|
Cost - Medical High Cost Patient
|
Indicates if the Patient has High Medical Cost (configurable parameter value defined by the Health System) in the current rolling 12 month period
|
|
Cost - Pharmacy High Cost Patient
|
Indicates if the Patient has High Pharmacy Cost (configurable parameter value defined by the Health System) in the current rolling 12 month period
|
|
Cost - Total High Cost Patient
|
Indicates if the Patient has High Total Medical and Pharmacy Cost (configurable parameter value defined by the Health System) in the current rolling 12 month period
|
|
Count of Chronic Conditions Excluded - Accepted
|
Chronic Condition Exclusions submitted by a physician's office for contraindications which have been accepted by an auditor
|
|
Count of Chronic Conditions Excluded - Pending
|
Chronic Condition Exclusions submitted by a physician's office for contraindications which are still awaiting audit
|
|
Count of Chronic Conditions Excluded - Rejected
|
Chronic Condition Exclusions submitted by a physician's office for contraindications which have been rejected by an auditor
|
|
Count of Contraindications Excluded - Accepted
|
Contraindications submitted by a physician's office for contraindications which have been accepted by an auditor
|
|
Count of Contraindications Excluded - Pending
|
Contraindications submitted by a physician's office for contraindications which are still awaiting audit
|
|
Count of Contraindications Excluded - Rejected
|
Contraindications submitted by a physician's office for contraindications which have been rejected by an auditor
|
|
Coverage Status
|
Indicates if the Patient is currently enrolled in a Medical Product
|
|
CRA
|
The CRA is the patients' risk score if they are assigned to a practice and have a commercial insurance product. The risk score is determined using the HHS Commercial Risk Adjustment model
|
|
Currently in Case Management
|
Number of patients enrolled in a Case Management program
|
|
Currently in Disease Management Program
|
Number of patients enrolled in a Disease Management program
|
|
Currently in Maternity Management
|
Number of patients enrolled in a Maternity Case Management program
|
|
Custom QI Opportunities - Closed - Patients
|
The count of custom QI opportunities which have been closed
|
|
Custom QI Opportunities - Open - Patients
|
The count of custom QI opportunities which are still open
|
|
Custom QI Opportunities - Pending - Patients
|
The count of custom QI opportunities which have been submitted by an ACA and are awaiting audit determination
|
|
Custom QI Opportunities - Snoozed - Patients
|
The count of custom QI opportunities which have been postponed by the ACA for review at a future date
|
|
Demographic Risk Score
|
A member-level risk score calculated based upon the patient's demographic age and gender
|
|
Diabetes Indicator
|
Indicates if Patient has Diabetes
|
|
Discharged in Last 10 days
|
Number of attributed patients discharged from an acute or MHSA inpatient facility within the last 10 days (based on discharge date). This number is updated daily.
|
|
Drug PMPM
|
Pharmacy Cost per member per month for the current rolling 12 month period
|
|
ED Visits per 1K
|
Number of Emergency Department visits per 1000 members in the current rolling 12 month period
|
|
Gender - F
|
Indicates if the Patient Gender is Female
|
|
Gender - M
|
Indicates if the Patient Gender is Male
|
|
Gender - Other
|
Indicates if the Patient Gender is other than Male or Female
|
|
Generic Drug Opportunities - Non-Specialty - Patients
|
Count of patients who have a non-specialty generic drug opportunity
|
|
Generic Drug Opportunities - Specialty - Patients
|
Count of patients who have a specialty drug generic opportunity
|
|
High Condition Risk
|
Number of patients that are in the top 5% of the patient population based on descending prospective risk score
|
|
High Priority - High Condition Risk - Patients
|
Number of patients who qualify for being within the top 5% of condition risk
|
|
High Priority - High RAF/CRA - Patients
|
Number of patients who qualify for being within the top 5% of RAF or CRA risk scores
|
|
High Specialist Utilization
|
Number of patients with 10 or more specialist visits in the last 14 months
|
|
High Utilization - Emergency Department - Patients
|
Patients who have had 3 or more ED visits in the last 12 months
|
|
High Utilization - Inpatient - Patients
|
Patients who have had 3 or more inpatient admissions in the last 12 months
|
|
High Utilization - Outpatient - Patients
|
Patients who fall within the 95th percentile of outpatient services
|
|
High Utilization - Pharmacy - Patients
|
Patients who have had unusually high pharmacy costs
|
|
High Utilization - Radiology - Patients
|
Patients who have had 10 or more radiology services over the last 12 months
|
|
High Utilization - Specialist - Patients
|
Patient who have had 10 or more specialty visits within the last 12 months
|
|
High Volume Medical Events - Emergency Department
|
Indicates if attributed patient has high utilization (i.e. 3 or more) of Emergency Department in the current rolling 12 month period
|
|
High Volume Medical Events - Inpatient
|
Indicates if attributed patient has high utilization (i.e. 3 or more) of Inpatient Admissions in the current rolling 12 month period
|
|
High Volume Medical Events - Outpatient
|
Indicates if attributed patient has high utilization (i.e. 13 or more) of Outpatient Admissions in the current rolling 12 month period
|
|
High Volume Medical Events - Pharmacy
|
Indicates if attributed patient has high utilization of Pharmacy cost ((i.e. greater than or equal to $1800 Pharmacy cost) in the last 14 months
|
|
High Volume Medical Events - Radiology
|
Indicates if attributed patient has high utilization (i.e. 10 or more) of Radiology in the current rolling 12 month period
|
|
High Volume Medical Events - Specialist
|
Indicates if attributed patient has high utilization (i.e. 10 or more) Specialist Visits in the current rolling 12 month period
|
|
Hospitalized - Admitted within Last 30 Days
|
Indicates if the attributed patient has been admitted to an Acute or MHSA inpatient facility in the Last 30 Days
|
|
Hospitalized - Currently Admitted
|
Indicates if the attributed patient is currently admitted to an Acute or MHSA inpatient facility
|
|
Hospitalized - Discharge Disposition
|
Indicates the Discharge status of an attributed patient previously admitted to an Acute or MHSA inpatient facility
|
|
Hospitalized - Discharged Between Day1 And Day2
|
Indicates the date range for Discharge Dates for attributed patient previously admitted to an Acute or MHSA inpatient facility
|
|
Hospitalized - Discharged within Last 10 Days
|
Indicates if the attributed patient has been discharged from an Acute or MHSA inpatient facility in the Last 10 days
|
|
Hospitalized - Facility List
|
Indicates the Name of the Hospital that the attributed patient was admitted to
|
|
Hospitalized - Readmitted within Last 30 Days
|
Indicates if the attributed patient has been readmitted to an acute care facility within last 30 days.
|
|
Hospitalized - Type of Facility
|
Indicates whether the attributed patient was admitted to an Acute, MHSA, SNF, or Rehab facility
|
