This report provides detail on the all the care events during a member’s pregnancy. It should be noted that depending on the detailed reporting period, gestation period illustrated might have begun (first diagnosis of pregnancy) prior to the beginning of the reporting period.
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 Processes Impacted by this Report
Identification of high-risk pregnancy and pregnancy gaps in care with the maternity data can engage case managers with members to manage or reduce the risk of premature delivery or complications.
Best practices can be identified in the data and referral patterns can be modified to support a high performing network using the maternity metrics.
This report is designed to provide detail on provider performance for OB/delivery cases, with a goal of improving operational performance.
Detail and Definitions
Events or included in the calendar month in which they occurred, and are color coded by type, e.g. Office, Outpatient, Inpatient – Hospital, Ambulatory, Urgent Care. Months where no care events occurred of a specific type are shown with “No available values”.
The left side of the screen lists “Service Type” (which can be filtered on), and includes “Total Paid”, “Visits”, and “Paid/Claim”. Also shown is a “Pregnancy View” which lists the events associated with the pregnancy in chronological order and includes detail for Specialty, Procedure, Diagnosis, and Total Paid.