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Review the sample report for an office-based primary care physician (PCP). I'd like you to consider how you might use this information in a work setting. PLEASE NOTE: THERE IS A GLOSSARY AT THE BACK OF THE REPORT.

You are medical manager at an MCO. You need to evaluate this PCP. Consider:

• What does this information tell you about the members served by this physician?
• What does the information tell you about the quality and cost of the care provided by this PCP?
• Are there opportunities for this PCP to improve cost or quality? If so, which appear to be the area(s) of greatest opportunity? Please justify.
• Based on this information, would you deem this PCP to be high-performing or low-performing?

SAMPLE FAMILY PRACTICE REPORT Overall Summary by Service Category D.nntinnRM2 HealthPartner's Total Cost Index (TCI) \& Resource Use Index (RUI): TCI \& RUI provide insight into overall cost, practice efficiency \& price competiveness. TCl= Practice Adj. PMPM/Benchmark PMPM RUl is based on standardized cost for procedures The benchmark index for TCl or RUI is 1.0. Index values below 1.0 indicate a practice that is delivering services in a more cost or resource-efficient manner than the benchmark. Example: Inpatient Facility TCl=.85 means the practice is 15% more cost-effective than the benchmark. the practice is 15% more cost-effective than the benchmark. Practice Trends in Cost a Professional Does it cost more or require more healthcare resources to manage your panel over time? Pharmacy 1.21.00.80.60.40.20.0 file://C:/Users/dhame/Downloads/Module 4 exercise_Provider Report Sample (1).pdf Reporting Pe SAMPLE FAMILY PRACTICE REPORT Inpatient PMPM by Service Category Admissions \& Length of Stay per 1,000 Inpatient Admissions by Quarter 30 Evaluate the differences in admission rates versus lenth of stay. If admissions are low, but length of stay is high when compared to the benchmark, this may indicate a population of higher morbidity. Inpatient Utilization Inpatient Admissions: Top 10 Most-Frequent DRG 30-Day All-Cause Readmissions by Quarter Outpatient Facility \& Professional PMPM by Service Category Emergency Department Utilization Emergencv Dedartment Visits bv Quarter Radiology Dashboard (OP Facility \& Professional Services) Top 10 Primary Diagnoses for Outpatient Facility \& Professional Visits Patients with Multiole Imaging ner Year file:///C:/Users/dhame/Downloads/Module 4 exercise_Provider Report Sample (1).pdf AMPLE FAMILY PRACTICE REPORT Evaluation \& Management: Primary \& Specialty Care Utilization Specialist Utilization Top 10 Multi-Source Brand Medications with Generic Equivalents Pharmacy by Service Category Pharmacy Utilization Please see glossary on Page 7 for details on terminology and calculations file:///C:/Users/dhame/Downloads/Module 4 exercise_Provider Report Sample (1).pdf SAMPLE FAMILY PRACTICE REPORT Care Management Compliance Summary Comparing risk-adjusted allowed per patient costs against the benchmark may help identify opportunities for reducing the costs of managing various clinical conditions. The allowed per patient cost \& resource indexes can then be used to compare potential drivers (cost per service or services per patient) of the differences in allowed per patient. Hirh raot Claimant2 nuarniaw Leading Diagnoses among High Cost Claimants High Cost Claimant Utilization 1. Allowed/Patient Index: The total cost or resource use for a patient with the condition on the row. Benchmark=1.0. Please see glossary on Page 7 for details on terminology and calculations 2. High Cost Claimant refers to patients with >$100k in medical \& pharmacy spend in the reporting period. file:///C:/Users/dhame/Downloads/Module 4 exercise_Provider Report Sample (1).pdf SAMPLE FAMILY PRACTICE REPORT Comprehensi SAMPLE FAMILY PRACTICE REPORT Page 2 of Specialist Specialists are determined through use of CMS Taxonomy Utilization codes. Rate of evalaution and management visits by specialists is included in this report. This includes all nonprimary care medical specialties that billed for an evalaution and management visit (see Primary Care above). TCI: Total Cost The Total Cost Index is the total amount of reimbursement to Index providers for care provided to the practice's panel during the reporting year compared to the Benchmark (average for all the patients in the cohort for all practices receiving a report). It is adjusted for the Retrospective Risk (see above) and size of the panel. It is intended to be used in conjunction with the Resource Use Index. These measures were developed by HealthPartners in 2004 . FMI: http://www.healthpartners.com/public/tcoc/ Quality Measures Quality measures are reported regardless of patient cohort size. Measures that apply to fewer than 30 patients in the cohort are displayed differently to indicate that reliable statistics are not