of the report from PMPM, Total Paid, Paid per Claim (all dollar amounts) or Patients (a numeric value).  


KPI (selection) – allow the user to change the view of the report from:

  • Paid/Claim
  • PMPM
  • Patients
  • Total Paid


Condition Drivers of Cost

  • Major Condition Category
  • By KPI selected (Paid/Claim, PMPM, Total Paid, Patients)


Primary Care Providers

  • PCP Name
  • (KPI)
  • % Spent


Condition Drivers by Place of Service

  • POS
  • (KPI)
  • % Spent


Condition Drivers by Provider Type

  • Provider Type
  • (KPI)
  • % Spent


Costs by Servicing Providers

  • Provider
  • Provider ID
  • Patients
  • Avg Risk
  • Direct Costs
  • Indirect Costs
  • Total Costs
  • Cost/Member



Note that filtering order in the visualization is:

  1. Condition (not a required selection)
  2. Institutions and Non Physicians (Cost of Treating Disease) (not a required selection)
  3. Top Physician