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Medical Events
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A count of any known medical event within the last 14 months
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Medical PMPM
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Medical Cost per member per month for the current rolling 12 month period.
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MHSA Admissions per 1K
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Number of MHSA Admissions per 1000 members in the current rolling 12 month period
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New Patients
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Number of patients newly attributed to provider within the last 3 months
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Non-Acute Admissions per 1K
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Number of Non-Acute Admissions per 1000 patients in the current rolling 12 month period
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Not Seen by PCP Practice in the last 12 Months
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Number of patients who have not seen their attributed primary care provider practice for an Evaluation and Management visit within the last 12 months
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Number of Acute IP Admits
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A patient's de-duplicated count of Acute Inpatient admission in the last 14 months as sourced from both census and claims data
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Number of ED Visits
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The count of a patient's visits to an Emergency Department in the last 14 months. Does not include ED visits that resulted in an admission
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Number of Non-Acute IP Admits
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A patient's de-duplicated count of Non-Acute Inpatient admission in the last 14 months as sourced from both census and claims data
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Number of Prescriptions Filled
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The count of 30-day equivalent pharmacy claims during the last 14 months
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Number of Specialty Visits
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The count of a patient's visits to specialist providers in the last 14 months
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Open Activities
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Number of open Coding, Quality, and Custom QI opportunities for follow up
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Open Coding Opportunities
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Number of patients with all open missing and suspect HCCs
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Open Custom QI Opportunities
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Number of patients with open Custom Quality Initiative Opportunities
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Open Quality Opportunities
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Number of patients with open Quality Opportunities
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Overall Adherence %
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Percentage of closed quality opportunities over the total number of quality opportunities for the selected population
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Patient Age
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The age of the patient as of the last day of the previous month
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Patient Alerts
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Count of automated alerts which have been triggered
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Patient Attribution - New to Existing Cohort
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Indicates if the Patient has been attributed to the Cohort in the last 3 months
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Patient Attribution - Newly Attributed Patient
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Indicates if the Patient has been attributed to the Provider Practice in the last 3 months
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Patient Attribution - Not Seen by Attributed PCP in Previous 12 Months
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Indicates patients who have not seen their attributed primary care provider practice for an Evaluation and Management visit within the last 12 months
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Patient Attribution - Previously Attributed to Another Provider
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Indicates if the Patient was assigned to another Provider in the previous rolling 12 month period
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Patient Exclusion
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The reason which an ACA is requesting that a patient be excluded from custom QI obligations
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Patient Exclusion Outcome
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Outcome of a patient exclusion which has been submitted by an ACA to remove a patient from custom QI obligations
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Patient Status
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The calculated status of a patient to determine if all custom QI opportunities have been effectively closed
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Patients Currently Admitted
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Number of attributed patients currently admitted to an acute or MHSA inpatient facility. This number is updated daily.
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Patients in Panel
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Number of patients currently attributed and enrolled in a health plan, includes current and newly attributed patients
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Patients Nearing Opportunity Date
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Number of patients who have an opportunity due date within the next three (3) months
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Payer - Name - Patients
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A summary of counts of patients by payer
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Quality Opportunities - Closed - Patients
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The count of HEDIS-driven quality opportunities which have been closed
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Quality Opportunities - Open - Patients
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The count of HEDIS-driven quality opportunities which are still open
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Quality Opportunities - Pending - Patients
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The count of HEDIS-driven quality opportunities which have been submitted by an ACA and are awaiting audit.
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Quality Opportunities - Snoozed - Patients
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The count of HEDIS-driven quality opportunities which have been postponed by the ACA for review at a future date
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RAF
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The RAF is the patients' risk score if they are assigned to the practice and have a Medicare Advantage insurance product. The risk score is determined using the CMS risk adjustment model
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Recent ED visit
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Number of patients with an Emergency Department visit within the last 15 months
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Risk Assessment - Demographic or Actuarial Risk Score
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Indicates if the Patient has a High Demographic or Actuarial Risk Score (i.e. Patient is in the top 5% of the patient population based on descending prospective risk score)
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Risk Assessment - High Condition Risk
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Indicates if the Patient has a High Condition Risk Score (i.e. Patient is in the top 5% of the patient population based on descending prospective risk score)
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Risk Assessment - High RAF/CRA
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Indicates if the Patient has a High RAF/CRA (i.e. Patient is in the top 5% of the patient population based on descending prospective risk score)
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STARS Adherence %
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Percentage of closed STARs opportunities (Medicare only) over the total number of STARs opportunities for the selected population.
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Sum of Alerts
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A sum of all automated alerts set up within Care Collaborator
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Total # of Closed Coding Opportunities
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For a given member, the total number of Instances defined by a set of standardized HCC where actionable steps have been taken to achieve compliance or non-compliance based on missing or suspect opportunities
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Total # of Closed Custom QI Opportunities
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For a given member, the number of instances to improve the patient satisfaction of care (as per the agreement by the Health System and Practice) that have been met
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Total # of Closed Quality Opportunities
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From a review of members' clinical events, circumstances that are defined as clinical opportunities are reviewed to check for anticipated current or subsequent actions. If those actions are found, the opportunity is considered closed and counted here
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Total # of Current Care Programs
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The number of recommended care opportunities identified for a member that remain open
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Total # of HCCs Missing
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For a given patient, the total number of situations where a retrospective review of the patient's coded history would likely indicate the presence of a condition unlikely to have resolved, and hence inadvertently and incidentally left out of their current claims coding
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Total # of HCCs Suspected
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For a given patient, the total number of situations where advanced algorithms have predicted a patient may have a condition not present in their claims coding, due to the presence of other factors observed in the claims data and often seen with the suspect condition
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Total # of Open Coding Opportunities
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For a given member, the total number of Instances defined by a set of standardized HCC where actionable steps can be taken to achieve compliance or non-compliance based on missing or suspect opportunities
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Total # of Open Custom QI Opportunities
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For a given member, the number of instances to improve the patient satisfaction of care (as per the agreement by the Health System and Practice) that have not been met
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Total # of Open Quality Opportunities
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From a review of members' clinical events, circumstances that are defined as clinical opportunities are reviewed to check for anticipated current or subsequent actions. If those actions are not found, the opportunity is considered open and counted here
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Total # of Pending Coding Opportunities
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Count of pending coding opportunities
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Total # of Pending Custom QI Opportunities
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For a given member, the number of instances to improve the patient satisfaction of care (as per the agreement by the Health System and Practice) that are awaiting Audit Review of Patient Exclusions
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Total # of Pending Quality Opportunities
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Count of pending quality opportunities
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Total # of Snoozed Coding Opportunities
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count of snoozed coding opportunities
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Total # of Snoozed Custom QI Opportunities
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For a given member, the number of instances to improve the patient satisfaction of care (as per the agreement by the Health System and Practice) that have been temporarily postponed
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Total # of Snoozed Quality Opportunities
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count of snoozed quality opportunities
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Total # of STARS Opportunities
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Sum of Open Quality Opportunities for STAR Measures
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Total Closed/Pending Opportunities
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Count of closed and pending quality opportunities for the selected population
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Total Open Opportunities
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Count of open quality opportunities for the selected population
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Total PMPM
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Total Cost per member per month for the current rolling 12 month period
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