available. Cardiovascular Conditions Cholesterol Percentage of individuals 18-75 years of age who were Management discharged alive for AMI, coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the first 10 months of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to measurement year, who had LDL-C screening in the measurement year. (HEDIS CMC) SAMPLE FAMILY PRACTICE REPORT Overall Summary by Service Category D.nntinnRM2 HealthPartner's Total Cost Index (TCI) \& Resource Use Index (RUI): TCI \& RUI provide insight into overall cost, practice efficiency \& price competiveness. TCl= Practice Adj. PMPM/Benchmark PMPM RUl is based on standardized cost for procedures The benchmark index for TCl or RUI is 1.0. Index values below 1.0 indicate a practice that is delivering services in a more cost or resource-efficient manner than the benchmark. Example: Inpatient Facility TCl=.85 means the practice is 15% more cost-effective than the benchmark. the practice is 15% more cost-effective than the benchmark. Practice Trends in Cost a Professional Does it cost more or require more healthcare resources to manage your panel over time? Pharmacy 1.21.00.80.60.40.20.0 file://C:/Users/dhame/Downloads/Module 4 exercise_Provider Report Sample (1).pdf Reporting Pe SAMPLE FAMILY PRACTICE REPORT Inpatient PMPM by Service Category Admissions \& Length of Stay per 1,000 Inpatient Admissions by Quarter 30 Evaluate the differences in admission rates versus lenth of stay. If admissions are low, but length of stay is high when compared to the benchmark, this may indicate a population of higher morbidity. Inpatient Utilization Inpatient Admissions: Top 10 Most-Frequent DRG 30-Day All-Cause Readmissions by Quarter Outpatient Facility \& Professional PMPM by Service Category Emergency Department Utilization Emergencv Dedartment Visits bv Quarter Radiology Dashboard (OP Facility \& Professional Services) Top 10 Primary Diagnoses for Outpatient Facility \& Professional Visits Patients with Multiole Imaging ner Year file:///C:/Users/dhame/Downloads/Module 4 exercise_Provider Report Sample (1).pdf AMPLE FAMILY PRACTICE REPORT Evaluation \& Management: Primary \& Specialty Care Utilization Specialist Utilization Top 10 Multi-Source Brand Medications with Generic Equivalents Pharmacy by Service Category Pharmacy Utilization Please see glossary on Page 7 for details on terminology and calculations file:///C:/Users/dhame/Downloads/Module 4 exercise_Provider Report Sample (1).pdf SAMPLE FAMILY PRACTICE REPORT Care Management Compliance Summary Comparing risk-adjusted allowed per patient costs against the benchmark may help identify opportunities for reducing the costs of managing various clinical conditions. The allowed per patient cost \& resource indexes can then be used to compare potential drivers (cost per service or services per patient) of the differences in allowed per patient. Hirh raot Claimant2 nuarniaw Leading Diagnoses among High Cost Claimants High Cost Claimant Utilization 1. Allowed/Patient Index: The total cost or resource use for a patient with the condition on the row. Benchmark=1.0. Please see glossary on Page 7 for details on terminology and calculations 2. High Cost Claimant refers to patients with >$100k in medical \& pharmacy spend in the reporting period. file:///C:/Users/dhame/Downloads/Module 4 exercise_Provider Report Sample (1).pdf SAMPLE FAMILY PRACTICE REPORT Comprehensi SAMPLE FAMILY PRACTICE REPORT Page 2 of Specialist Specialists are determined through use of CMS Taxonomy Utilization codes. Rate of evalaution and management visits by specialists is included in this report. This includes all nonprimary care medical specialties that billed for an evalaution and management visit (see Primary Care above). TCI: Total Cost The Total Cost Index is the total amount of reimbursement to Index providers for care provided to the practice's panel during the reporting year compared to the Benchmark (average for all the patients in the cohort for all practices receiving a report). It is adjusted for the Retrospective Risk (see above) and size of the panel. It is intended to be used in conjunction with the Resource Use Index. These measures were developed by HealthPartners in 2004 . FMI: http://www.healthpartners.com/public/tcoc/ Quality Measures Quality measures are reported regardless of patient cohort size. Measures that apply to fewer than 30 patients in the cohort are displayed differently to indicate that reliable statistics are not available. Cardiovascular Conditions Cholesterol Percentage of individuals 18-75 years of age who were Management discharged alive for AMI, coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the first 10 months of the year prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to measurement year, who had LDL-C screening in the measurement year. (HEDIS CMC)

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