Cost and utilization summary by cost bucket
PMPM dollar amounts spread across the seven (7) cost and use buckets (ED, hospital services, lab, pharmacy, primary care, radiology, and specialty). Each bucket has PMPM’s divided into ‘actual’ and ‘norm’ categories.
Enrollment detail
Enrollment information related to the product at the member level such as contract type and description, plan and product description, and eligibility start and end date.
Enrollment summary
Enrollment information related to the product at the employer group level such as plan and product description, total member, subscriber, and dependent count, and total member, subscriber, and dependent paid amount.
Executive summary
An overview of medical and pharmacy data for the current and previous year as well as a comparison against the norm.
Financial summary
Employer PMPM medical and pharmacy cost for the previous and current period, as well as the previous PMPM adjusted for change in risk, in comparison to the norm.
Inpatient admission
Past and current inpatient admissions based on a supporting claim or census data. Information is presented one-line per confinement with multiple descriptive fields.
Member opportunity detail
A member level detailing of care, deviation, and coding-missing opportunities. This report contains information such as member name, attributed provider name, opportunity type, opportunities, opportunity status, star measure, etc.
Member opportunity summary
A member-by-member listing of various opportunities (total open opportunities, total number of open HCCs, open HCCs suspected, open HCCs missing, open care, open star, and number of deviations) along with counts for each category. Patient birth date, gender, and age are provided along with their practice/facility/site name and provider name.
Member summary
High level overview of each member. Information is presented one-line per member with multiple descriptive fields. Provides the ability to drill down to specific ‘action reports,’ such as claim detail, member opportunity detail, pharmacy detail, etc., through clickable information.
Prescribing pattern
Various pharmacy data metrics. From an overall perspective, total prescriptions and costs for data compared to the norm. Also, an NDC summarized list with multiple metrics including specialty drug indicator, generic name, class description, total cost, scripts filled, and generic available indicator.
Program detail
Member enrollment in, and utilization of, care management programs, including program type, program level, enrollment open and close date, number of interactions, and currently engaged indicator.
Program summary
Care management programs stratified by program level and program code. Also displays the number of enrolled members within each program as well as the engagement rate of those individuals.
Quality opportunity summary
A listing of quality measures that displays the measure description and number of Medicare advantage star opportunities. Also identifies the capture rate by dividing the number of quality opportunities met per measure by the number of quality opportunities per measure.
Top 10 performing providers by cost bucket
Actual PMPM dollar amounts spread across the seven cost and use buckets (ED, hospital services, lab, pharmacy, primary care, norm and a generated Index score to determine efficiency. Other metrics include: total paid, total visits, and percentage of total cost bucket.
Top 10 performing providers by specialty
Actual PMPM dollar amounts for the top 10 providers under specialty groupings. Other metrics include total paid, total visits, percentage of total cost bucket, and percentage of total specialty bucket.
