This report is designed to show where a client has member/patient leakage.  This report can also be used with capitated contracts.

 

 

Target Audience for this Report 

Chief Medical Officer, Compliance & Regulatory Department, Finance Department and CFO, Leadership Team, Physician Relations, Utilization Management and Sales and Client Relations.

 

Business Processes Impacted by this Report

Identifies areas where provider network coverage might be lacking.  

 

Detail and Definitions

Navigation options on this report are limited.  The user can select a group(s) in the first table “Group Panel and Utilizers of Primary Care Services” to filter on a group in that table.  Hold the “Ctrl” key to select multiple groups.  The User can then select a row(s) in the “Leakage to Groups” table to populate the other tables including; Service Types, Member types, and a detail member table.  The header information is somewhat constant and does not change with selections made within the visualization.  It will change with page filters applied.  Leakage refers to when a member’s PCP Group name is different than the Provider Billing Group.

 

Primary Care Provider Group

  • Group Name
  • Panel
  • Utilizing Members
  • Total Leakage

 

Leakage to Groups

  • Group
  • Total Leakage
  • Leakage %

 

Leakage to Providers (Graph)

  • Provider Leakage
  • Total Leakage

 

Utilizers of Primary Care Service by Age and Gender (Graph)

  • Age (Adult and Children) and Gender
  • Total Patients

 

Services Used by Members (Graph)

  • Service Category
  • Total Leakage

 

Members

  • Member Number
  • Member Name
  • Age
  • Gender
  • Paid