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Aggregate Expenditure and Utilization
Provider NPI Analytics Buttons:
Display aggregate data at the National Provider identifier (NPI) / individual provider level, Subgroup / location level, Tax Identification Number (TIN) / facility level, or Division level.
View individual providers within the organization. A provider or NPI is the specific provider billing under the given National Provider Identifier.
View groups of NPIs setup in a group, created in the Network Manager.
View Individual Facilities designated by a Tax Identification Number (TIN). A facility is a single TIN with access to all provider data under the TIN.
View groups of facilities setup in a group, created in Network Manager.
This button will bring users to the Patient Master Dashboard showing all patients that make up data in the Analytics Dashboard.
The columns button allows the end user to define the columns to view.
Export to Excel:
Export to Excel to view the filtered information.
A group of facilities. This column has a "Contains" filter. Type in a portion of the division name and the solution will filter and display.
Subgroup (Facility Location)
E.g., a TIN may have 2000 patients and 5 locations. This column has a "contains" filter. Type in a portion of the subgroup name and the solution will filter and display.
Name of the practice for the shown NPI
Provider / NPI
A specific provider that is billing under the given National Provider Identifier.
Clicking on the NPI number allows a drilldown to the aggregate expenditure and utilization benchmarks for the NPI.
Click scorecard 'Go' button to view the scorecard for the organization, NPI, Subgroup or TIN shown. The scorecard shows financial and quality performance for the hierarchy selected.
Click KPI Suite 'Go' button to view the KPI Suite for the organization, NPI, Subgroup or TIN shown. The KPI Suite shows financial performance and identifies targets for health outcome improvement, cost reductions and more.
#No. Costly Patients
Patients costly today or trending to be costly in the future. Risk score in the top 30% this year or previous year, 1 or more hospitalizations in last 12 months, 3 or more emergency department visits in the last 24 months and 3 or more chronic conditions. Click No. Costly Patients to view the patient Master Dashboard for those specific patients.
#No. Patients Opted Out
Shows the number of patients that have opted out of data sharing. Click No. Patients with Claims to view the Patient Master Dashboard with those specific patients shown.
#No. Patients with Claims
Shows the number of patients that are active/attributed and have claims data. Patients with no encounters or that have opted out of data sharing will not display in this number. Click No. Patients with Claims to view the Patient Master Dashboard with those specific patients shown.
The ration of observed (actual) versus expected (benchmark) of hospital discharges. A negative number indicates below the benchmark (green color) and a positive number indicates above the benchmark (red color) for acute hospitalizations. Clicking on the number in a row will bring you to the Acute Hospital Utilization quick report for review.
HCC Diagnosis Recapture Rate:
A comparison of the current year to past year recaptured HCC diagnoses codes. This column displays the total percentage of HCC diagnoses (recurring chronic condition codes) that have been captured again in the current year. Clicking on the button here will drill down to a quick report for additional review.
Current Year HCC Risk Score:
The average HCC risk score for the assigned patients calculated for TIN, Subgroup or NPI. An average above 1.5 is a moderately sick population. An average above 2.0 is a very sick population. The risk score is calculated using the diagnoses for the current year. Diagnoses not captured in the current year are not included in the current year risk score.
Average Hierarchical Condition Categories (HCC) Risk Score
The Average HCC risk score for the assigned patients calculated for TIN, Subgroup or NPI. An average above 1.5 is a moderately sick population. An average above 2.0 is a very sick population. Click on the button to expand to past year scores. The risk scores are calculated using the diagnoses for the year
The percentage of Annual Wellness Visits (AWV) completed during a rolling 12 months from Claims through date. You may click on the button to drill to the incomplete patients.
Change in Spend (per patient)
The per patient for the selected year as compared to the prior year.
Spend Allowance Predictor
A warning symbol indicates our algorithm is predicting the actual spend will exceed the financial benchmark before the end of the current year.
Loss in benchmark caused by not capturing a diagnosis in the performance year that existed in your previous benchmark years.
Percent of Spend Allowance Used YTD
Percentage of financial spend benchmark used year to date. What has actually been spent vs the total HCC benchmark.
Year to Date Average Per Patient Spend
Average year to date per patient spend for Part A and Part B (including DME) bur not including Part D for assigned patients to a TIN, Subgroup or NPI.
HCC Spend Allowance YTD
The financial benchmark calculated using the HCC Risk Score for the Organization, TIN, Subgroup, or NPI based on the Average HCC Score for assigned patients.
HCC Risk Score Change
Selected year risk score compared to the prior year.
Sometimes an organization has subsidiaries, sister companies, or companies they may merge with in the future for ACO and commercial lines. When they want the company accounts separate, this option allows the assignment of company access.
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